Yttrium-90 Radioembolization of the Right Inferior Phrenic Artery in 20 Patients with Hepatocellular Carcinoma

摘要

PurposeTo address the feasibility of infusion of yttrium-90 (90Y) glass microspheres directly through the right inferior phrenic artery (RIPA). Materials and MethodsFrom November 2015 to May 2017, 20 patients underwent90Y radioembolization through the RIPA. When the systemic-to-pulmonary shunt was demonstrated on C-arm computed tomography (CT) of the RIPA, prophylactic embolization by polyvinyl alcohol (PVA) particles was performed prior to infusion of90Y glass microspheres. Follow-up CT scans were retrospectively reviewed for pulmonary complications. Tumor response was determined by the modified Response Evaluation Criteria in Solid Tumors. ResultsNine (45%) patients had systemic-to-pulmonary shunts on C-arm CT images of the RIPA. The feeder of the systemic-to-pulmonary shunt was the azygoesophageal branch (n?= 7) and the anterior branch (n?= 2). The mean activity of90Y glass microspheres infused into the RIPA was 0.49 GBq (range, 0.19–1.55 GBq). No patient had symptomatic radiation pneumonitis or cutaneous complications during follow-up. Seven patients had focal atelectasis (n?= 5), focal ground-glass opacity (n?= 2), and/or a small amount of pleural effusion (n?= 2) on follow-up image. Best tumor response fed by the RIPA was complete response (n?= 4), partial response (n?= 9), stable disease (n?= 2), progressive disease (n?= 4), and unevaluable (n?= 1). ConclusionThe administration of90Y glass microspheres through the RIPA may be safe after embolization of a systemic-to-pulmonary shunt identified on C-arm CT.