Publications by authors named "Robert J Lewandowski"

244 Publications

CBCT-guided TACE-MWA for HCC Measuring up to 5 cm.

Acad Radiol 2021 Jun 18. Epub 2021 Jun 18.

Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, Illinois, 60611; Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acra.2021.05.012DOI Listing
June 2021

Duramycin radiosensitization of MCA-RH 7777 hepatoma cells through the elevation of reactive oxygen species.

J Cancer Res Ther 2021 Apr-Jun;17(2):543-546

Department of Radiology, Northwestern University, Chicago, Illinois, USA.

Objective: The objective of this study is to explore the radiosensitization effects of duramycin against the liver cancer hepatoma cells and relationship to reactive oxygen species (ROS) generation.

Materials And Methods: MCA-RH 7777 cells were treated with various combinations of duramycin concentrations and radiation doses. After the treatment, cell viabilities were determined by a cell proliferation assay; intracellular ROS levels were detected with the flow cytometric method.

Results: MCA-RH 7777 cell viability was found significantly reduced after combining duramycin and radiation exposure (comparing to that of either treatment alone). Increased intracellular ROS levels were observed in cells treated with combinations of duramycin and radiation.

Conclusion: Duramycin increased the intracellular ROS generation and also increased the radiosensitivity of MCA-RH 7777 cells.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.JCRT_284_18DOI Listing
June 2021

Y90 Radioembolization to the Prostate Gland: Proof of Concept in a Canine Model and Clinical Translation.

J Vasc Interv Radiol 2021 Apr 8. Epub 2021 Apr 8.

Purpose: The feasibility, safety and absorbed dose distribution of prostate artery (PA) radioembolization (RE) was investigated in a canine model.

Materials And Methods: 14 male castrated beagles received dihydroandrosterone/estradiol to induce prostatic hyperplasia for the duration of the study. Each dog underwent fluoroscopic PA catheterization. Y microspheres (TheraSphere, Boston Scientific) was delivered to one prostatic-hemigland (dose escalation from 60-200Gy), with the contralateral side serving as the control. Assessments for adverse events were performed throughout the follow-up (CTCAE v 5.0). PET-MRI provided post-delivery confirmation of absorbed dose distribution. MRI was obtained pre-, and 3, 20, and 40 days post-RE. Tissue harvest of the prostate, rectum, bladder, urethra, penis, and neurovascular bundles occurred 60 days post-RE.

Results: All animals successfully underwent RE. PET-MRI demonstrated localaization to and good coverage of only the treated hemigland. No adverse events occurred. MRI showed a significant dose-dependent decrease in treated hemigland size at 40 days (25-60%, p< 0.001). No extra-prostatic radiographic changes were observed. Necropsy demonstrated no gross rectal, urethral, penile or bladder changes. Histology revealed RE-induced changes in treated prostatic tissues of the highest dose group, with gland atrophy and focal necrosis. No extra-prostatic RE-related histologic findings were observed.

Conclusion: Prostate Y RE is safe and feasible in a canine model, with focal dose-dependent changes to the gland without inducing unwanted extra-postatic effects. These results suggest that investigation in nonoperative prostate cancer is warenteed..
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2021.01.282DOI Listing
April 2021

Comparing Real World, Personalized, Multidisciplinary Tumor Board Recommendations with BCLC Algorithm: 321-Patient Analysis.

Cardiovasc Intervent Radiol 2021 Jul 6;44(7):1070-1080. Epub 2021 Apr 6.

Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.

Purpose: To evaluate hepatocellular carcinoma (HCC) treatment allocation, deviation from BCLC first-treatment recommendation, and outcomes following multidisciplinary, individualized approach.

Methods: Treatment-naïve HCC discussed at multidisciplinary tumor board (MDT) between 2010 and 2013 were included to allow minimum 5 years of follow-up. MDT first-treatment recommendation (resection, transplant, ablation, transarterial radioembolization (Y90), transarterial chemoembolization, sorafenib, palliation) was documented, as were subsequent treatments. Overall survival (OS) analyses were performed on an intention-to-treat (ITT) basis, stratified by BCLC stage.

Results: Three hundred and twenty-one patients were treated in the 4-year period. Median age was 62 years, predominantly male (73%), hepatitis C (41%), and Y90 initial treatment (52%). There was a 76% rate of BCLC-discordant first-treatment. Median OS was not reached (57% alive at 10 years), 51.0 months, 25.4 months and 13.4 months for BCLC stages A, B, C and D, respectively.

Conclusion: Deviation from BCLC guidelines was very common when individualized, MDT treatment recommendations were made. This approach yielded expected OS in BCLC A, and exceeded general guideline expectations for BCLC B, C and D. These results suggest that while guidelines are helpful, implementing a more personalized approach that incorporates center expertise, patient-specific characteristics, and the known multi-directional treatment allocation process, improves patient outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00270-021-02810-8DOI Listing
July 2021

Does significantly elevated lung shunt fraction (LSF >20%) promote extrahepatic progression in patients with hepatocellular carcinoma treated with radioembolization?

Nucl Med Commun 2021 Jul;42(7):725-731

Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center.

Purpose: Radioembolization with yttrium-90 (Y-90) is an effective locoregional therapy for primary and metastatic liver tumors, but its use is restricted or contraindicated for patients with elevated lung shunt fraction (LSF) because of an increased risk of developing pulmonary adverse events, including but not limited to radiation pneumonitis. Elevated LSF is also thought to be correlated with liver tumor progression and metastases.

Methods: In this retrospective cohort study, we examine rates of metastasis development, rates of adverse events and overall survival (OS) in 23 patients with hepatocellular carcinoma (HCC) and elevated LSF >20% on Tc-99 m macroaggregated albumin scan treated with Y-90 radioembolization at our institution from 2005 to 2016. To minimize confounding variables, patients with baseline extrahepatic metastases or portal vein tumor thrombosis were excluded. Kaplan-Meier estimates were performed for OS and time to development of metastases.

