TARE - TransArterial RadioEmbolization interventional procedure with nuclear medicine sivaprakash2611@gmail.com

1. Transarterial
Radioembolization (TARE)
V. Siva Prakash, M.Sc.MIT
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2. TRANSARTERIAL RADIOEMBOLIZATION
Radioembolization is the delivery of radioactive
microspheres to cancer cells using an (Transarterial)
endovascular approach.
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3. RADIOEMBOLIZATION
Radioembolization is a combination of
radiation therapy and a procedure called
embolization to treat cancer of the liver.
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4. RADIOEMBOLIZATION
 This treatment is called internal radiation therapy.
 Tiny glass or resin beads called microspheres are placed inside the blood
vessels that feed a tumor in order to block the supply of blood to the cancer
cells.
 Once these microspheres, which are filled with the radioactive isotope yttrium
Y-90, become lodged at the tumor site, they deliver a high dose of radiation to
the tumor and not to normal tissues.
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5. INDICATIONS
 Hepatocellular carcinoma
 Hepatic metastases from colorectal carcinoma
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6. CONTRAINDICATIONS
Absolute contraindications
 Excessive hepatopulmonary shunting (results in radiation pneumonitis)
 Demonstrable gastrointestinal shunting (results in gastric ulceration)
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7. CONTRAINDICATIONS
Relative contraindications
 hepatic and/or renal dysfunction
 previous hepatic irradiation
 portal vein thrombus
 portal venous hypertension
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8. PREPARATION
 Previous history/records collected
 NPO
 RFT values obtained
 Prothrombin test (25-30sec) INR-1.0-1.5
 Avoid drugs/medicine (e.g. blood thinner- warfarin)
 Previous angiogram.
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9. MATERIALS
 Fluoroscopy/c arm
 Local anesthesia
 Catheter, guide wire
 yttrium-90 with microspheres, or tiny
glass beads
 Iodinated contrast
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10. why yttrium-90..?
• Pure beta particle
• Penetration 2.5mm
• Half life 60.1hr (94% dose delivered within 11days)
• 40% higher dose than external beam radiation.
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11. DUAL SUPPLY
 Normal liver tissue receives about 75 percent
of its blood supply from the portal vein
 25 percent from the hepatic artery and its
branches.
 When a tumor grows in the liver, it receives
almost all of its blood supply from the
hepatic artery.
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12. ANGIO- HEPATIC ARTERY
 An initial arteriogram is performed to visualize the upper abdominal arteries.
 Arteries to areas of the stomach and duodenum which may have beads flow
into them are closed (embolized) with tiny coils of wire.
 Minimize extra hepatic delivery
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13. HEPATO-PULMONARY SHUNT
 Lead to deposition in lung through intra tumoral AV
shunt
 A nuclear medicine tracer Tc-99m MAA is injected
observed through gamma camera.
 This will allow the interventional radiologist to
calculate how much of the treatment dose can go to
the lungs (<30Gy) so that lung damage does not
occur.
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14. DOSE CALCULATION
1. EMPIRIC METHOD
1. 2GBq for <25%
2. 3GBq for 25-50%
3. 5GBq for >50%
2. Body surface area - BSA method
BSA+ tumor volume
tumor volume + liver volume
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15. PROCEDURE - TARE
 Vital signs are monitored
 IV line – local anesthesia
 Surgical draping is made
 Femoral puncture
 Placement of catheter
 Glass beads and microspheres are injected.
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16. ADVERSE EFFECTS
 Nausea, vomiting, abdominal discomfort
 Portal hypertension
 Pneumonitis
 GI ulcer
 Vascular injury
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17. THANK YOU
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