Comparing Laboratory Toxicity of Selective Intraarterial Radionuclide Therapy for Primary and Metastatic Liver Tumors: Resin versus Glass Microspheres

Comparing Laboratory Toxicity of Selective Intraarterial Radionuclide Therapy for Primary and Metastatic Liver Tumors: Resin versus Glass Microspheres | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparing Laboratory Toxicity of Selective Intraarterial Radionuclide Therapy for Primary and Metastatic Liver Tumors: Resin versus Glass Microspheres Başak Soydaş Turan, M. Fani Bozkurt, Gonca Eldem, Bora Peynircioglu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4421013/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jan, 2025 Read the published version in Annals of Nuclear Medicine → Version 1 posted 4 You are reading this latest preprint version Abstract Objective: To compare the acute (within 30 days of treatment) laboratory toxicities of Yttrium-90 (Y-90)resin and glass microspheres. Methods: Selective intra-arterial radionuclide therapies (SIRTs) with Y-90 resin and glass microspheres were retrospectively reviewed. Liver-hematological data were collected at baseline and at one week and one month follow-up. The percentage change of laboratory data and the albumin-bilirubin (ALBI) score were calculated. Results: A total of 219 SIRTs (n: 110 resin, n: 109 glass) from 177 patients were included. There was no difference in age, liver pathologies, extrahepatic disease, baseline liver function tests, and total blood counts between the two microsphere groups. Administered activity was higher in treatments with Y-90 glass microspheres (p<0.001). An increase in serum liver enzymes was observed after treatment with both microspheres. The difference between the treatment groups was the higher percentage increase of AST and ALT at the first week following Y-90 glass treatment (p<0.001). But, this situation was not observed after one month. No difference in the percentage change of other laboratory parameters was found between two groups. The number of patients with an increase (resin n: 24 (24.7%) vs glass n: 26 (27.1%), p: 0.711) and decrease (resin n: 13 (13.4%) vs glass n: 8 (8.3%), p: 0.258) in the ALBI grade after SIRT were similar among groups. Conclusions: An increase in liver enzymes was observed in the early period after SIRT with both microspheres. No significant difference in liver and hematological data was detected during early follow-up between the two groups, except that the percentage increase of AST and ALT were higher at the first week in the Y-90 glass group. Yttrium-90 glass resin microspheres toxicity Introduction Selective intra-arterial radionuclide therapy (SIRT) using beta emitter Yttrium-90 (Y-90) loaded microspheres is a safe and efficient treatment option for patients with unresectable primary and metastatic liver tumors [ 1 ]. The delivery of Y-90 microspheres via the arterial circulation of the liver depends on the fact that hepatic tumors are fed mainly by branches of hepatic artery (90%), while normal parenchyma derives the majority of its blood supply (70–80%) from the portal venous system [ 2 ]. Therefore, intra-arterial delivery of therapeutic radiation-loaded microspheres gives rise to high tumor-to-background ratio in the liver while minimizing side effects on normal liver tissue. Because of this, SIRT is able to provide high intra-tumoral radiation-absorbed doses, up to approximately 150 Gray (Gy) in a single treatment session, compared to traditional external beam radiation therapy in which 30–35 Gy is often the threshold for the development of undesired effects and the risk for injury to adjacent organs [ 3 ]. Intra-arterial radionuclide therapies are primarily used for non-resectable hepatocellular carcinoma (HCC). It can be utilized as downstaging the patients to become eligible for liver resection or transplantation or as a definitive treatment [ 4 , 5 ]. It may also be used for intrahepatic cholangiocarcinoma [ 6 ], as well as for intrahepatic metastatic disease [ 7 , 8 ], which is the most common form of liver malignancy. The two