Results: No patient developed clinical and imaging signs of radiation pneumonitis. Median intention to treat OS from day of radioembolization was 21.3 months; median censored OS was 14.7 months. Five out of 23 patients (22%) developed at least one metastasis during follow-up, for an incidence of 20 per 1000 patient-years (compared to the historical rate of 6 per 1000 patient-years for HCC patients in general).

Conclusion: HCC patients with LSF >20% treated with Y-90 radioembolization have acceptable toxicities and appear to have a rate of extrahepatic tumor development (22%) higher than expected for patients with HCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MNM.0000000000001392DOI Listing
July 2021

Development and Validation of Sorafenib-eluting Microspheres to Enhance Therapeutic Efficacy of Transcatheter Arterial Chemoembolization in a Rat Model of Hepatocellular Carcinoma.

Radiol Imaging Cancer 2021 01 8;3(1):e200006. Epub 2021 Jan 8.

Department of Radiology, Feinberg School of Medicine (W.P., S.C., J.J., R.J.L., A.C.L., D.H.K.), and Robert H. Lurie Comprehensive Cancer Center (R.J.L., A.C.L., D.H.K.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering (A.C.L., D.H.K.); and Department of Electrical Engineering and Computer Science (A.C.L.) and International Institute of Nanotechnology (A.C.L.), Northwestern University, Evanston, Ill.

Purpose: To validate the therapeutic efficacy of sorafenib-eluting embolic microspheres (SOR-EMs) used in combination with transarterial chemoembolization (TACE) for treatment of hepatocellular carcinoma (HCC) in a preclinical animal model.

Materials And Methods: SOR-EMs were prepared with poly(d,l-lactide--glycolide), iron oxide nanoparticles, and sorafenib. The morphology of the prepared SOR-EMs was confirmed by using optical microscopy. Drug release from the SOR-EMs was quantified in vitro by using high-performance liquid chromatography. In an orthotopic rat model of HCC, embolic doxorubicin-Lipiodol (ethiodized oil) emulsion (DLE) and SOR-EMs were sequentially injected into the hepatic artery of the rats: The rats in group 1 were injected with DLE; group 2 was injected with DLE plus unloaded embolic microspheres (DLE + EM); group 3, with DLE plus SOR-EMs (DLE + SOR-EM); and group 4, with saline solution. The SOR-EM and tumor size changes in each group (of six rats each) over time were measured by using MRI. Tissues were assessed by using immunohistochemistry, with hematoxylin-eosin and terminal deoxynucleotidyl transferase-mediated dUTP (2'-deoxyuridine 5'-triphosphate) nick-end labeling staining used for dead cells and CD34 staining used for new microvessel formation.

Results: The SOR-EMs were a mean size of 6.6 μm ± 2.3 (standard deviation) and showed 53.7% ± 8.3 sorafenib loading efficiency with T2-weighted MRI capability. In the HCC rat model, the intra-arterially injected SOR-EMs were successfully monitored by using MRI. The DLE + SOR-EM-treated rats showed a superior tumor growth-inhibitory effect compared with the rats treated with DLE only ( < .05). Immunohistochemical assessment of tissue specimens showed that compared with the other treatment groups, the DLE + SOR-EM treatment group had the lowest number of microvessels, as quantified by using the percentage of CD34-positive stained area ( < .01 for all comparisons).

Conclusion: In a preclinical rat HCC model, SOR-EMs used in combination with DLE TACE were effective in treating HCC. Chemoembolization, Experimental Investigations, Laboratory Tests, Liver, Technology Assessment © RSNA, 2021See also the commentary by Yamada and Gayed in this issue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/rycan.2021200006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850235PMC
January 2021

Safety and Efficacy of Segmental Yttrium-90 Radioembolization for Hepatocellular Carcinoma after Transjugular Intrahepatic Portosystemic Shunt Creation.

J Vasc Interv Radiol 2021 02 12;32(2):211-219. Epub 2021 Jan 12.

Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois; Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois. Electronic address:

Purpose: To evaluate safety and efficacy of segmental yttrium-90 (Y90) radioembolization for hepatocellular carcinoma (HCC) after transjugular intrahepatic portosystemic shunt (TIPS) placement. The hypothesis was liver sparing segmental Y90 for HCC after TIPS would provide high antitumor response with a tolerable safety profile.

Materials And Methods: This single-arm retrospective study included 39 patients (16 women, 23 men) with ages 49-81 years old who were treated with Y90. Child-Pugh A/B liver dysfunction was present in 72% (28/39) with a median Model for End-stage Liver Disease score of 18 (95% confidence interval, 16.4-19.4). Primary outcomes were clinical and biochemical toxicities and antitumor imaging response by World Health Organization (WHO) and European Association for the Study of the Liver (EASL) criteria. Secondary outcomes were orthotopic liver transplantation (OLT), time to progression (TTP), and overall survival (OS) estimates by the Kaplan-Meier method.

Results: The 30-day mortality was 0%. Grade 3+ clinical adverse events and grade 3+ hyperbilirubinemia occurred in 5% (2/39) and 0% (0/39), respectively. Imaging response was achieved in 58% (22/38, WHO criteria) and 74% (28/38, EASL criteria), respectively. Median TTP was 16.1 months for any cause and 27.5 months for primary index lesions. OLT was completed in 88% (21/24) of listed patients at a median time of 6.1 months (range, 0.9-11.7 months). Median OS was 31.6 months and 62.9 months censored and uncensored to OLT, respectively.

