JVIR ’ Late-Breaking Abstracts and Poster Winners ’ 1081

SD¼0.06). Changes in perfusion index (PI) values were evident 24 h post

TACE (PI pre¼62.25, PI post¼4, p¼0.04), and persisted at 7 and 14 days

(p¼0.0002 and p¼0.0001, respectively), but were normalized at 20 days

(p¼0.35, compared to baseline, and p¼0.62 compared to controls). On

pathology, tumor necrosis was significantly increased at 7 days compared

to 24 h (p¼0.0001) but significantly decreased from 7 days to 14 days

(po0.0001). Lipiodol retention was evident in vessels, as well as viable

and necrotic tumor cells on TEM for all time points, with droplet size

ranging from 3-17m at 24 hours after TACE to 0.5-5m at 14 days

following TACE. There was a statistically significant correlation between

tumor PI and lipiodol tumor uptake at 24 h after TACE. There was no

statistically significant correlation between tumor necrosis and Lipiodol

tumor uptake at 24 h, 7 and 14 days after TACE.

Conclusions: Lipiodol tumor uptake ratio can serve as an imaging

biomarker of tumor targeting after TACE. Lipiodol accumulates in

viable and necrotic tumor cells and early decrease in tumor CT perfusion

index correlates with increased lipiodol tumor retention.

Scientific Session 23

Embolization II

Wednesday, April 17, 20133:30 PM – 5:00 PM

Room: 288

4:50 PM Abstract No. LB10

Chemo-radiation for hepatic malignancies:

maximum tolerated dose in a dose-escalating

study of Y90 with capecitabine for metastatic

disease to the liver

R.M. Hickey1, M.F. Mulcahy2, R.J. Lewandowski1,

E. Gonda2, R. Salem1; 1Dept of Radiology, Division of

Vascular/Interventional Radiology, Northwestern

University, Chicago, IL, United States; 2Dept of

Hematology/Oncology, Northwestern University,

Chicago, IL, United States.

Purpose: Radiosensitizing chemotherapy improves outcomes

compared to radiation alone for several types of gastrointestinal

cancers. Delivery of internal radiation to primary and metastatic

hepatic malignancies, in combination with radiosensitizing

chemotherapy, is an opportunity to enhance radiation effects on

hepatic malignancies. Capecitabine is an oral fluoropyrimidine that

preferentially delivers 5-FU to tumor cells via thymidine

phosphorylase. Since thymidine phosphorylase is up-regulated by

radiotherapy, internal tumor radiation may increase preferential

delivery of 5-FU to these tumors.

Materials: Patients with intrahepatic cholangiocarcinoma or metastatic

cancer confined to the liver and limited prior treatment are treated

with sequential cycles of capecitabine and receive an assigned dose of

Y90 according to dose-escalation protocol, which includes 110, 130,

150 and 170Gy cohorts. Dose limiting toxicity is determined up to 6

weeks from Y90 infusion. The primary endpoint is to determine the

maximum tolerated dose of Y90 with capecitabine. Secondary

endpoints include evaluation of overall and hepatic response.

Results: From April 2009 to January 2013, fifteen patients have been

treated according to the study protocol. Two of the planned three

patients have been treated in the final cohort at 170Gy. Neither of

these patients has experienced a dose-limiting toxicity, indicating that

the maximum tolerated dose exceeds 170Gy. Four patients

experienced hepatic toxicities, three of which are common toxicity

criteria (CTC) grade 3.

Conclusions: The maximum tolerated dose of Y90 microspheres

delivered in conjunction with oral capecitabine in the setting of

intrahepatic cholangiocarcinoma or metastatic disease confined to

the liver has been shown to exceed 170Gy. This is the highest hepatic

dose reported to date and has important implications on combined

therapy with intra-arterial Y90 and the radiosensitizing oral

chemotherapeutic capecitabine.

Poster Winners

Best Original Scientific Research Poster

Medical student interventional radiology

symposium: the Emory experience

P. Mulligan, E. McIntosh, M. Mccullough, H.S. Kim; Inter-

ventional Radiology and Image Guided Medicine, Emory

University School of Medicine, Atlanta, GA, United States.

Poster

Winners

Best Educational Exhibit Poster

Endovascular treatment for varices and variceal hemor-

rhage associated with portal hypertension: A

pictorial review

S.M. Ibrahim, J. Pollak, J.E. Aruny, S. Amirbekian, M.H.

Arici, H.R. Mojibian, R. Ayyagari, E. Reiner; Diagnostic

Radiology, Section of Vascular and Interventional Radi-

ology, Yale University School of Medicine, New Haven,

CT, United States.

Poster Awards

Tissue Distribution of Clonidine Following Intraforaminal

Implantation of Biodegradable Pellets: Potential Alter-

native to Epidural Steroid for Radiculopathy

D. Beall1, T.R. Deer2, J. Wilsey3, A. Walsh3, J.H. Block3,

W. McKay3, J.M. Zanella3, B.P. Parsons1, C.C. Carson1;1Interventional Spine, Clinical Radiology of Oklahoma,

Oklahoma City, OK, United States; 2Timothy R. Deer, The

Center for Pain Relief, Charleston, WV, WV, United States;3Medtronic, Spinal and Biologics Division, Memphis, TN,

United States.