Transarterial radioembolization (tare)

TARE - TransArterial RadioEmbolization
interventional procedure with nuclear medicine
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1. Transarterial Radioembolization (TARE) V. Siva Prakash, M.Sc.MIT [email protected]

2. TRANSARTERIAL RADIOEMBOLIZATION Radioembolization is the delivery of radioactive microspheres to cancer cells using an ( Transarterial ) endovascular approach. [email protected] 2

3. RADIOEMBOLIZATION Radioembolization is a combination of radi ation therapy and a procedure called embolization to treat cancer of the liver. [email protected] 3

4. RADIOEMBOLIZATION This treatment is called internal radiation therapy. Tiny glass or resin beads called microspheres are placed inside the blood vessels that feed a tumor in order to block the supply of blood to the cancer cells. Once these microspheres, which are filled with the radioactive isotope yttrium Y-90 , become lodged at the tumor site, they deliver a high dose of radiation to the tumor and not to normal tissues. [email protected] 4

5. INDICATIONS Hepatocellular carcinoma Hepatic metastases from colorectal carcinoma [email protected] 5

6. CONTRAINDICATIONS Absolute contraindications Excessive hepatopulmonary shunting (results in radiation pneumonitis ) Demonstrable gastrointestinal shunting (results in gastric ulceration ) [email protected] 6

7. CONTRAINDICATIONS Relative contraindications hepatic and/or renal dysfunction previous hepatic irradiation portal vein thrombus portal venous hypertension [email protected] 7

8. PREPARATION Previous history/records collected NPO RFT values obtained Prothrombin test (25-30sec) INR-1.0-1.5 Avoid drugs/medicine (e.g. blood thinner- warfarin) Previous angiogram. [email protected] 8

9. MATERIALS Fluoroscopy/c arm Local anesthesia Catheter, guide wire yttrium-90 with microspheres, or tiny glass beads Iodinated contrast [email protected] 9

10. why yttrium-90..? Pure beta particle Penetration 2.5mm Half life 60.1hr (94% dose delivered within 11days) 40% higher dose than external beam radiation. [email protected] 10

11. DUAL SUPPLY Normal liver tissue receives about 75 percent of its blood supply from the portal vein 25 percent from the hepatic artery and its branches. When a tumor grows in the liver, it receives almost all of its blood supply from the hepatic artery. [email protected] 11

12. ANGIO- HEPATIC ARTERY An initial arteriogram is performed to visualize the upper abdominal arteries. Arteries to areas of the stomach and duodenum which may have beads flow into them are closed (embolized) with tiny coils of wire. Minimize extra hepatic delivery [email protected] 12

13. HEPATO-PULMONARY SHUNT Lead to deposition in lung through intra tumoral AV shunt A nuclear medicine tracer Tc-99m MAA is injected observed through gamma camera. This will allow the interventional radiologist to calculate how much of the treatment dose can go to the lungs (<30Gy) so that lung damage does not occur. [email protected] 13

14. DOSE CALCULATION EMPIRIC METHOD 2GBq for <25% 3GBq for 25-50% 5GBq for >50% 2. Body surface area - BSA method BSA+ tumor volume tumor volume + liver volume [email protected] 14

15. PROCEDURE - TARE Vital signs are monitored IV line – local anesthesia Surgical draping is made Femoral puncture Placement of catheter Glass beads and microspheres are injected. [email protected] 15

16. ADVERSE EFFECTS Nausea, vomiting, abdominal discomfort Portal hypertension Pneumonitis GI ulcer Vascular injury [email protected] 16

17. THANK YOU [email protected] 17