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Urinary Excretion of Yttrium-90 after Radioembolization with Yttrium-90-Labeled Resin-based Microspheres

Grosser, Oliver, S.*; Ruf, Juri; Pethe, Annette*; Kupitz, Dennis*; Wissel, Heiko*; Benckert, Christoph‡§; Pech, Maciej*; Ricke, Jens* **; Amthauer, Holger*††

doi: 10.1097/HP.0000000000000734
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In radioembolic therapy (RET) of hepatic malignancies using yttrium‐90 (90Y)-labeled resin microspheres, radiation protection is primarily concerned with avoiding contamination by radioactive spheres. However, as 90Y is bound to the microsphere surface by a potentially reversible ion-exchange process, the aim of this study was to assess the extent of the potential excreted activity in urine. After RET with 90Y-labeled resin-based microspheres, urinary excretion of free 90Y was prospectively analyzed in 51 interventions (n = 45 patients) by sampling urine over 48 h (two 24‐h intervals) consecutively. The measured urinary concentration of 90Y, normalized to the administered microsphere activity, was a median of 58.5 kBq L−1 GBq−1 (range = 3.5-590.9 kBq L−1 GBq−1) and 17.8 kBq L−1 GBq−1 (1.8-58.8 kBq L−1 GBq−1) for the first and second 24‐h periods after administration, respectively (p ≤ 0.0001, F = 28.4, result from ANOVA). The total excreted activity significantly decreased (p ≤ 0.0001) from a median of 72.5 kBq in the first 24‐h period to a median of 22.1 kBq in the second 24‐h period. Urinary excretion of free 90Y after resin-based RET occurs for a longer period and at a higher activity excretion than previously published, which has to be considered when patients are either hospitalized or return home after RET. Existing approaches for patient hospitalization, especially in temporary radiation protection areas, justified by the previously reported lower excretion rate, should be re-evaluated, and as a consequence, the current product safety information and handling recommendations for 90Y-labeled resin-based microspheres may need to be revised.

*Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany; †Department of Nuclear Medicine, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ‡Department of General, Visceral and Vascular Surgery, University Hospital Magdeburg, Magdeburg, Germany; §Department of General- and Vascular Surgery, Vivantes, Berlin, Germany; **Department of Clinical Radiology, Munich University Hospitals–Grosshadern, Ludwig Maximilians University, Munich, Germany; ††Department of Nuclear Medicine, Charité, Berlin, Germany.

Oliver S. Grosser, Maciej Pech, Jens Ricke, and Holger Amthauer have received research grants and honoraria by Sirtex Inc. The remaining authors declare no conflicts of interest.

For correspondence contact: Oliver Stephan Grosser, Klinik für Radiologie und Nuklearmedizin, University Hospital Magdeburg, Leipziger Strasse 44 39120, Magdeburg, Germany, or email at oliver.grosser@med.ovgu.de.

(Manuscript accepted 5 August 2017)

© 2018 by the Health Physics Society