A comparative study between sterile water and glucose 5% as application agents in radioembolization with resin microspheres

Objectives The application of resin microspheres is normally carried out using sterile water; however, early stasis and reflux represent limiting events during therapy, preventing full application of the calculated dose. Sterile water causes damage to the endothelium with subsequent vasospasm and premature stasis. In some clinics worldwide, glucose 5% is currently used instead of sterile water. In this study, we compared these two agents with respect to the applied total activity, the number of cases which exhibited stasis and discomfort during application.

Methods In 2014, all radioembolization (RE) was performed with resin microspheres using glucose 5%. This was retrospectively compared with RE from 2013, where sterile water was still being used. For comparison, only medical records with full documentation of all events and parameters were included. The amount of residual activity was measured in all patients after therapy. The therapy preparation and dose calculation were identical for both groups.

Results A total of 108 RE were carried out in 81 patients with various cancers. Of these, 57 were with sterile water (group A; mean age: 61.5 y/o mean activity: 1.2 GBq) and 51 with glucose 5% (group B; mean age: 65 y/o average activity: 1.2 GBq; p: ns). Stasis occurred in groups A and B in 54.5% and 21.6% of the treatments, respectively (p = 0.001). Reflux occurred in groups A and B in 20.4% and 0%, respectively (p = 0.001).The mean activity of the total calculated dose administered in groups A and B was 77% and 96%, respectively (p < 0.0001). Complaints during therapy (mild to moderate abdominal pain and discomfort) occurred in 50% and 2% of patients in groups A and B (p < 0.0001).

Conclusions The occurrence of stasis and reflux during RE with resin microsphere is significantly lower when using glucose 5%. The amount of injected activity was significantly higher when using glucose 5% and patients had significantly less discomfort during application.