Transarterial radioembolisation (TARE) – basics and clinical use

1.Introduction16
1.1.References17
2.Legal and infrastructural conditions20
2.1.Introduction20
2.1.1.Multidisciplinary approach 20
2.1.2.Radioembolisation team (TARE working group)20
2.2.Legal requirements for the performance of radioembolisation in hospitals21
2.3.Infrastructural requirements for the performance of radioembolisation in hospitals21
2.3.1.Appropriate institutions21
2.3.2.Training courses for interventional radiologists and specialists in nuclear medicine22
2.3.3.Diagnostic equipment22
2.3.4.Radiation protection22
2.3.4.1.Angiography Suite22
2.3.4.2.Angiography catheter and further medical disposables22
2.3.4.3.Medical staff and other persons22
2.3.4.4.Patients23
2.4.References23
3.Basics of radioembolisation and clinical use of microspheres26
3.1.Radioembolisation26
3.1.1.Mode of action26
3.2.Yttrium-90 microspheres27
3.2.1.Historical development27
3.2.2.Materials and physical principles28
3.2.2.1.Resin spheres29
3.2.2.2.Glass spheres29
3.2.3.References for Chapters 3.1. and 3.2.30
3.3.Holmium-166 microspheres30
3.3.1.Historical development30
3.3.2.Materials and physical principles31
3.3.3.Clinical characteristics32
3.3.4.Imaging32
3.3.5.Imaging33
3.3.5.1.166Ho SPECT-CT33
3.3.5.2.166Ho MRI33
3.3.5.3.Work-up with a holmium-166 scout dose33
3.3.6.Results of clinical studies34
3.3.6.1.Ongoing studies in The Netherlands35
3.3.7.Future perspectives36
3.3.8.Summary37
3.3.9.Referenzes for Chapter 3.3.37
4.Indications for treatment and patient selection42
4.1.Introduction42
4.2.Indications and contraindications42
4.3.Hepatocellular carcinoma in cirrhotic liver - a special challenge46
4.4.Summary46
4.5.References47
5.TARE from surgeons point of view50
5.1.TARE and liver surgery50
5.2.Role of surgery in the treatment of liver tumors50
5.3.Residual liver volume limits surgical treatment50
5.4.Combination of different procedures allows more frequent curative surgical therapy50
5.5.Effect of TARE on tumor and liver tissue and related strategies before surgical resection51
5.5.1.TARE to improve local resectability51
5.5.2.TARE for local tumor controll52
5.5.3.TARE for induction of liver hypertrophy52
5.5.4.TARE as palliative therapy52
5.6.TARE and liver surgery - current references52
5.7.Own experiences53
5.7.1.Karlsruhe TARE board54
5.8.Future54
5.9.References54
6.TARE from Nuclear Medicine specialists point of view58
6.1.Treatment planning58
6.1.1.Planar scintigraphy and SPECT or SPECT-CT with 99mTc MAA or radiolabeled microspheres58
6.1.2.Concepts for the calculation of therapy activity61
6.1.3.Considerations concerning achievable focal dose62
6.2.Performance of therapy63
6.3.Post-therapy scan65
6.3.1.Bremsstrahlen scintigraphy65
6.3.2.Post-therapeutic distribution imaging using PET65
6.3.3.Post-therapeutic distribution imaging for 166Ho66
6.4.Pre- and post-therapeutic care on ward66
6.5.References67
7.TARE from radiologists point of view70
7.1.Introduction70
7.2.Radiological imaging before therapy70
7.2.1.Ultrasound70
7.2.2.Multiple detector computed tomography (MDCT)71
7.2.3.PET CT72
7.2.4.Magnetic resonance imaging (MRI)73
7.2.5.99mTc MAA angiography75
7.3.Treatment75
7.3.1.Angiographic procedure during therapy75
7.4.Radiological follow-up76
7.4.1.RECIST and modified RECIST76
7.4.2.Recommendated follow-up77
7.5.References78
8.Tips and tricks for using angiography82
8.1.Introduction82
8.2.99mTc MAA angiography: technique and material82
8.3.Frequent anatomical norm variants84
8.3.1.Left gastrohepatic trunk84
8.3.2.Hepatomesenteric trunk86
8.3.3.Celiac trunk compress