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.