commercially available forms of Y-90 microspheres are resin (SIRSphere, Sirtex Medical Australia and Europe, Bonn, Germany) and glass (TheraSphere, MDS Nordion, Toronto, Canada). Although both forms have almost similar biological effects, their physical properties are different from each other. For example, the mean particle number is approximately 1.2 million for glass microspheres while 40–80 million for resin microspheres for the same therapy dose. Therefore, the average radioactivity loaded per particle is higher for glass, but its embolic effect is lower than resin. Also, the dose calculation of treatment differs according to the type of microsphere used because of the difference in biodistribution. Glass microspheres are assumed to have a homogenous distribution, whereas resin microspheres distribute heterogeneously. Therefore, the activity for glass microspheres is calculated by using the volume of the liver lobe/segment to be treated, while body surface area or partition model-based dose calculation methods are recommended to calculate the treatment activity for resin [ 1 ]. Although minimally invasive, SIRT is not without adverse effects. Laboratory toxicity in terms of elevated liver enzymes can be expected. Patients should be monitored after the therapy with liver function tests, because this may be an early indicator of radiation-induced liver disease. There is extensive data in the literature regarding the efficacy of intra-arterial radionuclide therapies. However, there is little data directly comparing the two available forms in terms of liver and hematological toxicity. Thus, the objective of this study was to compare the acute (within 30 days of treatment) laboratory toxicities of glass and resin microspheres. Materials and Methods Patients and Data Collection This study was approved by the local institutional ethical board of Hacettepe University Faculty of Medicine (Approval Number: 2020/10–25). Patients with primary and metastatic liver tumors treated with SIRT using either Y-90 labelled resin or glass microspheres at Hacettepe University between April 2008 and December 2018 were retrospectively reviewed. Data were extracted from the database and separated based on treatment modality (resin vs. glass), including demographics, patients’ diagnoses, and the presence of extrahepatic metastases. Selective Intraarterial Radionuclide Therapy Technique All patients underwent a clinical and laboratory evaluation. Planning angiography 1–3 weeks before SIRT was performed to evaluate tumoral arterial anatomy, detect anatomic variants, determine optimal placement of the microcatheter, and embolize any vessels that could allow leakage of microspheres into the gastrointestinal tract. Technetium-99m macroaggregated albumin (99mTc-MAA) was delivered through the hepatic artery. Hepatic artery perfusion scintigraphy (whole body planar views and abdominal SPECT/CT) was performed within 1 hour to evaluate radioactivity distribution in the tumoral and healthy liver tissue, detect extrahepatic leakage, and calculate the hepatopulmonary shunt ratio. Once the procedure was deemed safe, patients were referred to SIRT with either resin or glass microspheres. Treatment doses of Y-90 resin were calculated according to manufacturer guidelines using the body surface area method [ 9 ]. The doses of Y-90 glass were calculated by using the target liver lobe or segment volume and hepatopulmonary shunt ratio in the program recommended by the manufacturer based on this formula: Activity (GBq) = Desired dose (Gy) × mass of selected liver target lobe (kg)/50 [ 10 ]. For both microsphere types, dose reduction was made according to the hepatopulmonary shunt ratio. All 99mTc-MAA and SIRT procedures were performed by experienced nuclear medicine physicians and interventional radiologists. The administered SIRT activity, number, and route of treatments were obtained from patients’ records. Biochemical and Hematological Follow-up Liver function tests [aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, total bilirubin] and total blood counts were