Transarterial radioembolization: a systematic review on gaining control over the parameters that influence microsphere distribution

Abstract

[Purpose] Transarterial radioembolization (TARE) is an established treatment modality for patients with unresectable liver cancer. However, a better understanding of treatment parameters that influence microsphere distribution could further improve the therapy. This systematic review examines and summarizes the available evidence on intraprocedural parameters that influence the microsphere distribution during TARE as investigated by in vivo, ex vivo, in vitro and in silico studies. [Methods] A standardized search was performed in Medline, Embase and Web of Science to identify all published articles investigating microsphere distribution or dynamics during TARE. Studies presenting original research on parameters influencing the microsphere distribution during TARE were included. [Results] A total of 42 studies reporting a total of 11 different parameters were included for narrative analysis. The investigated studies suggest that flow distribution is not a perfect predictor of microsphere distribution. Increasing the injection velocity may help increase the similarity between flow and microsphere distributions. Furthermore, the microsphere distributions are very sensitive to the radial and axial catheter position. [Conclusion] The most promising parameters for future research which can be controlled in the clinic appear to be microsphere injection velocity as well as the axial catheter position. Up to now, many of the included studies do not take clinical feasibility into account, limiting the translation of results to clinical settings. Future research should therefore focus on the applicability of in vivo, in vitro, or in silico research to patient specific scenarios to improve the efficacy of radioembolization as treatment for liver cancer.

Keywords:

• Radioembolization
• TARE
• microspheres
• distribution
• computational fluid dynamics
• CFD

Disclosure statement

J.F.W. Nijsen is co-founder of Quirem Medical which has been acquired by Terumo Europe NV in July 2020. Nijsen has a scientific advisory role and is entitled to certain milestone payments from Terumo which are related to Quirem’s financial, operational and regulatory performance in the future. Furthermore, Nijsen is inventor on the patents related to radioactive microspheres that are assigned to University Medical Center Utrecht Holding BV, Quirem Medical or BASF Corp. The activities of J.F.W. Nijsen within Quirem Medical are approved and supported by the Board of Directors of the Radboudumc. The other authors declare that they have no conflict of interest.

Ethical approval statement

Ethics approval was not required for this systematic review.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by T.J. Snoeijink and T.G. Vlogman. The first draft of the manuscript was written T.J. Snoeijink and T.G. Vlogman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Additional information

Funding

This work was supported by the Netherlands Organization for Scientific Research (NWO) under Grant number 18427.