Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases.

OBJECTIVE: To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. MATERIAL AND METHODS: This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. RESULTS: Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8GBq (0.7-6.4GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. CONCLUSIONS: Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines.

Radioembolización en hepatocarcinoma: a propósito de 53 casos / Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases

Objetivo Contribuir con la presentación de los resultados de nuestro estudio a ampliar la evidencia científica sobre el empleo de la radioembolización en el manejo de pacientes con hepatocarcinoma. Material y método Se trata de una revisión retrospectiva realizada en nuestro centro que incluye a 53 pacientes con hepatocarcinoma tratados con radioembolización. Los pacientes fueron clasificados según el algoritmo del BCLC (Barcelona Clinic Liver Cancer) y de forma pormenorizada por su estado funcional siguiendo la clasificación de Child-Pugh. Se realizó un estudio de supervivencia siguiendo la metodología de Kaplan-Meier. Se empleó el método de regresión de Cox para la determinación de parámetros clínicos significativos, incluyendo dosis administradas en los parámetros estudiados. Resultados La serie evaluada comprende a pacientes con una media de edad de 60 años (rango 28-86). Se llevaron a cabo un total de 61 procedimientos. La actividad media administrada fue de 2,8 GBq (0,7-6,4 GBq), administrando una dosis media en tumor de 229,9 Gy (74-425,9 Gy). El tiempo libre de progresión fue de 6,7 meses desde el momento del tratamiento y la supervivencia global fue de 12,8 meses. La clasificación de los pacientes según BCLC (p=0,848) y Child-Pugh (p=0,252) no resultó significativa respecto al tiempo libre de enfermedad. Los parámetros clínicos que resultaron con diferencias significativas en cuanto a supervivencia global fueron los niveles de bilirrubina (p<0.001) y las cifras de transaminasas (GOT) pretratamiento (p=0.022), la subclasificación Child-Pugh (p=0.003) y la dosis recibida por el tumor (p=0,001). Tan solo uno de los pacientes tratados presentó un efecto adverso grave, con fallo hepático posterapia y resultado de muerte... (AU)

Objective To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. Material and methods This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. Results Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8 GBq (0.7-6.4 GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. Conclusions Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines. (AU)

Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases. / Radioembolización de hepatocarcinomas: a propósito de 53 casos.

OBJECTIVE: To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma. MATERIAL AND METHODS: This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center. Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status. We analyzed survival using the Kaplan-Meier method. We used Cox regression analysis to determine clinically significant parameters, including the doses administered in the parameters studied. RESULTS: Patients ranged in age from 28 to 86 years (mean, 60 years). A total of 61 procedures were done. The mean activity administered was 2.8 GBq (0.7-6.4 GBq), with a mean dose of 229.9Gy (74-425.9Gy) administered in the tumor. Progression-free survival was 6.7 months and overall survival was 12.8 months. Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant (p=0.848 and p=0.252, respectively). The clinical parameters that were significantly different with respect to overall survival were bilirubin levels (p<0.001), pretreatment transaminase levels (AST) (p=0.022), Child-Pugh subclassification (p=0.003), and dose administered in the tumor (p=0.001). Only one patient had a severe adverse reaction, developing posttreatment liver failure resulting in death. CONCLUSIONS: Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma. Liver function and the doses received by the tumor are key parameters for the efficacy of treatment. The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines.

Uso del 177Lu-DOTATATE como terapia en carcinomas de tiroides yodorrefractarios / Use of 177Lu-dotatate in the treatment of iodine refractory thyroid carcinomas

Ante un paciente con cáncer diferenciado de tiroides, el protocolo de tratamiento estándar a seguir es cirugía, ablación con 131Iodo (131I) de restos tiroideos y supresión de TSH. Pero en algunos casos, el tratamiento con 131I no es efectivo y deja de ser una opción terapéutica debido a la desdiferenciación celular con pérdida de la captación de 131I. Como otras opciones, se puede recurrir a tratamiento sistémico, si bien los pacientes no siempre son respondedores, pudiendo progresar la enfermedad y quedando sin opciones terapéuticas. Los tumores endocrinos pueden expresar receptores de la somatostatina, lo que se ha utilizado tanto para el diagnóstico como para su tratamiento mediante el marcaje de los análogos de la somatostatina con isótopos radiactivos. Presentamos el caso de una paciente con carcinoma folicular de tiroides yodorrefractario, con expresión de receptores de la somatostatina, tratada con 177Lu-DOTATATE, con excelente respuesta clínica y analítica (AU)