obtained at baseline, at one week and one month follow-up. Serum levels of laboratory data were compared before and after treatment for each group. Changes in percentage of serum level were calculated as one week/one month serum level minus baseline serum level, divided by baseline level. Also, albumin-bilirubin (ALBI) score was calculated as (log 10 bilirubin [µmol/L] × 0.66) + (albumin [g/L] × −0.0852) and graded as follows: ALBI score ≤ − 2.60 (grade 1), > −2.60 to ≤ − 1.39 (grade 2), and > − 1.39 (grade 3) [ 11 ]. Patients without baseline and/or follow-up laboratory investigations were excluded. Statistical Analysis Statistical analyses were performed using SPSS software version 23.0 (IBM, NY, USA), and p-value < 0.05 was used for statistical significance. Data were presented as mean ± standard deviation (SD) or median (min-max) for continuous variables and as frequencies (percentages) for categorical variables. All continuous variables were tested for normal distribution using the Kolmogorov-Smirnov test. Normally distributed continuous variables from two independent groups were compared using the independent sample T-test. Nonnormally distributed continuous data were compared using the Mann-Whitney U test. If the variables were categorical, the Pearson Chi-square test was performed. Comparisons of laboratory data before and after treatment were made using a paired sample T-test for normal distribution or Wilcoxon test for nonnormally distribution. Results Patients’ Demographics and SIRT Characteristics Five hundred forty treatments were applied to 428 patients between 2008 and 2018, but a total of 219 treatments of 177 patients with complete laboratory follow-ups were included in this study. Sixty-six (37%) of the patients were female, and the mean age was 58 ± 11 years. The majority of patients had colon cancer (n: 64, 36.2%). As primary pathology, 40 (22.6%) patients had HCC, and 16 (9%) patients had cholangiocellular carcinoma. Patient characteristics of the two microsphere groups were summarized in Table 1 . There was no difference in age, liver pathologies, extrahepatic disease, baseline liver function tests, and total blood counts between the two microsphere groups. Table 1 Comparison of patients’ characteristics according to treatment modality. Resin Glass p N (%) N (%) Female 35 (31.81) 50 (45.87) 0.033 Diagnosis 0.843 Hepatocellular cancer 24 (21.81) 23 (21.10) Cholangiocellular cancer 10 (9.09) 9 (8.25) Colon cancer 42 (38.18) 35 (31.11) Breast cancer 12 (10.90) 12 (11.00) Neuroendocrine tumor 9 (8.18) 12 (11.00) Gastric cancer 3 (2.72) 2 (1.83) Others 10 (9.09) 16 (14.67) Extrahepatic disease 35 (31.81) 42 (38.53) 0.298 N Mean ± SD Median (min-max) N Mean ± SD Median (min-max) Age (years) 110 58.59 ± 11.63 59 (20–91) 109 58.61 ± 11.46 59 (28–78) 0.993 Baseline AST (U/L) 108 46.41 ± 30.94 36.50 (12–240) 105 44.84 ± 25.20 40 (18–133) 0.917 Baseline ALT (U/L) 108 33.67 ± 23.18 26 (7-126) 106 32.99 ± 19.59 30 (8-116) 0.584 Baseline GGT (U/L) 95 171.55 ± 169.41 109 (19–946) 94 174.56 ± 150.83 125.50 (14–876) 0.497 Baseline ALP (U/L) 92 175.45 ± 120.01 133 (40–659) 92 194.73 ± 135.87 153 (38–893) 0.221 Baseline albumin (g/dL) 100 3.89 ± 0.44 3.86 (2.70–5.28) 99 3.81 ± 0.50 3.71 (2.73–4.90) 0.174 Baseline total bilirubin (mg/dL) 104 0.74 ± 0.39 0.64 (0.10–2.43) 104 0.81 ± 0.47 0.69 (0.18–2.96) 0.444 Baseline hemoglobin (g/dL) 102 12.35 ± 1.73 12.50 (8.20–16.30) 99 11.94 ± 1.90 12.20 (7.50–16.80) 0.111 Baseline leukocyte (x10 3 /µL) 100 7.09 ± 2.70 7 (2.80–15) 98 7.03 ± 2.97 6.40 (2.20–18.30) 0.608 Baseline platelet (x10 3 /µL) 99 212.78 ± 117.08 199 (53–678) 98 202.86 ± 91.99 196.50 (30–431) 0.903 Hundred and ten treatments were done with Y-90 resin (50.2%), and 109 treatments were done with Y-90 glass (49.8%) microspheres. SIRT was applied to 36 (16.4%) patients twice, 5 (2.3%) patients three times, and 1 patient four times. The majority of treatments were given to the right lobe (n: 144, 65%). The routes of treatment were found to be similar (p: 0.951). Administered activity was higher in treatments with Y-90 glass