Asunto(s)
Bronquitis/etiología , Disnea/etiología , Embolización Terapéutica , Anomalías Linfáticas/complicaciones , Conducto Torácico/anomalías , Adulto , Edad de Inicio , Variación Anatómica , Bronquitis/terapia , Disnea/terapia , Femenino , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Anomalías Linfáticas/sangre , Anomalías Linfáticas/diagnóstico por imagen , Anomalías Linfáticas/terapia , Vasos Linfáticos/anomalías , Vasos Linfáticos/diagnóstico por imagen , Linfografía , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/terapia , Conducto Torácico/diagnóstico por imagenAsunto(s)
Embolización Terapéutica/normas , Neoplasias Hepáticas/terapia , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Radiofármacos/administración & dosificación , Consenso , Técnica Delphi , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Embolización Terapéutica/tendencias , Medicina Basada en la Evidencia/normas , Predicción , Humanos , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Mejoramiento de la Calidad/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Radiofármacos/efectos adversos , Resultado del TratamientoRESUMEN
Chemotherapy-resistant colon carcinoma metastases to a patient's right hepatic lobe progressed after right lobar radioembolization with yttrium-90. The metastasis-free left lobe had adequate volume as a future liver remnant. Repeat right lobar radioembolization with supratherapeutic activity of (90)Y caused shrinking of the tumors and the right lobe with no adverse outcome. With an adequate tumor-free future liver remnant, one hepatic lobe bearing a large tumor burden may be administered supratherapeutic activity of (90)Y, risking lobar ablation for greater probability of tumor eradication. This is analogous to hepatic lobectomy. This case is presented as a proof of principle.
Asunto(s)
Carcinoma/radioterapia , Carcinoma/secundario , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundario , Anciano , Femenino , Hepatectomía/métodos , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del TratamientoRESUMEN
Nausea and vomiting may occur in a significant minority of patients following hepatic artery embolization with yttrium-90 spheres (K. T. Sato et al. Radiology 247:507-515, 2008). This encumbers human and economic resources and undercuts the assertion that it is as a well-tolerated outpatient treatment. A single intravenous dose of palonosetron HCl was administered before hepatic artery embolization with yttrium-90 spheres to ameliorate posttreatment nausea and vomiting, in 23 consecutive patients. The patients were discharged the day of procedure on oral antiemetics, steroids, and blockers of gastric acid release. All patients had clinical and laboratory evaluation at 2 weeks after the procedure. The data were gathered and reviewed retrospectively. At 2-week follow-up, none reported significant nausea, vomiting, additional antiemetic use, need for parenteral therapy, hospital readmission, or palonosetron-related side effects. All patients recovered from postembolization symptoms within a week after treatment. In conclusion, this retrospective study suggests that single-dose palonosetron is feasible, safe, and effective for acute and delayed nausea and vomiting in this group of patients. The added cost may be offset by benefits.