In major hepatic resection candidates with normal liver function, what is the standardized future liver remnant (sFLR) cutoff for PVE? The size of the FLR needs to be standardized to patient size as larger patients require a larger liver mass to support their essential functions compared to smaller patients. sFLR is expressed as a percentage …
Preoperative portal vein embolization (PVE) PVE is an image-guided procedure performed prior to resection of liver malignancies to increase the size of the future liver remnant (FLR) or the liver segments that will remain after surgery. By embolizing the portal vein branches supplying the tumor-bearing segments, flow is redirected to the non–tumor-bearing segments, resulting in …
Potential advantages of 90 Y radioembolization compared with TACE 90 Y radioembolization has a decreased incidence and severity of PES and thus can be performed as an outpatient procedure without the need for hospitalization. Recent studies suggest better disease control (longer time to progression) with less toxicity with 90 Y radioembolization than TACE, although no survival differences between the …
In the pretreatment workup of patients considered for 90 Y radioembolization, what imaging procedures besides cross-sectional imaging must occur? Prior to 90 Y radioembolization, diagnostic visceral arteriography with injection of the celiac, superior mesenteric, left gastric, gastroduodenal, proper hepatic, and right and left hepatic arteries should be performed. Embolization of the gastroduodenal artery as well as any right gastric …
Contraindications of 90 Y radioembolization • Uncorrectable coagulopathy • Severe anaphylactic or anaphylactoid contrast reaction • Severe liver or renal dysfunction • Lung or gastrointestinal (GI) shunts that cannot be corrected • Untreated varices at high risk of bleeding • Bilirubin greater than 2 mg/dL in the absence of a reversible cause • Greater than 70% tumor replacement of liver unless synthetic function …
Indications for 90 Y radioembolization 90 Y radioembolization is indicated for treatment of unresectable or medically inoperable primary or secondary liver malignancies. The tumor burden should be liver dominant but does not have to be exclusive to the liver. The Eastern Cooperative Oncology Group performance status should be 0 to 1 and life expectancy should be …
Food and Drug Administration (FDA)–approved and commercially available radioactive microspheres and describe their differences SIR-Spheres are nonbiodegradable resin spheres with a median size of 32 μm and are FDA approved for the treatment of unresectable colorectal liver metastases. TheraSphere therapy consists of nonbiodegradable glass spheres with a median size of 25 μm and is FDA …