Conclusions: Segmental Y90 for HCC appears safe and efficacious in patients after TIPS. Preserved transplant eligibility suggests that Y90 is a useful tool for bridging these patients to liver transplantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2020.09.007DOI Listing
February 2021

Correlation and Agreement of Yttrium-90 Positron Emission Tomography/Computed Tomography with Ex Vivo Radioembolization Microsphere Deposition in the Rabbit VX2 Liver Tumor Model.

J Vasc Interv Radiol 2021 01 12;32(1):23-32.e1. Epub 2020 Nov 12.

Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.

Purpose: To demonstrate a stronger correlation and agreement of yttrium-90 (Y) positron emission tomography (PET)/computed tomography (CT) measurements with explant liver tumor dosing compared with the standard model (SM) for radioembolization.

Materials And Methods: Hepatic VX2 tumors were implanted into New Zealand white rabbits, with growth confirmed by 7 T magnetic resonance imaging. Seventeen VX2 rabbits provided 33 analyzed tumors. Treatment volumes were calculated from manually drawn volumes of interest (VOI) with three-dimensional surface renderings. Radioembolization was performed with glass Y microspheres. PET/CT imaging was completed with scatter and attenuation correction. Three-dimensional ellipsoid VOI were drawn to encompass tumors on fused images. Tumors and livers were then explanted for inductively coupled plasma (ICP)-optical emission spectroscopy (OES) analysis of microsphere content. Y PET/CT and SM measurements were compared with reference standard ICP-OES measurements of tumor dosing with Pearson correlation and Bland-Altman analyses for agreement testing with and without adjustment for tumor necrosis.

Results: The median infused activity was 33.3 MBq (range, 5.9-152.9). Tumor dose was significantly correlated with Y PET/CT measurements (r = 0.903, P < .001) and SM estimates (r = 0.607, P < .001). Bland-Altman analyses showed that the SM tended to underestimate the tumor dosing by a mean of -8.5 Gy (CI, -26.3-9.3), and the degree of underestimation increased to a mean of -18.3 Gy (CI, -38.5-1.9) after the adjustment for tumor necrosis.

Conclusions: Y PET/CT estimates were strongly correlated and had better agreement with reference measurements of tumor dosing than SM estimates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2020.09.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086791PMC
January 2021

Transarterial Yttrium-90 Radioembolization of Hepatocellular Carcinoma Perfused by the Cystic Artery: Multi-institutional Feasibility Study.

J Vasc Interv Radiol 2020 12 10;31(12):2022-2027. Epub 2020 Nov 10.

Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida.

Purpose: To assess the safety and efficacy of transarterial yttrium-90 radioembolization via the cystic artery for patients with hepatocellular carcinoma (HCC) adjacent to the gallbladder with cystic artery supply.

Materials And Methods: This retrospective study included 17 patients treated at 4 institutions. Patients with HCC perfused by the cystic artery who received ablative-dose radioembolization were included. Median tumor size was 3.8 cm (range, 2.0-8.8 cm). Fourteen patients (82%) had Child-Pugh class A cirrhosis and 3 (18%) had class B cirrhosis. Adverse events, tumor response, and time to progression were analyzed.

Results: Median dose to the tissue perfused by the cystic artery was 340 Gy (range, 200-720 Gy). There were no occurrences of acute cholecystitis warranting invasive intervention. Four patients (24%) experienced transient right upper quadrant pain, with symptom resolution within 3 mo. Six patients (35%) exhibited gallbladder wall edema on follow-up imaging. Two (12%) and 0 grade 3/4 increases in alkaline phosphatase and bilirubin were observed, respectively. Follow-up imaging demonstrated complete response in 13 target tumors (76%) and partial response in 4 (24%). There were no cases of target tumor progression during a median follow-up of 9 mo (range, 3-72 mo).

Conclusions: Direct infusion of Y microspheres via the cystic artery appears to have an acceptable safety profile, without resulting in acute cholecystitis warranting invasive intervention. In selected patients with HCC in whom other treatments may be contraindicated and the tumor is supplied via the cystic artery, treatment with selective ablative radioembolization can be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2020.08.014DOI Listing
December 2020

Radioembolisation with personalised dosimetry: improving outcomes for patients with advanced hepatocellular carcinoma.

Lancet Gastroenterol Hepatol 2021 01 7;6(1):2-3. Epub 2020 Nov 7.

Department of Radiology, Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, IL 60611, USA; Department of Medicine, Division of Hematology and Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL 60611, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2468-1253(20)30306-XDOI Listing
January 2021

On-demand degradable embolic microspheres for immediate restoration of blood flow during image-guided embolization procedures.

Biomaterials 2021 01 24;265:120408. Epub 2020 Sep 24.

Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60607, USA; Department of Biomedical Engineering, McCormick School of Engineering, Evanston, IL, 60208, USA; Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, 60611, USA. Electronic address:

Degradable embolic agents that provide transient arterial occlusion during embolization procedures have been of interest for many years. Ideally, embolic agents are visible with standard imaging modalities and offer on-demand degradability, permitting physicians to achieve desired arterial occlusion tailored to patient and procedure indication. Subsequent arterial recanalization potentially enhances the overall safety and efficacy of embolization procedures. Here, we report on-demand degradable and MRI-visible microspheres for embolotherapy. Embolic microspheres composed of calcium alginate and USPIO nanoclusters were synthesized with an air spray atomization and coagulation reservoir equipped with a vacuum suction. An optimized distance between spray nozzle and reservoir allowed uniform size and narrow size distribution of microspheres. The fabricated alginate embolic microspheres crosslinked with Ca demonstrated highly responsive on-demand degradation properties in vitro and in vivo. Finally, the feasibility of using the microspheres for clinical embolization and recanalization procedures was evaluated with interventional radiologists in rabbits. Digital subtraction angiography (DSA) guided embolization of hepatic arteries with these embolic microspheres was successfully performed and the occlusion of artery was confirmed with DSA images and contrast enhanced MRI. T2 MRI visibility of the microspheres allowed to monitor the distribution of intra-arterial (IA) infused embolic microspheres. Subsequent on-demand image-guided recanalization procedures were also successfully performed with rapid degradation of microspheres upon intra-arterial infusion of an ion chelating agent. These instant degradable embolic microspheres will permit effective on-demand embolization/recanalization procedures offering great promise to overcome limitations of currently available permanent and biodegradable embolic agents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.biomaterials.2020.120408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673262PMC
January 2021

Percutaneous Access of the Modified Hutson Loop for Retrograde Cholangiography, Endoscopy, and Biliary Interventions.

