Transarterial radioembolisation (TARE) – basics and clinical use () von Ralf-Thorsten Hoffmann

1.Introduction161.1.References172.Legal and infrastructural conditions202.1.Introduction202.1.1.Multidisciplinary approach 202.1.2.Radioembolisation team (TARE working group)202.2.Legal requirements for the performance of radioembolisation in hospitals212.3.Infrastructural requirements for the performance of radioembolisation in hospitals212.3.1.Appropriate institutions212.3.2.Training courses for interventional radiologists and specialists in nuclear medicine222.3.3.Diagnostic equipment222.3.4.Radiation protection222.3.4.1.Angiography Suite222.3.4.2.Angiography catheter and further medical disposables222.3.4.3.Medical staff and other persons222.3.4.4.Patients232.4.References233.Basics of radioembolisation and clinical use of microspheres263.1.Radioembolisation263.1.1.Mode of action263.2.Yttrium-90 microspheres273.2.1.Historical development273.2.2.Materials and physical principles283.2.2.1.Resin spheres293.2.2.2.Glass spheres293.2.3.References for Chapters 3.1. and 3.2.303.3.Holmium-166 microspheres303.3.1.Historical development303.3.2.Materials and physical principles313.3.3.Clinical characteristics323.3.4.Imaging323.3.5.Imaging333.3.5.1.166Ho SPECT-CT333.3.5.2.166Ho MRI333.3.5.3.Work-up with a holmium-166 scout dose333.3.6.Results of clinical studies343.3.6.1.Ongoing studies in The Netherlands353.3.7.Future perspectives363.3.8.Summary373.3.9.Referenzes for Chapter 3.3.374.Indications for treatment and patient selection424.1.Introduction424.2.Indications and contraindications424.3.Hepatocellular carcinoma in cirrhotic liver a special challenge464.4.Summary464.5.References475.TARE from surgeons point of view505.1.TARE and liver surgery505.2.Role of surgery in the treatment of liver tumors505.3.Residual liver volume limits surgical treatment505.4.Combination of different procedures allows more frequent curative surgical therapy505.5.Effect of TARE on tumor and liver tissue and related strategies before surgical resection515.5.1.TARE to improve local resectability515.5.2.TARE for local tumor controll525.5.3.TARE for induction of liver hypertrophy525.5.4.TARE as palliative therapy525.6.TARE and liver surgery current references525.7.Own experiences535.7.1.Karlsruhe TARE board545.8.Future545.9.References546.TARE from Nuclear Medicine specialists point of view586.1.Treatment planning586.1.1.Planar scintigraphy and SPECT or SPECT-CT with 99mTc MAA or radiolabeled microspheres586.1.2.Concepts for the calculation of therapy activity616.1.3.Considerations concerning achievable focal dose626.2.Performance of therapy636.3.Post-therapy scan656.3.1.Bremsstrahlen scintigraphy656.3.2.Post-therapeutic distribution imaging using PET656.3.3.Post-therapeutic distribution imaging for 166Ho666.4.Pre- and post-therapeutic care on ward666.5.References677.TARE from radiologists point of view707.1.Introduction707.2.Radiological imaging before therapy707.2.1.Ultrasound707.2.2.Multiple detector computed tomography (MDCT)717.2.3.PET CT727.2.4.Magnetic resonance imaging (MRI)737.2.5.99mTc MAA angiography757.3.Treatment757.3.1.Angiographic procedure during therapy757.4.Radiological follow-up767.4.1.RECIST and modified RECIST767.4.2.Recommendated follow-up777.5.References788.Tips and tricks for using angiography828.1.Introduction828.2.99mTc MAA angiography: technique and material828.3.Frequent anatomical norm variants848.3.1.Left gastrohepatic trunk848.3.2.Hepatomesenteric trunk868.3.3.Celiac trunk compression syndrome878.4.Aberrant and high risk vessels888.4.1.Gastroduodenal artery888.4.2.Cystic artery898.4.3.Right gastric artery918.4.4.Hepatic falciform artery918.4.5.Lower esophageal branches928.5.Intrahepatic shunts938.5.1.Arterioportal and arteriovenous shunts938.6.Radioembolisation949.Results of TARE969.1.Primary liver cancer969.1.1.Hepatocellular carcinoma (HCC)969.1.2.Intrahepatic cholangiocarcinoma (ICC)969.2.Metastases979.2.1.Colorectal cancer (CRC)979.2.2.Neuroendocrine tumors (NET)979.2.3.Breast cancer989.3.Summary989.4.References9810.Side effects and complications10210.1.Extrahepatic complications10210.1.1.Pancytopenia and lymphopenia10210.1.2.Radiation-induced pneumonia10210.1.3.Gastrointestinal and pancreatic complications 10210.2.Intrahepatic complications10310.2.1.Radiation-induced cholecystitis10310.2.2.Complications of the bile duct system10310.2.3.Radioembolisation induced liver disease (REILD)10310.3.Summary10410.4.References10411.Outlook perspectives for TARE10611.1.Radioembolisation as adjuvant or in combination with systemic therapies10611.2.Radioembolisation physico-technical developments10711.3.References10712.Annex11012.1.List of abbreviations11012.2.Manufacturers11012.2.1.Manufacturers of spheres11112.2.2.Manufacturers of coils11112.2.3.Manufacturers of catheters and angiography supplies111Index112

Due to the widespread use of radioembolisation not only in Germany but also in Europe this 3rd edition has been published in English to increase the range of coverage of this book. Beside a change of the term from SIRT (selective internal radiation therapy) to TARE (transarterial radioembolisation) in professional literature there were substantial changes during the last five years regarding the indications and frequency of TARE.Precisely because the TARE is still under development regarding indications and material used, the present revised and updated textbook would like to give all oncological colleagues and colleagues interested in TARE, especially the newcomers, a short, structured overview about this interdisciplinary kind of therapy with a special focus on indications and benefits for treated patients.