Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2021; 13(5): 440-452
Published online May 15, 2021. doi: 10.4251/wjgo.v13.i5.440
Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond
Mohammad Elsayed, Mohammad Loya, James Galt, David M Schuster, Zachary L Bercu, Janice Newsome, David Brandon, Sonia Benenati, Keywan Behbahani, Richard Duszak, Ila Sethi, Nima Kokabi
Mohammad Elsayed, Mohammad Loya, Zachary L Bercu, Janice Newsome, Sonia Benenati, Keywan Behbahani, Richard Duszak, Nima Kokabi, Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
James Galt, David M Schuster, David Brandon, Ila Sethi, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
Author contributions: Elsayed M collected the data, performed the analysis, and wrote the paper; Loya M, Newsome J and Duszak R contributed to critical analysis and review of the manuscript; Galt J, Bercu ZL, Brandon D and Sethi I collected and contributed the data and analysis tools; Bercu ZL contributed to the data and the critical review of the manuscript; Benenati S collected and contributed the data; Behbahani K wrote the paper and provided critical review of the manuscript; Kokabi N conceived and designed the analysis and provided critical review of the manuscript.
Institutional review board statement: This series has been approved by the local Institutional Review Board, and the need for written informed consent was waived.
Conflict-of-interest statement: No authors received specific funding for the development of this manuscript. Kokabi N conducts Y-90 radioembolization research partially funded by Sirtex Medical Ltd; Duszak R receives research support from the Harvey L. Neiman Health Policy Institute.
Data sharing statement: No additional data is available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Keywan Behbahani, BSc, Academic Research, Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322, United States. kbehbah@emory.edu
Received: December 8, 2020
Peer-review started: December 8, 2020
First decision: March 8, 2021
Revised: March 21, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: May 15, 2021
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic has made it more challenging for patients to undergo yttrium-90 (Y-90) radioembolization (RE). Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19, thus improving patient access.
AIM
To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography (SPECT/CT) in order to optimize therapy.
METHODS
All patients were selected for Y-90 RE through a multidisciplinary tumor board, and were screened and tested for COVID-19 infection per institutional protocol. A same day procedure was developed, consisting of angiography, imaging, and Y-90 resin particle delivery. Routine SPECT/CT after technetium-99m macroaggregated albumin (Tc-99m MAA) administration was performed for assessment of arterial supply, personalized dosimetry, and extrahepatic activity. Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery, by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles.
RESULTS
A total of 14 patients underwent same day Y-90 RE between March and June 2020. Mean lung shunt fraction was 6.13% (range 3.5%-13.1%). Y-90 RE was performed for a single lesion in 7 patients, while the remaining 7 patients had treatment of multifocal lesions. The largest lesion measured 8.3 cm. All patients tolerated the procedure well and were discharged the same day.
CONCLUSION
Same day Y-90 RE with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond. We recommend consideration of SPECT/CT, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.
Core Tip: Same day yttrium-90 (Y-90) radioembolization with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the coronavirus disease 2019 pandemic and beyond. We recommend consideration of single photon emission computed tomography/computed tomography, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.