J Vasc Interv Radiol 2020 Dec 16;31(12):2113-2120.e1. Epub 2020 Sep 16.

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.

Purpose: The purpose of this study was to present the institutional experience of performing endoscopy, cholangiography, and biliary interventions through the modified Hutson loop by interventional radiology.

Materials And Methods: A total of 61 of 64 modified Hutson loop access procedures were successful. This single-center retrospective study included 61 successful procedures of biliary interventions using existing modified Hutson loops (surgically affixed subcutaneous jejunal limb adjacent to biliary anastomosis or anastomoses) for diagnostic or therapeutic purposes in 21 patients. Seventeen of 21 patients (81%) had undergone liver transplantation. Indications included biliary strictures (n = 18) and biliary leaks (n = 3). The clinical success and complications were evaluated.

Results: There were 3 of 26 modified Hutson loop retrograde biliary intervention failures (12%) before introduction of endoscopy and no failures (0 of 38 [0%]) subsequently (P = .06). Endoscopy or cholangioscopy was performed in 19 procedures by interventional radiologists. Retrograde biliary interventions included diagnostic cholangiography (n = 26), cholangioplasty (n = 25), stent placement (n = 29), stent retrieval (n = 25), and biliary drainage catheter placement (n = 5). No procedure-related mortality occurred. There was 1 major complication (duodenal perforation) (1.6%) and 12 minor complications (19%). In the 9 patients undergoing therapeutic interventions for biliary strictures, there was a significant decrease in median alkaline phosphatase (288.5 to 174.5 U/L; P = .03). There was a trend toward decrease in median bilirubin levels (1.7 to 1 mg/dL; P = .06) at 1 month post-intervention.

Conclusions: The modified Hutson loop provided interventional radiologists a safe and effective alternative access to manage biliary complications in patients with biliary-enteric anastomoses. Introduction of the endoscope in interventional radiology has improved the success rate of these procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2020.06.011DOI Listing
December 2020

Excimer Laser Sheath-Assisted Retrieval of "Closed-Cell" Design Inferior Vena Cava Filters.

J Am Heart Assoc 2020 09 20;9(17):e017240. Epub 2020 Aug 20.

Department of Radiology Northwestern University Chicago IL.

Background Numerous reports have shown that inferior vena cava filters are associated with clinically significant adverse events. Complicating factors, such as caval incorporation, may lead to technical challenges at retrieval. The use of advanced techniques including the laser sheath have increased technical success rates; however, the data are limited on which filter types necessitate and benefit from its use. Methods and Results From October 2011 to September 2019, patients with inferior vena cava filter dwell times >6 months or with prior failed retrievals were considered for laser sheath-assisted retrieval. Standard and nonlaser advanced retrieval techniques were attempted first; if the filter could not be safely or successfully detached from the caval wall using these techniques, the laser sheath was used. Technical success, filter type, necessity for laser sheath application based on "open" versus "closed-cell" filter design, dwell times, and adverse events were evaluated. A total of 441 patients (216 men; mean age, 54 years) were encountered. Mean dwell times for all filters was 56.6 months, 54.4 among closed-cell filters and 58.5 among open-cell filters (=0.63). Technical success of retrieval was 98%, with the laser sheath required in 143 cases (40%). Successful retrieval of closed-cell filters required laser sheath assistance in 60% of cases as compared with 7% of open-cell filters (odds ratio, 20.1; <0.01). In closed-cell inferior vena cava filters, dwell time was significantly associated with need for laser, requiring it in 64% of retrievals with dwell times >6 months (=0.01). One major adverse event occurred among laser sheath retrievals when a patient required a 2-day inpatient admission for a femoral access site hemorrhage. Conclusions Closed-cell filters may necessitate the use of the laser sheath for higher rates of successful and safe retrieval.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.120.017240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660756PMC
September 2020

Yttrium-90 Portal Vein Radioembolization in Sprague-Dawley Rats: Dose-Dependent Imaging and Pathological Changes in Normal Liver.

Cardiovasc Intervent Radiol 2020 Dec 16;43(12):1925-1935. Epub 2020 Aug 16.

Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.

Purpose: Portal vein embolization (PVE) is an established neoadjuvant method to induce future liver remnant hypertrophy prior to surgical resection of hepatic tumors. The purpose of our study was to examine the feasibility of PVE with glass Y microspheres (Y90 PVE) in Sprague-Dawley rats. We tested the hypothesis that increased doses of Y90 PVE would increase target lobe fibrosis and atrophy.

Methods: Twenty-two rats were assigned to four groups for Y90 PVE to the right median lobe: very high- (273.8 MBq; n = 2), high- (99.9 MBq; n = 10), medium- (48.1 MBq; n = 5), and low-dose (14.8 MBq; n = 5). An untreated control group included seven rats. Y PET/CT of Y distributions confirmed lobar targeting. MRI volumes were measured at baseline, 2-, 4-, 8- and 12-weeks. Explanted hepatic lobes were weighed, sectioned, and stained for H&E and immunohistochemistry. Digitized slides allowed quantitative measurements of fibrosis (20 foci/slide).