microspheres when compared to Y-90 resin (p < 0.001) [Table 2 ]. Table 2 Comparison of SIRT characteristics. Resin (n: 110) Glass (n: 109) p Route of treatments N (%) N (%) 0.951 Left lobe 25 (22.72) 26 (23.85) Right lobe 72 (65.45) 72 (66.05) Bi-lobar 6 (5.45) 6 (5.50) Right lobe + Segment IV 7 (6.36) 5 (4.58) Administered activity (GBq) Mean ± SD Median (min-max) Mean ± SD Median (min-max) Left lobe 0.74 ± 0.37 0.55 (0.30–1.76) 1.40 ± 0.69 1.39 (0.41–3.15) < 0.001* Right lobe 1.13 ± 0.23 1.11 (0.59-2.00) 3.00 ± 0.95 2.75 (1.41–5.90) < 0.001* Bi-lobar 1.62 ± 0.31 1.56 (1.30-2.00) 3.39 ± 0.29 3.33 (3.08–3.90) < 0.001* Right lobe + Segment IV 1.12 ± 0.091 1.11 (1.00-1.25) 3.45 ± 0.76 3.44 (2.58–4.54) < 0.001* Laboratory Toxicities The mean serum AST and ALT levels were not statistically different in the Y-90 resin group after treatment compared to baseline (Table 3 ). But a significant rise in serum AST and ALT levels was observed after Y-90 glass treatment (Table 4 ). In patients treated with Y-90 glass microspheres, the percentage increase of AST and ALT was found to be higher when compared to the Y-90 resin group at one-week follow-up. One month after treatment, there was no significant difference between the two groups (Table 5 ). Table 3 Comparison of follow-up liver function tests and total blood counts with baseline in Y-90 resin group. Baseline 7th day 30th day N Mean ± SD Mean ± SD p Mean ± SD p AST (U/L) 108 46.41 ± 30.94 43.14 ± 28.21 0.299 45.86 ± 22.73 0.206 ALT (U/L) 108 33.67 ± 23.18 35.39 ± 28.11 0.841 33.12 ± 22.89 0.927 GGT (U/L) 95 171.55 ± 169.41 191.92 ± 168.08 < 0.001* 187.41 ± 153.64 0.003* ALP (U/L) 92 175.45 ± 120.01 197.95 ± 133.15 < 0.001* 203.11 ± 129.14 < 0.001* Albumin (g/dL) 100 3.89 ± 0.44 3.82 ± 0.40 0.090 3.85 ± 0.48 0.251 Total bilirubin (mg/dL) 104 0.74 ± 0.39 0.88 ± 0.70 0.025* 0.89 ± 0.81 0.025* Hemoglobin (g/dL) 102 12.35 ± 1.73 12.43 ± 1.75 0.450 12.60 ± 1.76 0.038 Leukocyte (x10 3 /µL) 100 7.09 ± 2.70 6.62 ± 2.62 0.037* 6.46 ± 2.87 0.017* Platelet (x10 3 /µL) 99 212.78 ± 117.08 231.64 ± 132.85 0.023 199.46 ± 126.74 0.116 Table 4 Comparison of follow-up liver function tests and total blood counts with baseline in Y-90 glass group. Baseline 7th day 30th day N Mean ± SD Mean ± SD p Mean ± SD p AST (U/L) 105 44.84 ± 25.20 55.22 ± 34.10 < 0.001* 50.14 ± 25.36 0.010* ALT (U/L) 106 32.99 ± 19.59 44.90 ± 37.39 < 0.001* 37.40 ± 37.39 0.108 GGT (U/L) 94 174.56 ± 150.83 224.59 ± 180.96 < 0.001* 225.73 ± 179.57 < 0.001* ALP (U/L) 92 194.73 ± 135.87 235.82 ± 203.81 < 0.001* 241.84 ± 150.19 < 0.001* Albumin (g/dL) 99 3.81 ± 0.50 3.76 ± 0.56 0.275 3.70 ± 0.60 0.079 Total bilirubin (mg/dL) 104 0.81 ± 0.47 1.14 ± 1.15 < 0.001* 1.29 ± 1.98 0.005* Hemoglobin (g/dL) 99 11.94 ± 1.90 12.12 ± 2.05 0.019 12.10 ± 2.13 0.128 Leukocyte (x10 3 /µL) 98 7.03 ± 2.97 6.91 ± 3.01 0.910 6.54 ± 5.80 0.035* Platelet (x10 3 /µL) 98 202.86 ± 91.99 212.19 ± 95.19 0.110 200.48 ± 99.66 0.737 Table 5 Comparison of percentage change in serum levels of liver function tests and total blood counts between two microspheres group. 7th day 30th day Resin Glass Resin Glass Median (min-max) Median (min-max) p Median (min-max) Median (min-max) p AST -1.08 (-90.16–510.34) 17.07 (-75–844.44) < 0.001* 10.24 (-80.67–234.09) 12.12 (-79.17–291.30) 0.648 ALT 0 (-72.29–583.33) 22.96 (-57.53–1450) 0.001* 0 (-86.67–408.33) 3.78 (-81.82–525) 0.217 GGT 21.05 (-54.22–483.78) 27.68 (-34.71–364.41) 0.078 27.69 (-91.56–510.81) 32.18 (-83.93–1113.56) 0.432 ALP 13.82 (-48.01–220.25) 18.13 (-89.81–1668.32) 0.183 17.28 (-76.63–298.73) 22.27 (-87.88–681.19) 0.332 Albumin 0 (-38.38–25.93) -1.13 (-37.78–26.62) 0.872 -0.13 (-34.78–23.08) -2.80 (-54.63–27.03) 0.322 Total bilirubin 3.16 (-83.33–397.10) 17.13 (-45.21–900) 0.128 9.12 (-75 − 1500) 14.15 (-57.14–1259.43) 0.303 Hemoglobin 0 (-22.12–43.18) 1.96 (-28.99–29.33) 0.207 1.71 (-26.92–42.05) 2.06 (-27.74–41.41) 0.705 Leukocyte -5.31 (-58.24–165.17) -1.74 (-62.14–114.12) 0.232 -6.82 (-72–184.62) -8.81 (-58.24–166.67) 0.887 Platelet 6.55 (-56.39–206.38) 6.55 (-79.20–106.86) 0.958 -6.43 (-72.46–163.12) -0.23 (-71.16–129.41) 