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Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma

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AAPM Medical Physics Practice Guideline 14.a: Yttrium-90 microsphere radioembolization.

Nathan C Busse¹, Muthana S A L Al-Ghazi², Nadine Abi-Jaoudeh³

¹Colorado Associates in Medical Physics, Denver, Colorado, USA.

Journal of Applied Clinical Medical Physics

|October 11, 2023

Summary

This study outlines essential guidelines for establishing Yttrium-90 (⁹⁰ Y) radioembolization programs. It details medical physicist roles, patient preparation, dose delivery, and safety protocols for treating liver tumors.

Keywords:

MPPG Yttrium-90 brachytherapy hepatic tumors practice guideline radioembolization

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Area of Science:

Interventional Radiology
Medical Physics
Nuclear Medicine

Background:

Radioembolization with Yttrium-90 (⁹⁰ Y) microspheres is a standard treatment for liver tumors.
Establishing a safe and effective ⁹⁰ Y program requires comprehensive guidelines.
Medical physicists are crucial for ensuring patient and staff safety.

Purpose of the Study:

To provide minimum practice guidelines for establishing and supporting Yttrium-90 (⁹⁰ Y) radioembolization programs.
To identify key roles, procedures, and safety considerations for program implementation.
To guide institutions in regulatory compliance and staff training.

Main Methods:

Summarizing available Yttrium-90 (⁹⁰ Y) products and suppliers.
Describing pre-treatment patient workup, including imaging (Technetium-99^m (Tc-99^m) mapping, MRI/CT/PET-CT) and dose calculation.
Detailing the treatment procedure, dose assay, image guidance, radiation safety measures, and post-procedure surveys.

Main Results:

Identification of critical steps from patient selection to post-treatment assessment.
Emphasis on the importance of accurate lung shunt fraction (LSF) quantification and tumor burden assessment.
Highlighting the necessity of institutional radioactive materials license amendments and comprehensive staff training.

Conclusions:

Successful implementation of Yttrium-90 (⁹⁰ Y) radioembolization necessitates adherence to detailed guidelines.
Robust safety protocols, regulatory compliance, and thorough training are paramount.
These guidelines aim to ensure the safe and effective delivery of Yttrium-90 (⁹⁰ Y) therapy for liver malignancies.