Results: Ex vivo measurements confirmed 91-97% activity was localized to the target lobe (n = 4). The percent growth of the target lobe relative to baseline was - 5.0% (95% CI - 17.0-6.9%) for high-, medium dose rats compared to + 18.6% (95% CI + 7.6-29.7%) in the low-dose group at 12-weeks (p = 0.0043). Radiation fibrosis increased in a dose-dependent fashion. Fibrotic area/microsphere was 22,893.5, 14,946.2 ± 2253.3, 15,304.5 ± 4716.6, and 5268.8 ± 2297.2 μm for very high- (n = 1), high- (n = 4), medium- (n = 3), and low-dose groups (n = 5), respectively.

Conclusion: Y90 PVE was feasible in the rat model, resulted in target lobe atrophy, and dose-dependent increases in hepatic fibrosis at 12 weeks. The onset of imaging-based volumetric changes was 8-12 weeks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00270-020-02614-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655630PMC
December 2020

Impact of COVID-19 on IR Fellowship.

J Vasc Interv Radiol 2020 09 2;31(9):1492-1494. Epub 2020 Jul 2.

Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, 676 N. Saint Clair Street, Suite 800, Chicago, IL 60611.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2020.06.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330558PMC
September 2020

Inferior Vena Cava Filter Retrieval: Patient Selection, Procedural Planning, and Postprocedural Complications.

AJR Am J Roentgenol 2020 10 5;215(4):790-794. Epub 2020 Aug 5.

Department of Radiology, Division of Interventional Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair, Ste 800, Chicago, IL 60611.

Utilization of retrievable inferior vena cava filters (rIVCFs) has come under increased scrutiny because of historically high rates of placement, generalized lack of retrieval when the inferior vena cava filter (IVCF) is no longer indicated, and reports of device-related complications. These events have led to an increased interest in IVCF retrieval, including the development of advanced endovascular retrieval techniques and the proliferation of specialized clinical practices for rIVCFs. We aim to describe the indications for IVCF retrieval, patient selection, procedural planning, and procedural complications and management. IVCFs continue to have a role in the prevention of pulmonary embolism in select patients. Rising awareness of device-related complications paired with historically low retrieval rates has prompted renewed emphasis and interest in filter retrieval. Diligent follow-up and procedural planning permit prompt and safe filter retrieval.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.19.22387DOI Listing
October 2020

Correlation of Y90-absorbed radiation dose to pathological necrosis in hepatocellular carcinoma: confirmatory multicenter analysis in 45 explants.

Eur J Nucl Med Mol Imaging 2021 02 4;48(2):580-583. Epub 2020 Aug 4.

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.

Purpose: To study the correlation between absorbed perfused liver dose using Y90 radioembolization and degree of hepatocellular carcinoma (HCC) necrosis in liver explants in a multicenter cohort analysis METHODS: A retrospective analysis of 45 HCC patients treated between 2014 and 2017 is presented. Inclusion criteria were treatment-naïve solitary HCC ≤ 8 cm and Child-Pugh A liver status using the radiation segmentectomy approach. All patients underwent liver resection or transplantation (LT). Liver explants were examined per institutional routine protocols to assess histopathological viability of HCC. Tumor pathological necrosis was classified into complete (100% necrosis), extensive (> 50% and ≤ 99%) necrosis, and partial (< 50%) necrosis. Absorbed perfused liver doses were estimated using MIRD calculations. Associations between dose and degree of necrosis were studied.

Results: Thirty-four (76%) patients underwent LT, and 11 (24%) patients underwent hepatic resection. Median radiation dose was 240 (IQR: 136-387) Gy. Thirty (67%) patients had complete pathologic necrosis (CPN) at explant, while 10 (22%) and 5 (11%) had extensive and partial necrosis, respectively. There were significant differences among perfused liver doses that exhibited partial, extensive, and complete necrosis (p = 0.001). Twenty-four out of twenty-eight (86%) patients who had dose > 190 Gy achieved CPN, while 11/17 (65%) who had < 190 Gy did not (Fisher's exact test; p = 0.001). Using binary logistic regression, only absorbed radiation dose was significantly associated with CPN (p = 0.01), while tumor size was not (p = 0.35). All patients receiving > 400 Gy exhibited CPN.

Conclusion: Radiation segmentectomy for early HCC with ablative dosing > 400 Gy results in CPN. This represents the new standard target dose for radiation segmentectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-020-04976-8DOI Listing
February 2021

Feasibility of Combination Intra-arterial Yttrium-90 and Irinotecan Microspheres in the VX2 Rabbit Model.

Cardiovasc Intervent Radiol 2020 Oct 12;43(10):1528-1537. Epub 2020 Jun 12.

Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA.

Purpose: To evaluate the combination of Y radioembolization (Y90) and drug-eluting bead irinotecan (DEBIRI) microspheres in the VX2 rabbit model.

Materials And Methods: An initial dose finding study was performed in 6 White New Zealand rabbits to identify a therapeutic but subcurative dose of Y90. In total, 29 rabbits were used in four groups: Y90 treatment (n = 8), DEBIRI treatment (n = 6), Y90 + DEBIRI treatment (n = 7), and an untreated control group (n = 8). Hepatic toxicity was evaluated at baseline, 24 h, 72 h, 1 week, and 2 weeks. MRI tumor volume (TV) and enhancing tumor volume were assessed baseline and 2 weeks. Tumor area and necrosis were evaluated on H&E for pathology.