In a patient with a differentiated thyroid cancer the standard treatment protocol to be followed is surgery, ablation of thyroid remnants with 131Iodine (131I), and TSH suppression. However, the treatment with 131I is not effective in some cases, and it no longer becomes a therapeutic option due to cell de-differentiation with loss of 131I uptake. Systemic treatment can be used as other options, although patients are not always responsive; thus, the disease may progress and therapeutic options may run out. Endocrine tumours may express somatostatin receptors,and this characteristic has been used, not only for diagnosis, but also for their treatment through somatostatin analogue labelling with radioactive isotopes. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin receptors expression, treated with 177Lu-DOTATATE, showing an excellent clinical and analytical response (AU)

Use of 177Lu-dotatate in the treatment of iodine refractory thyroid carcinomas. / Uso del 177Lu-DOTATATE como terapia en carcinomas de tiroides yodorrefractarios.

In a patient with a differentiated thyroid cancer the standard treatment protocol to be followed is surgery, ablation of thyroid remnants with 131Iodine (131I), and TSH suppression. However, the treatment with 131I is not effective in some cases, and it no longer becomes a therapeutic option due to cell de-differentiation with loss of 131I uptake. Systemic treatment can be used as other options, although patients are not always responsive; thus, the disease may progress and therapeutic options may run out. Endocrine tumours may express somatostatin receptors,and this characteristic has been used, not only for diagnosis, but also for their treatment through somatostatin analogue labelling with radioactive isotopes. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin receptors expression, treated with 177Lu-DOTATATE, showing an excellent clinical and analytical response.

Dosis efectivas asociadas a las exploraciones multimodales habituales en medicina nuclear / Effective doses associated to the usual multimodal examinations in nuclear medicine

Objetivo. Dar a conocer las dosis efectivas (E) que pueden ser impartidas en las exploraciones multimodales comunes en medicina nuclear, tomografía por emisión de fotón único y tomografía por emisión de positrones combinadas con tomografía computerizada, SPECT/TAC y PET/TAC. Se expresará E según el tiempo equivalente de radiación natural (TERN) y se estudiará la contribución del TAC a la dosis total. Material y métodos. Se ha calculado E de cada exploración como suma de las dosis por irradiación externa (parte TAC) e interna (administración de radiofármaco). Los datos de cada parte se han recopilado mediante una amplia búsqueda bibliográfica. Resultados. Se muestra un intervalo de dosis efectiva mínima y máxima [Emin, Emax] asociada a cada exploración. Dichas dosis varían entre 0,5 y 49,1 mSv. El TERN va desde 2,6 meses hasta los 20,4 años. La contribución del TAC a la dosis efectiva total es muy variada (desde el 2,1 hasta el 93%) dependiendo del modo de adquisición de la imagen y su propósito. Adquirir un TAC diagnóstico supone aumentar hasta 4,3 veces la dosis respecto a la adquisición para corrección por atenuación y localización anatómica. Conclusiones. Este trabajo nos orienta sobre el nivel de dosis efectiva que puede impartirse en procedimientos multimodales, teniendo presente que los datos están sujetos a variaciones constantes y deben ser actualizados periódicamente. Es importante conocer el impacto dosimétrico al añadir la adquisición TAC. La aplicación de protocolos optimizados según la indicación del estudio supone reducir la exposición al paciente sin pérdida significativa de información(AU)

Objective. To know the effective doses (E) that can be given in the common multimodal procedures in nuclear medicine, Single Photon Emission Tomography and Positron Emission Tomography, combined with Computed Tomography, SPECT/CT and PET/CT. Effective dose will be expressed according to Background Equivalent Radiation Time (BERT) and the contribution of the CT scan to the total dose will also be studied. Material and methods. The effective dose of each procedure has been calculated as the sum of the external radiation dose (CT part) and internal one (radiopharmaceutical administration). Data from each side were collected through extensive literature search. Results. A range of minimum and maximum effective dose [Emin, Emax] associated with each procedure is shown. These doses range from 0.5 to 49.1 mSv. BERT ranges from 2.6 months to 20.4years. The CT contribution to the total effective dose varies from 2.1% to 93%, according to the image acquisition protocol and its purpose. Performing a diagnostic CT scan increases the dose up to a factor of 4.3 times compared to the dose used for CT acquisition for attenuation correction and anatomic localization. Conclusions. This article focus on the effective dose level that can be given in multimodal procedures, bearing in mind that the data are subject to constant changes and should be updated periodically. It is important to know the dosimetric impact when the CT scan is added. The application of optimized protocols according to the indication of the study reduces the patient's exposure without the loss of significant information(AU)

[Effective doses associated to the usual multimodal examinations in nuclear medicine]. / Dosis efectivas asociadas a las exploraciones multimodales habituales en medicina nuclear.