0.338 Although there was a significant rise in serum GGT and ALP levels after both treatments (Table 3 – 4 , p < 0.001), no difference was detected between the groups (Table 5 ). There was no significant decrease in serum albumin level after SIRT compared to baseline. But, an increase in serum total bilirubin levels was observed both at one week and one month follow-up after both types of treatment (Table 3 – 4 ). No statistical difference in percentage change of albumin and total bilirubin was found between the two groups (Table 5 ). There was no significant decrease in hemoglobin and platelet levels after both treatments, and no difference between the two microsphere groups was observed. A decrease in leukocyte count was detected after treatment, which did not differ between groups. There was no difference in ALBI grade between microsphere groups at baseline or after SIRT (Table 6 ). During the follow-up, the number of patients with an increase (resin n: 24 (24.7%) vs. glass n: 26 (27.1%), p: 0.711), and a decrease (resin n: 13 (13.4%) vs. glass n: 8 (8.3%), p: 0.258) in ALBI grade were similar. Table 6 Comparison of ALBI grades of Y-90 resin and glass group at baseline and during follow-up. Baseline 7th day 30th day Resin (n: 97) Glass (n: 96) p Resin (n: 97) Glass (n: 96) p Resin (n: 97) Glass (n: 96) p Grade 1 14 12 0.405 10 8 0.085 12 10 0.282 Grade 2 80 77 80 71 73 66 Grade 3 3 7 7 17 12 20 Discussion To the best of our knowledge, there is little data in the literature directly comparing the laboratory toxicity of two microspheres, as we have done in this study [ 12 – 14 ]. It may be due to the small number of institutions that have access to both microspheres. Our institution has the opportunity to obtain both modalities, which allow a direct comparison to be done. We found that there was a significant increase in serum GGT, ALP, and total bilirubin levels at one week and one month follow-up in both groups. In addition to that, in the Y-90 glass group a significant rise in serum AST and ALT levels was observed. Between the two groups, no significant difference in liver and hematological data was detected during follow-up, except that the percentage increase of AST and ALT were higher at the first week in the Y-90 glass group. In a retrospective study of 28 patients with colorectal liver metastases, Srinivas et al. [ 14 ] identified similar liver toxicities for both microsphere types within 90 days after treatment. Additionally, Braat et al. [ 13 ] found comparable biochemical and hematological toxicities for both microspheres in 85 patients with primary and metastatic liver disease. However, in these studies, toxicity comparisons were made three months after treatment. This study compared the early changes in biochemical and hematological parameters. Higher activity doses given in the Y-90 glass treatment group may be the reason for the higher percentage increase of AST and ALT in patients treated with Y-90 glass microspheres. Since one of the other expected laboratory toxicities was thrombocytopenia, a total blood count evaluation was also performed. Thrombocytopenia can be seen mostly three months after the therapy. As Y-90 microsphere therapy is locally administered only to the liver tissue and it has high in vivo stability, thrombocytopenia is not expected to originate from the direct radiation effect on bone marrow, but it is postulated to occur because of the insufficient production of some blood proteins that are needed for thrombocytes by the liver due to malfunction and transient failure secondary to the therapy [ 1 ]. Another hypothesis is that splenomegaly, which is a result of portal hypertension, is an independent risk factor for low platelet count [ 15 ]. In the current study, no significant decrease was observed in platelet count within early period after SIRT. In recent years, the ALBI score, which was based on serum bilirubin and albumin levels, acted as a novel model for liver function assessment [ 11 ]. This score was initially applied to evaluate the severity of liver dysfunction in liver cancer