Abstract
PURPOSE: To standardize the indications, techniques, multimodality
treatment approaches, and dosimetry to be used for yttrium-90 (Y90)
microsphere hepatic brachytherapy. METHODS AND MATERIALS: Members
of the Radioembolization Brachytherapy Oncology Consortium met as
an independent group of experts in interventional radiology, radiation
oncology, nuclear medicine, medical oncology, and surgical oncology
to identify areas of consensus and controversy and to issue clinical
guidelines for Y90 microsphere brachytherapy. RESULTS: A total of
14 recommendations are made with category 2A consensus. Key findings
include the following. Sufficient evidence exists to support the
safety and effectiveness of Y90 microsphere therapy. A meticulous
angiographic technique is required to prevent complications. Resin
microsphere prescribed activity is best estimated by the body surface
area method. By virtue of their training, certification, and contribution
to Y90 microsphere treatment programs, the disciplines of radiation
oncology, nuclear medicine, and interventional radiology are all
qualified to use Y90 microspheres. The panel strongly advocates the
creation of a treatment registry with uniform reporting criteria.
Initiation of clinical trials is essential to further define the
safety and role of Y90 microspheres in the context of currently available
therapies. CONCLUSIONS: Yttrium-90 microsphere therapy is a complex
procedure that requires multidisciplinary management for safety and
success. Practitioners and cooperative groups are encouraged to use
these guidelines to formulate their treatment and dose-reporting
policies.
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