OBJECTIVE: To know the effective doses (E) that can be given in the common multimodal procedures in nuclear medicine, Single Photon Emission Tomography and Positron Emission Tomography, combined with Computed Tomography, SPECT/CT and PET/CT. Effective dose will be expressed according to Background Equivalent Radiation Time (BERT) and the contribution of the CT scan to the total dose will also be studied. MATERIAL AND METHODS: The effective dose of each procedure has been calculated as the sum of the external radiation dose (CT part) and internal one (radiopharmaceutical administration). Data from each side were collected through extensive literature search. RESULTS: A range of minimum and maximum effective dose [E(min), E(max)] associated with each procedure is shown. These doses range from 0.5 to 49.1 mSv. BERT ranges from 2.6 months to 20.4 years. The CT contribution to the total effective dose varies from 2.1% to 93%, according to the image acquisition protocol and its purpose. Performing a diagnostic CT scan increases the dose up to a factor of 4.3 times compared to the dose used for CT acquisition for attenuation correction and anatomic localization. CONCLUSIONS: This article focus on the effective dose level that can be given in multimodal procedures, bearing in mind that the data are subject to constant changes and should be updated periodically. It is important to know the dosimetric impact when the CT scan is added. The application of optimized protocols according to the indication of the study reduces the patient's exposure without the loss of significant information.

Esplenosis abdominal: una entidad frecuentemente infradiagnosticada / Abdominal splenosis: an often underdiagnosed entity

La esplenosis se define como el autotrasplante heterotópico de tejido esplénico como resultado de una rotura del bazo por trauma o cirugía. Es una condición benigna y de hallazgo casual, aunque en ciertas ocasiones las pruebas de imagen puedan orientar a malignidad simulando tumores renales, linfomas abdominales y endometriosis, entre otros. Presentamos el caso de un varón de 42 años al que, tras un estudio por dolor abdominal, se le realiza una resonancia magnética en la que se observan múltiples adenopatías en el abdomen que pueden orientar a un síndrome linfoproliferativo. Como antecedente importante, presenta esplenectomía por trauma abdominal a los 9 años. Tras varios estudios, se decide realizar una gammagrafía con hematíes desnaturalizados marcados con tecnecio-99m que muestra múltiples depósitos patológicos distribuidos por todo el abdomen e, incluso, la pelvis, siendo este hallazgo compatible con esplenosis(AU)

Splenosis is defined as the heterotopic autotransplantation of splenic tissue because of a ruptured spleen due to trauma or surgery. It is a benign and incidental finding, although imaging tests may sometimes orient toward malignancy simulating renal tumors, abdominal lymphomas, endometriosis, among other. We report the case of a 42-year old male in whom a MRI was performed after a study due to abdominal pain. Multiple enlarged lymph nodes were observed in the abdomen, suggestive of lymphoproliferative disease. As an important background, splenectomy was carried out due to abdominal trauma at age 9. After several studies, it was decided to perform a 99mTc-labeled heat-damaged red blood cell scintigraphy that showed multiple pathological deposits distributed throughout the abdomen, and even the pelvis, being consistent with splenosis(AU)

[Abdominal splenosis: an often underdiagnosed entity]. / Esplenosis abdominal: una entidad frecuentemente infradiagnosticada.

Splenosis is defined as the heterotopic autotransplantation of splenic tissue because of a ruptured spleen due to trauma or surgery. It is a benign and incidental finding, although imaging tests may sometimes orient toward malignancy simulating renal tumors, abdominal lymphomas, endometriosis, among other. We report the case of a 42-year old male in whom a MRI was performed after a study due to abdominal pain. Multiple enlarged lymph nodes were observed in the abdomen, suggestive of lymphoproliferative disease. As an important background, splenectomy was carried out due to abdominal trauma at age 9. After several studies, it was decided to perform a (99m)Tc-labeled heat-damaged red blood cell scintigraphy that showed multiple pathological deposits distributed throughout the abdomen, and even the pelvis, being consistent with splenosis.