title: Five percent dextrose maximizes dose delivery of Yttrium-90 resin microspheres and reduces rates of premature stasis compared to sterile water.
abstract: Resin Yttrium-90 (Y90) microspheres have historically been infused using sterile water (H2O). In 2013, recommendations expanded to allow delivery with 5% dextrose in water (D5W). In this retrospective study, we hypothesized that D5W would improve Y90 delivery with a lower incidence of stasis. We reviewed 190 resin Y90 infusions using H2O (n=137) or D5W (n=53). Y90 dosimetry was calculated using the body surface area method. Infusion was halted if intra-arterial stasis was fluoroscopically identified prior to clearing the vial. Differences between H2O and D5W groups were calculated for activity prescription, percentage of cases reaching stasis, and percentage delivery of prescribed activity using z- and t-test comparisons, with α=0.05. Thirty-one of 137 H2O infusions developed stasis compared to 2 of 53 with D5W (z=3.07, p=1.05E-03). D5W also had a significantly higher prescribed activity than H2O [28.2 millicuries (mCi) vs. 20.4 mCi, respectively; t=5.0, p=1.1E-6]. D5W had a higher delivery percentage of the prescribed dose compared to H2O (101.5 vs. 92.7%, respectively; t=3.8, p=1.92E-4). In conclusion, resin microsphere infusion utilizing D5W has a significantly lower rate of stasis than H2O and results in more complete dose delivery. D5W is preferable to H2O for resin microsphere infusion.
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Koran
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Baker
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lipnik
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Fil
authors.initials: F
authors.lastname: Banovac
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.affiliation: Department of Radiology and Radiologic Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Brown
keywords: liver; locoregional therapy; metastatic disease; palliative therapy; radioembolization; yttrium-90