Subject(s)
Bronchitis/etiology , Dyspnea/etiology , Embolization, Therapeutic , Lymphatic Abnormalities/complications , Thoracic Duct/abnormalities , Adult , Age of Onset , Anatomic Variation , Bronchitis/therapy , Dyspnea/therapy , Female , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Lymphatic Abnormalities/blood , Lymphatic Abnormalities/diagnostic imaging , Lymphatic Abnormalities/therapy , Lymphatic Vessels/abnormalities , Lymphatic Vessels/diagnostic imaging , Lymphography , Pregnancy , Pregnancy Complications/diagnostic imaging , Pregnancy Complications/therapy , Thoracic Duct/diagnostic imagingSubject(s)
Embolization, Therapeutic/standards , Liver Neoplasms/therapy , Quality Improvement/standards , Quality Indicators, Health Care/standards , Radiopharmaceuticals/administration & dosage , Consensus , Delphi Technique , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/methods , Embolization, Therapeutic/trends , Evidence-Based Medicine/standards , Forecasting , Humans , Liver Neoplasms/blood supply , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Quality Improvement/trends , Quality Indicators, Health Care/trends , Radiopharmaceuticals/adverse effects , Treatment OutcomeABSTRACT
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.
Subject(s)
Carcinoma/radiotherapy , Carcinoma/secondary , Liver Neoplasms/radiotherapy , Liver Neoplasms/secondary , Aged , Female , Hepatectomy/methods , Humans , Minimally Invasive Surgical Procedures/methods , Treatment OutcomeABSTRACT
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.
