Downloaded from http://journals.lww.com/nuclearmedicinecomm by BhDMf5ePHKbH4TTImqenVMvFrBEFsYEgy156UCx/q8GOzH93YpZO0aeUzFoNeP1XBTM4Kl18ttc= on 07/20/2020 Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 0143-3636 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MNM.0000000000001225 Original article Freeze-dried microspheres for selective intra-arterial radionuclide therapy: an affordable solution Jaya Shukla a , Naveen Kalra b , Bhagwant Rai Mittal a , Ajay Duseja c , Rajender Kumar a , Harmandeep Singh a , Sreedhara Bettadahally Chaluvashetty b , Madan Parmar a , Swathy Krishnan a , Ganesh Kumar a , Rakhee Vatsa a , Anupriya Chhabra a , Kavita Bansal a , Yogesh Rathore a and Somit Pandey a Objective Selective intra-arterial radionuclide therapy (SIRT) using radiolabelled microspheres is for the delivery of therapeutic radioisotope to liver cancers and thus, sparing healthy liver. Several radiolabelled microspheres are commercially available. The main issue associated with these microspheres is affordability. Re-188 is a generator produced radionuclide, emits high energy therapeutic beta particle and imageable gamma photons for pre- and post-therapy dosimetry. Methods Tc-99m/Re-188 labelled microspheres have been developed and quality control tests have been performed for suitable clinical use. The clinical studies with Re-188 microspheres for SIRT have been performed. Post-therapy images were acquired for dosimetry. Results The microspheres were found to possess spherical morphology of less than 20 μm size. The quality control revealed the suitability of microspheres for intravenous administration. The preliminary studies in thirty patients demonstrated good retention in tumor and high tumor to normal liver ratio. Re-188 microspheres were well tolerated by patients. Same microspheres labelled with either Tc-99m or Re-188 were used for pretherapy dosimetry and Re-188 labeled microspheres for therapy (SIRT) as a single-day procedure. Conclusion The freeze-dried microspheres may emerge as highly cost-effective candidates for both pre-therapy dosimetry and SIRT and may benefit a large population with inoperable liver cancer. Nucl Med Commun 41: 817–823 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. Nuclear Medicine Communications 2020, 41:817–823 Keywords: hepatocellular carcinoma, liver cancer, locoregional treatment, selective intraarterial radionuclide therapy Departments of a Nuclear Medicine and PET, b Radiodiagnosis and Imaging and c Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India Correspondence to Jaya Shukla, PhD, Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research Chandigarh 160012, India Tel: +91 172 2756722; fax: +91 172 2742858; e-mail: shuklajaya@gmail.com Received 2 February 2020 Accepted 30 April 2020 Introduction Liver cancer is ffth for men and seventh for women cause of death worldwide [1,2]. Hepatocellular carcinoma (HCC), a tumor of hepatocytes, is the primary liver cancer comprising 75–85% liver cancer cases with predominance in Asia and Africa. The major causes of HCC include chronic infection with hepatitis B virus, hepatitis C virus, alcoholic liver disease, obesity, type 2 diabetes mellitus, nonalcoholic fatty liver disease, afatoxin-contaminated food, smoking, and genetics. Liver is also a common metastatic site of several primary tumors like neuroen- docrine tumors, bladder cancer, and colorectal cancers [3]. Surgical modalities including hepatic resection and liver transplantation are curative options in patients with HCC but are limited to only a select group of patients. Several nonsurgical curative treatment options like radio-frequency ablation, microwave ablation, high intensity focused ultrasound ablation, and cryotherapy are available for patients in the early stage of the disease. Most of the patients in intermediate stage who are not ft for surgical or non-surgical curative modalities are treated with palliative modalities like transarterial chemoembo- lization, or radioembolization and selective intra-arterial radionuclide therapy (SIRT) [4–6]. Trans- or intra-arterial therapies exploit the unique dual blood supply to liver. Normal hepatocytes receive major blood supply from portal vein (~80%) and rest by hepatic artery. However, hepatic artery is a major feeding vessel for liver cancer. The liver is radiosensitive organ, but, most of the healthy liver is spared if the therapy to liver cancers is given via hepatic artery. Therefore, delivery of therapeutic radioisotope via hepatic artery is a suita- ble option to treat liver cancer. Several isotope carriers like lipiodol, resin, glass beads, and spheres have shown suitability for treatment of liver cancer. However, it is important to note that if the portal vein is thrombosed,