Results: Infused activities of 84.0-94.4 MBq (corresponding to 55.1-72.7 Gy) were selected based on the initial dose finding study. Infusion of DEBIRI after Y90 was technically feasible in all cases (7/7). Overall, 21/29 animals survived to 2 weeks, and the remaining animals had extrahepatic disease on necropsy. Liver transaminases were elevated with Y90, DEBIRI, and Y90 + DEBIRI compared to control at 24 h, 72 h, and 1 week post-treatment and returned to baseline by 2 weeks. By TV, Y90 + DEBIRI was the only treatment to show statistically significant reduction at 2 weeks compared to the control group (p = 0.012). The change in tumor volume (week 2-baseline) for both Y90 + DEBIRI versus control (p = 0.002) and Y90 versus control (p = 0.014) was significantly decreased. There were no statistically significant differences among groups on pathology.

Conclusion: Intra-arterial Y90 + DEBIRI was safe and demonstrated enhanced antitumor activity in rabbit VX2 tumors. This combined approach warrants further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00270-020-02538-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529870PMC
October 2020

Yttrium-90 Radioembolization and Tumor Hypoxia: Gas-challenge BOLD Imaging in the VX2 Rabbit Model of Hepatocellular Carcinoma.

Acad Radiol 2021 06 7;28(6):849-858. Epub 2020 Jun 7.

Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.

Rationale And Objectives: To use a rapid gas-challenge blood oxygen-level dependent magnetic resonance imaging exam to evaluate changes in tumor hypoxia after Y radioembolization (Y90) in the VX2 rabbit model.

Materials And Methods: White New Zealand rabbits (n = 11) provided a Y90 group (n = 6 rabbits) and untreated control group (n = 5 rabbits). R2* maps were generated with gas-challenges (O/room air) at baseline, 1 week, and 2 weeks post-Y90. Laboratory toxicity was evaluated at baseline, 24 hours, 72 hours, 1 hours, and 2 weeks. Histology was used to evaluate tumor necrosis on hematoxylin and eosin and immunofluorescence imaging was used to assess microvessel density (CD31) and proliferative index (Ki67).

Results: At baseline, median tumor volumes and time to imaging were similar between groups (p = 1.000 and p = 0.4512, respectively). The median administered dose was 50.4 Gy (95% confidence interval:44.8-55.9). At week 2, mean tumor volumes were 5769.8 versus 643.7 mm for control versus Y90 rabbits, respectively (p = 0.0246). At two weeks, ΔR2* increased for control tumors to 12.37 ± 12.36sec and decreased to 4.48 ± 9.00sec after Y90. The Pearson correlation coefficient for ΔR2* at baseline and percent increase in tumor size by two weeks was 0.798 for the Y90 group (p = 0.002). There was no difference in mean microvessel density for control versus Y90 treated tumors (p = 0.6682). The mean proliferative index was reduced in Y90 treated tumors at 30.5% versus 47.5% for controls (p = 0.0071).

Conclusion: The baseline ΔR2* of tumors prior to Y90 may be a predictive imaging biomarker of tumor response and treatment of these tumors with Y90 may influence tumor oxygenation over time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acra.2020.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719607PMC
June 2021

Liver Transplantation Following Yttrium-90 Radioembolization: 15-Year Experience in 207-Patient Cohort.

Hepatology 2021 Mar 7;73(3):998-1010. Epub 2020 Nov 7.

Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.

Background And Aims: Radioembolization (yttrium-90 [Y90]) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver-directed therapy to curative liver transplantation (LT). In this study, we report long-term outcomes of LT for patients with HCC who were bridged/downstaged by Y90.

Approach And Results: Patients undergoing LT following Y90 between 2004 and 2018 were included, with staging by United Network for Organ Sharing (UNOS) tumor-node-metastasis criteria at baseline pre-Y90 and pre-LT. Post-Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long-term outcomes, including overall survival (OS), recurrence-free survival (RFS), disease-specific mortality (DSM), and time-to-recurrence, were reported. Time-to-endpoint analyses were estimated using Kaplan-Meier. Univariate and multivariate analyses were performed using a log-rank test and Cox proportional-hazards model, respectively. During the 15-year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with a median time to LT of 7.5 months [interquartile range, 4.4-10.3]. A total of 169 patients were bridged, whereas 38 were downstaged to LT. Respectively, 94 (45%), 60 (29%), and 53 (26%) patients showed complete, extensive, and partial tumor necrosis on histopathology. Three-year, 5-year, and 10-year OS rates were 84%, 77%, and 60%, respectively. Twenty-four patients developed recurrence, with a median RFS of 120 (95% confidence interval, 69-150) months. DSM at 3, 5, and 10 years was 6%, 11%, and 16%, respectively. There were no differences in OS/RFS for patients who were bridged or downstaged. RFS was higher in patients with complete/extensive versus partial tumor necrosis (P < 0.0001). For patients with UNOS T2 treated during the study period, 5.2% dropped out because of disease progression.

Conclusions: Y90 is an effective treatment for HCC in the setting of bridging/downstaging to LT. Patients who achieved extensive or complete necrosis had better RFS, supporting the practice of neoadjuvant treatment before LT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hep.31318DOI Listing
March 2021

Streamlining radioembolization in UNOS T1/T2 hepatocellular carcinoma by eliminating lung shunt estimation.

J Hepatol 2020 06 5;72(6):1151-1158. Epub 2020 Mar 5.

Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL; Department of Medicine, Division of Medical Oncology, Northwestern University, Chicago, IL. Electronic address:

Background & Aims: Pre-treatment Tc-99m macroaggregated albumin (MAA) scans are routinely performed prior to transarterial radioembolization (TARE) to estimate lung shunt fraction (LSF) and lung dose. In this study, we investigate LSF observed in early hepatocellular carcinoma (HCC) and provide the scientific rationale for eliminating this step from routine practice.

Methods: Patients with HCC who underwent Y90 from 2004 to 2018 were reviewed. Inclusion criteria were early stage HCC (UNOS T1/T2/Milan criteria: solitary ≤5 cm, 3 nodules ≤3 cm). LSF was determined using MAA in all patients. Associations between LSF and baseline characteristics were investigated. A "no-MAA" paradigm was then proposed based on a homogenous group that expressed very low LSF.

