0).12 The composite clinical laboratory parameter of liver decompensation (LD) was added and defined as the occurrence of any of the following features during follow-up: clinically detectable ascites, bleeding from esophageal varices, hepatic encephalopathy, total bilirubin >3 mg/dL, and prothrombin time international normalized ratio >2.2. Any LD occurring within 180 days of radioembolization was considered treatment-related. www.selleckchem.com/products/MDV3100.html Incidentally, the chosen definition of treatment-related

LD included all previously described toxicities related to Y90RE13–15 (Supporting Information). Assessment of tumor response after Y90RE was made on anonymized scans reviewed by two radiologists on staff; whenever response classification was not obvious, agreement was reached with a third radiologist. Tumor response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria,16 World Health Organization (WHO) criteria17 and EASL criteria,9 hence assessing dimensions, cross-products of lesions, and reduction in viable tumor volume. For each criterion, the objective response was defined as partial response + complete response, whereas the disease control rate (DCR) was defined as stable disease to partial response + complete response. According to EASL, progression was defined as the appearance of new lesions (intra- or extrahepatic)

or increase of enhancing tissue in the target lesions of at least 25%; partial response was defined as a decrease of at least 50% in the enhancement of the target lesions. The variations of PVT extension during follow-up were not considered selleckchem in tumor response evaluation, with the sole exception of complete disappearance

in case of complete response. Endonuclease AFP serum level was recorded but was not considered a parameter of response. Y90RE was performed according to standard practice7, 18 in two sessions (Fig. 1): (1) a simulation session, through celiac-mesenteric angioscintigraphy with 160 MBq technetium-99m macroaggregated albumin (99mTc-MAA) scanning, and (2) a treatment session 3 to 4 weeks later using 90Y-microspheres (TheraSphere; Nordion, Ottawa, Canada). Depending on tumor characteristics, a maximum of two treatments per patient were allowed (Supporting Information). The treatment planning goal was a lobar delivery of 120 Gy, as described.14, 19 After injection, planar and single photon emission computed tomography (SPECT) scintigrams were acquired with the 90Y Bremsstrahlung technique to check therapeutic biodistribution. Furthermore, a retrospective dose-response correlation analysis on tumor versus nontumor tissue was performed on CT-based, attenuation-corrected 99mTc-MAA SPECT images. Accordingly, the absorbed dose was calculated in each 4.42 side volumetric pixel (voxel) of the liver evaluating the absorbed dose as proportional to the 99mTc-MAA SPECT count fractions in each voxel. SPECT raw data were imported to a Siemens e.