patients and demonstrated its usefulness for predicting the prognosis of HCC patients [ 16 , 17 ]. Recent studies suggest that the ALBI score seems to be more accurate in evaluating liver function and prognosis than the Child-Pugh grading system [ 18 , 19 ]. Accordingly, some scholars advocate that the ALBI score can replace the Child-Pugh system as a tool for evaluating liver function. Moreover, recent studies have also indicated that the ALBI score has a prognostic value for non-small cell lung cancer, pancreatic cancer, intrahepatic cholangiocarcinoma, advanced gastric cancer, colorectal cancer, and breast cancer [ 20 – 25 ]. To our knowledge, there is currently no research in the literature to compare the change in ALBI grade between two microspheres. In this study, we did not observe any differences in ALBI grade after SIRT between groups. The most important limitation of this study was its retrospective design. Secondly, there was no data about the distribution of tumor burden among the microsphere groups and the actual radiation dose to tumor and healthy liver tissue. Thirdly, we did not evaluate the tumor response to therapy. So, rises in liver function tests could be the result of tumor progression instead of treatment-related toxicity. Even so, this study has larger patient population than prior ones for specifically comparing liver and hematological toxicities of both microspheres in primary and metastatic liver disease in early post-treatment period. Conclusion In this study, a significant increase in liver enzymes was observed after SIRT with both microspheres. 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Cite Share Download PDF Status: Published Journal Publication published 17 Jan, 2025 Read the published version in Annals of Nuclear Medicine → Version 1 posted Reviewers agreed at journal 10 Jun, 2024 Reviewers invited by journal 17 May, 2024 Editor assigned by journal 14 May, 2024 First submitted to journal 14 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4421013","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":303507037,"identity":"55ff3c28-1a9f-4c85-b4e3-48ae856659c2","order_by":0,"name":"Başak Soydaş Turan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYBACAyBmbACxDjAwPgYLMTM3EK2F2RjMZ2YkXgubNDIfJzBnP/7w44w/Nol9x48/qy6o+BPN3w7U8qNiG04tlj05xpIb29ISZ57JMbs944xB7ozDjA2MPWdu43bYgRwGyYcNhxM3HMhhu83bZpDbANTCzNiGR8v5549/PvgD1HL++bNikJb5BLXcSDCT3MAG1AJkMIO0bCCkxXLGGzPLmW1pxjNvvDGW5jljnLsRqOUgPr+Y86c/vtnzx0a273z6w888FXK5884fPvjgRwVuLTDg2IDMO0BQPRDYE6NoFIyCUTAKRigAAAeBY+oAZeP3AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-3425-751X","institution":"Kastamonu Education and Research Hospital, Nuclear Medicine Department","correspondingAuthor":true,"prefix":"","firstName":"Başak","middleName":"Soydaş","lastName":"Turan","suffix":""},{"id":303507038,"identity":"20b123ea-8d31-41c7-b316-e7397875778b","order_by":1,"name":"M. Fani Bozkurt","email":"","orcid":"","institution":"Hacettepe University Faculty of Medicine, Nuclear Medicine Department","correspondingAuthor":false,"prefix":"","firstName":"M.","middleName":"Fani","lastName":"Bozkurt","suffix":""},{"id":303507039,"identity":"a05fd205-316b-472c-ad00-2804f1f140e9","order_by":2,"name":"Gonca Eldem","email":"","orcid":"","institution":"Hacettepe University Faculty of Medicine, Department of Interventional Radiology","correspondingAuthor":false,"prefix":"","firstName":"Gonca","middleName":"","lastName":"Eldem","suffix":""},{"id":303507040,"identity":"596961c8-9255-4b04-ae1e-5b8d35186096","order_by":3,"name":"Bora Peynircioglu","email":"","orcid":"","institution":"Hacettepe University Faculty of Medicine, Department of Interventional Radiology","correspondingAuthor":false,"prefix":"","firstName":"Bora","middleName":"","lastName":"Peynircioglu","suffix":""},{"id":303507041,"identity":"e86a5833-abf2-4491-a690-6a59a5244976","order_by":4,"name":"Omer Ugur","email":"","orcid":"","institution":"Hacettepe University Faculty of Medicine, Nuclear Medicine