Caren van Roekel

37 Radioembolization with the microspheres, caused a temporary change in the osmolality of the blood, leading to vascular endothelial injury and vasospasm, causing stasis. Two studies have been published regarding the replacement of sterile water with glucose 5% water (G5W). Ahmadzadehfar et al. report about 78 patients treated with resin microspheres. Fifty procedures were performed with sterile water and 54 procedures were performed with G5W. A significantly higher proportion of the calculated activity was administered with G5W (96.1% versus 77.4%), there was a significantly lower incidence of stasis (28% versus 11%) and significantly less abdominal pain during the procedure (1.8% versus 44%) (70). The findings of Paprottka et al. confirm the positive effects of using G5W as a diluting solution, as they also showed a significantly reduced need for periprocedural analgesia (71). 90 Y glass microspheres are less prone to stasis because the number of microspheres is much lower. Administration of 90 Y glass microspheres is much faster, because they are injected in one bolus (69). To prevent high injection pressures, a small pressure relief valve is included in the administration set, limiting the injection pressure to 30 pound-force per square inch (PSI) (69). 166 Ho microspheres are administered in the same way as 90 Y resin microspheres: carefully with a low flow rate in a pulsatile manner, to avoid stasis and reflux (72). However, simultaneous injection with a diluted contrast agent is possible. 5.4. Possible side effects and adverse events In the literature, controversy exists on the term ‘toxicity’ after radioembolization. It is graded in multiple ways on diverse time points after treatment. To compare data on toxicity, it is essential this is graded according to the same definition. Most often, side effects after treatment are scored according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Adverse events (AEs) are defined as ‘any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medical treatment or procedure that may or may not be considered related to the medical treatment or procedure’. Five grades are used to classify the adverse events, referring to the severity of the AEs, with grade 1 being mild and grade 5 indicating death related to the AE (73). 2