title: Long-lived impurities of 90Y-labeled microspheres, TheraSphere and SIR-spheres, and the impact on patient dose and waste management.
abstract: Yittrium-90 microsphere brachytherapy procedures have increased in number due to their efficacy in treating some unresectable metastatic liver tumors. The discovery of long-lived impurities in two microsphere products, first reported between 2006 and 2007, has resulted in some radiation safety concerns. Since then, microsphere production processes have been refined, which reportedly lead to a reduction in detectable by-products. In this study unused vials of TheraSphere and SIR-Spheres, manufactured in early January 2011, were analyzed to identify and quantify the low-level radioactive impurities. Absorbed dose calculations were performed to assess the potential increased dose to the patient due to long-lived impurities. Results showed that while the SIR-Spheres vials contained no detectable impurities (contrary to other published results in the literature), the TheraSphere vials contained 17 radionuclides in one sample and 15 in the other. The dominant impurities were Y and Y, with specific activities ranging from 0.99 ± 3.40 × 10 kBq mg to 6.30 ± 0.40 kBq mg at vendor assay date. Other impurities were on the order of Bq mg. Based on Medical Internal Radiation Dose (MIRD) liver and lung dose estimates, the long-lived impurities would be expected to increase an administered dose by less than 0.1% from the prescribed dose.
authors.affiliation: Department of Environmental Health and Safety, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA. jpmetyko@mdanderson.org
authors.forename: John
authors.initials: J
authors.lastname: Metyko
authors.forename: John M
authors.initials: JM
authors.lastname: Williford
authors.forename: William
authors.initials: W
authors.lastname: Erwin
authors.forename: John
authors.initials: J
authors.lastname: Poston
authors.forename: Sandra
authors.initials: S
authors.lastname: Jimenez
mesh_terms: D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects; D004340:Drug Contamination; D005720:Gamma Rays; D006801:Humans; D007553:Isotope Labeling; D008099:Liver / Q000528:radiation effects; D008168:Lung / Q000528:radiation effects; D008297:Male; D008863:Microspheres; D011829:Radiation Dosage; D011850:Radioactive Waste; D012974:Sodium Iodide / Q000737:chemistry; D013057:Spectrum Analysis; D013793:Thallium / Q000737:chemistry; D013997:Time Factors; D018505:Waste Management; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000032:analysis / Q000627:therapeutic use
chemical_list: D011850:Radioactive Waste; D015021:Yttrium Radioisotopes; D013793:Thallium; D012974:Sodium Iodide