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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

A Journal on Nuclear Medicine and Molecular Imaging


A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the Society of Radiopharmaceutical Sciences and to the International Research Group of Immunoscintigraphy
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2009 June;53(3):325-35

language: English

Microsphere radioembolization of liver malignancies: current developments

Bult W. 1, Vente M. A. D. 1, Zonnenberg B. A. 2, Van Het Schip A. D. 1, Nijsen J. F. W. 1

1 Department of Radiology and Nuclear Medicine University Medical Center Utrecht, Utrecht, The Netherlands
2 Department of Internal Medicine University Medical Center Utrecht, Utrecht, The Netherlands


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The worldwide incidence of hepatic malignancies, both primary and secondary, exceeds 1 000 000 new cases each year. The poor prognosis of patients suffering from hepatic malignancies has lead to the development of a liver directed therapy which consists of intra-arterial administration of radioactive particles through a catheter. Yttrium-90 (90Y) microspheres are increasingly applied for this purpose, and up to now nearly all clinical experience with radioembolization has been obtained with these microspheres. The response rate is very promising in both patients with primary and metastatic liver malignancies. Currently, two commercially available 90Y microsphere devices are in use clinically, both as a first-line treatment and in a salvage setting. Unfortunately, the use of a pure b-emitter like 90Y hampers acquisition of high quality nuclear images for pre-treatment work-up and follow-up. This issue was addressed by the development of holmium-166 (166Ho) and rhenium-188 (188Re) microspheres, which emit both b-particles for therapeutic purposes and g-photons for nuclear imaging. Moreover, since holmium is paramagnetic it allows for magnetic resonance imaging. 166Ho loaded poly(L-lactic acid) microspheres have been thoroughly investigated in a preclinical setting, and recently the first clinical results for 188Re microspheres were reported. This review provides an overview of the current status and (pre-)clinical developments of radioactive microspheres for treatment of liver malignancies.

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