Results: Of 1,175 patients with HCC treated with TARE, 448 patients met inclusion criteria. Mean age was 65.6 years and 303 (68%) were males. A total of 352 (79%) had solitary lesions and 406 (91%) unilobar disease. Two-hundred and forty-three (54%), 178 (40%) and 27 (6%) patients were Child-Pugh class A, B and C, respectively. Median LSF was 3.9% (IQR 2.4-6%). Median administered activity was 0.9 GBq (IQR 0.6-1.4), for a median segmental volume of 170 cm (range: 60-530). Median lung dose was 1.9 Gy (IQR: 1.0-3.3). The presence of a transjugular intrahepatic portosystemic shunt (TIPS; n = 38) was associated with LSF >10% (odds ratio 12.2; 95% CI 5.2-28.6; p <0.001). Median LSF was 3.8% (IQR: 2.4-5.7%) and 6% (IQR: 3.8-15.3%) in no-TIPS vs. TIPS patients (p <0.001).

Conclusion: LSF is clinically negligible in patients with UNOS T1/T2 HCC without TIPS. When segmental injections are planned, this step can be eliminated, thereby reducing time-to-treatment, number of procedures, and improving convenience for patients traveling from faraway.

Lay Summary: Transarterial radioembolization is a microembolic transarterial treatment for hepatocellular carcinoma. In our study, we found that early stage patients, where segmental injections are planned, exhibited low lung shunting, effectively eliminating the risk of radiation pneumonitis. We propose that the lung shunt study be eliminated in this subgroup, thus leading to fewer procedures, a cost reduction and improved convenience for patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhep.2020.02.024DOI Listing
June 2020

Safety and Outcomes of Permanent and Retrievable Inferior Vena Cava Filters in the Oncology Population.

Int J Vasc Med 2020 5;2020:6582742. Epub 2020 Feb 5.

University of Colorado School of Medicine, Department of Medicine, Division of Hematology, USA.

Background: The role for inferior vena cava (IVC) filters in the oncology population is poorly defined.

Objectives: Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent filter groups. /.

Methods: A single-institution, retrospective study of patients with active malignancies and acute VTE who received a retrievable or permanent IVC filter between 2009-2013. Demographics and outcomes were confirmed on independent chart review. Cost data were obtained using Current Procedural Terminology (CPT) codes.

Results: 179 patients with retrievable filters and 207 patients with permanent filters were included. Contraindication to anticoagulation was the most cited reason for filter placement; however, only 76% of patients with retrievable filters and 69% of patients with permanent filters had an absolute contraindication to anticoagulation. 20% of patients with retrievable filters and 24% of patients with permanent filters had recurrent VTE. The median time from filter placement to death was 8.9 and 3.2 months in the retrievable and permanent filter groups, respectively. The total cost of retrievable filters and permanent filters was $2,883,389 and $3,722,688, respectively.

Conclusions: The role for IVC filters in cancer patients remains unclear as recurrent VTE is common and time from filter placement to death is short. Filter placement is costly and has a clinically significant complication rate, especially for retrievable filters. More data from prospective, randomized trials are needed to determine the utility of IVC filters in cancer patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/6582742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025073PMC
February 2020

Correction to: Prognosticating Survival in Hepatocellular Carcinoma with Elevated Baseline Alpha-fetoprotein Treated with Radioembolization Using a Novel Laboratory Scoring System: Initial Development and Validation.

Cardiovasc Intervent Radiol 2020 May;43(5):806

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.

The name of the eleventh author is listed incorrectly in the published article as Nitin Kataraya. The correct name is Nitin Katariya.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00270-020-02429-1DOI Listing
May 2020

Adverse Events Related to Partial Splenic Embolization for the Treatment of Hypersplenism: A Systematic Review.

J Vasc Interv Radiol 2020 Jul 1;31(7):1118-1131.e6. Epub 2020 Feb 1.

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, Illinois. Electronic address:

Partial splenic embolization is a common procedure that reduces thrombocytopenia in patients with hypersplenism. The present review evaluated the adverse event profile of partial splenic embolization detailed in 30 articles. Although the technical success rate of the procedure in these papers is high, many patients experienced postprocedural complications. Minor complications such as postembolization syndrome occurred frequently. Major complications were less frequent but sometimes resulted in mortality. Underlying liver dysfunction and high infarction rates may be risk factors leading to major complications. Interventional radiologists should be aware of the complication profile of this procedure and further advance research in techniques dealing with hypersplenism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2019.08.015DOI Listing
July 2020

Toxicity and Survival of Hepatocellular Carcinoma Patients with Hepatitis B Infection Treated with Yttrium-90 Radioembolization: An Updated 15-Year Study.

J Vasc Interv Radiol 2020 Mar 23;31(3):401-408.e1. Epub 2020 Jan 23.

Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 800, Chicago, IL, 60611. Electronic address:

Purpose: To evaluate the toxicity and survival of hepatocellular carcinoma (HCC) secondary to hepatitis B virus (HBV) infection treated with yttrium-90 transarterial radioembolization (TARE) over a 15-year period.

Materials And Methods: This study retrospectively analyzed 93 consecutive patients with HBV HCC-all derived from an original cohort of 1,000 patients-who were treated with TARE via standard radiation segmentectomy/lobectomy between December 2003 and December 2018. This group comprised 80 males and 13 females, with 79 having only HBV and 14 having additional liver comorbidities. Toxicity grades were determined by Common Terminology Criteria for Adverse Events, version 5.0. Overall survival (OS) was reported using intention-to-treat (ITT), censored, or competing risk. Univariate/multivariate analyses were used to evaluate predictors of OS.

Results: Posttreatment grade 3/4 toxicities included albumin (1.1%), bilirubin (4.3%), aspartate transaminase (6.5%), and alanine transaminase (3.2%). Median censored OS was 16.9 months (95% confidence interval [CI], 11.8-23.5): 17.5 months (95% CI, 11.5-86.9) for Child-Pugh (CP) A and 14.5 months (95% CI, 5.2-22.5) for CP B; not reached, 16.9 months (95% CI, 11.2-68.7), and 11.5 months (95% CI, 8.6-17.5) for Barcelona Clinic Liver Cancer (BCLC) A, B, and C, respectively. Multivariate analysis revealed albumin, alpha-fetoprotein, and portal vein thrombosis as independent predictors of ITT OS and albumin and tumor size as predictors when curative therapy was assigned as a competing risk.

Conclusions: This retrospective study showed that TARE therapy resulted in minimal toxicity in patients with HBV-derived HCC. Patients with CP A or BCLC A disease had superior survival outcomes compared to patients with CP B and BCLC B/C disease. These findings suggest that TARE is a viable treatment option for certain patient groups with HCC tumors secondary to HBV infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2019.08.033DOI Listing
March 2020

Endovascular Management of Acquired Hepatic Arterial-Portal Venous Malformations.

Cardiovasc Intervent Radiol 2020 Mar 25;43(3):466-477. Epub 2019 Nov 25.

Division of Interventional Radiology, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.

Purpose: Arteriovenous malformations (AVMs) are typically congenital in origin, but acquired types, such as dural arteriovenous fistula (AVF), have been described. This study aimed to describe the diagnosis and endovascular treatment of acquired hepatic arterial-portal venous (HA-PV) malformations.

Materials And Methods: A retrospective review of suspected acquired HA-PV malformations from 9/2011 to 2/2018 was performed. Eight patients (1M:7F, average age 62) with HA-PV malformations were identified. Four (50%) patients had a history of liver transplant. All HA-PV malformations were Yakes type IIIA (multiple inflow arteries with a single vein outflow and with the nidus located within the vein wall). In all cases, computed tomography angiography/magnetic resonance angiography was unable to distinguish AVMs from AVFs, and a wrong diagnosis was made in each instance.

Results: Review of pre-procedural Doppler ultrasounds in all cases demonstrated arterialization of portal vein waveforms. Review of pre-procedural cross-sectional (CT/MR) imaging in all of these cases demonstrates a network of arteries around the portal vein with early portal vein filling in every instance. Attempts to close the shunts via arterial inflow embolization but without venous nidus occlusion were performed and were unsuccessful in five out of eight (62.5%) cases. All curative therapies were via embolization of the outflow vein (segmental or lobar portal vein). Technical success was seen in seven of eight cases (87.5%), while one patient is planned to receive additional nidal vein embolization. Liver function was preserved after treatment without worsening of bilirubin or albumin levels.

Conclusion: The diagnosis of an acquired HA-PV malformation can guide curative endovascular treatment by embolization of the portal vein outflow.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00270-019-02380-wDOI Listing
March 2020

Quality of Life after Radioembolization for Hepatocellular Carcinoma Using a Digital Patient-Reported Outcome Tool.

J Vasc Interv Radiol 2020 Feb 13;31(2):311-314.e1. Epub 2019 Nov 13.

(Formerly) HealthLoop, Inc, Mountain View, California; Division of Hospital Medicine, University of California San Francisco, San Francisco, California.

Health-related quality of life (HRQoL) measurements are important for patient care, and emerging bundles in value-based care are placing an increasing emphasis on tying reimbursement to patient surveys. A multicenter pilot study was carried out to assess the efficacy of an automated digital patient engagement (DPE) platform for collecting HRQoL measurements at baseline and at 2- to 4-week intervals through 90 days after transarterial radioembolization (TARE) with yttrium-90 (Y) treatments for hepatocellular carcinoma (HCC). The results revealed a survey completion of 78.4% and demonstrated only 4 of 35 individual symptom instances across all time points of transient worsening relative to baseline. Most importantly, the DPE platform provided an effective means for deploying and collecting patient-reported outcome measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2019.06.018DOI Listing
February 2020

Contemporary Systematic Review of Health-Related Quality of Life Outcomes in Locoregional Therapies for Hepatocellular Carcinoma.

J Vasc Interv Radiol 2019 Dec 2;30(12):1924-1933.e2. Epub 2019 Nov 2.

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago Illinois. Electronic address:

Health-related quality of life has become an important aspect in oncologic decision making. Recent data suggest that Health-Related Quality of Life (HRQoL) measurements can play an important prognostic role in patients with hepatocellular carcinoma (HCC). Locoregional therapies (LRTs) such as radiofrequency ablation, transarterial chemoembolization, and radioembolization (TARE) are important parts of HCC management. Results demonstrated that radiofrequency ablation treatment results in improving HRQoL compared to surgery for up to 3 years after treatment. Between TARE and transarterial chemoembolization, TARE provides the most benefit in terms of HRQoL. This systematic review investigated contemporary data surrounding HRQoL in patients undergoing LRTs and its impact on clinical decision making.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2019.07.020DOI Listing
December 2019

Modified Radiation Lobectomy: An Evolving Paradigm to Convert Patients to Liver Resection Candidacy.

Semin Intervent Radiol 2019 Oct 31;36(4):343-348. Epub 2019 Oct 31.

Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1696648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823042PMC
October 2019

Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort.

Eur J Nucl Med Mol Imaging 2020 04 10;47(4):807-815. Epub 2019 Sep 10.

Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.

Background: Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%.

Methods: With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90.

Results: A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1-28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15-28) and 29.5 Gy (IQR 20.5-44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7-224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient.

Conclusion: Y90 can be performed in patients with LSF > 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF > 15% should not deter from treatment with Y90.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-019-04517-yDOI Listing
April 2020