Department","correspondingAuthor":false,"prefix":"","firstName":"Omer","middleName":"","lastName":"Ugur","suffix":""},{"id":303507042,"identity":"b9f15ad1-a81f-46ad-b611-d667a50f27dc","order_by":5,"name":"Bilge Volkan-Salanci","email":"","orcid":"","institution":"Hacettepe University Faculty of Medicine, Nuclear Medicine Department","correspondingAuthor":false,"prefix":"","firstName":"Bilge","middleName":"","lastName":"Volkan-Salanci","suffix":""}],"badges":[],"createdAt":"2024-05-14 18:37:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4421013/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4421013/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12149-024-02011-6","type":"published","date":"2025-01-17T15:57:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":74285696,"identity":"3c798c02-10e1-424a-a24d-d26b930e0a0b","added_by":"auto","created_at":"2025-01-20 16:14:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1180176,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4421013/v1/fa750442-56e4-48d3-aa7e-b1a8ab29a8fa.pdf"}],"financialInterests":"","formattedTitle":"Comparing Laboratory Toxicity of Selective Intraarterial Radionuclide Therapy for Primary and Metastatic Liver Tumors: Resin versus Glass Microspheres","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSelective intra-arterial radionuclide therapy (SIRT) using beta emitter Yttrium-90 (Y-90) loaded microspheres is a safe and efficient treatment option for patients with unresectable primary and metastatic liver tumors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The delivery of Y-90 microspheres via the arterial circulation of the liver depends on the fact that hepatic tumors are fed mainly by branches of hepatic artery (90%), while normal parenchyma derives the majority of its blood supply (70\u0026ndash;80%) from the portal venous system [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Therefore, intra-arterial delivery of therapeutic radiation-loaded microspheres gives rise to high tumor-to-background ratio in the liver while minimizing side effects on normal liver tissue. Because of this, SIRT is able to provide high intra-tumoral radiation-absorbed doses, up to approximately 150 Gray (Gy) in a single treatment session, compared to traditional external beam radiation therapy in which 30\u0026ndash;35 Gy is often the threshold for the development of undesired effects and the risk for injury to adjacent organs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIntra-arterial radionuclide therapies are primarily used for non-resectable hepatocellular carcinoma (HCC). It can be utilized as downstaging the patients to become eligible for liver resection or transplantation or as a definitive treatment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It may also be used for intrahepatic cholangiocarcinoma [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], as well as for intrahepatic metastatic disease [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which is the most common form of liver malignancy.\u003c/p\u003e \u003cp\u003eThe two commercially available forms of Y-90 microspheres are resin (SIRSphere, Sirtex Medical Australia and Europe, Bonn, Germany) and glass (TheraSphere, MDS Nordion, Toronto, Canada). Although both forms have almost similar biological effects, their physical properties are different from each other. For example, the mean particle number is approximately 1.2\u0026nbsp;million for glass microspheres while 40\u0026ndash;80\u0026nbsp;million for resin microspheres for the same therapy dose. Therefore, the average radioactivity loaded per particle is higher for glass, but its embolic effect is lower than resin. Also, the dose calculation of treatment differs according to the type of microsphere used because of the difference in biodistribution. Glass microspheres are assumed to have a homogenous distribution, whereas resin microspheres distribute heterogeneously. Therefore, the activity for glass microspheres is calculated by using the volume of the liver lobe/segment to be treated, while body surface area or partition model-based dose calculation methods are recommended to calculate the treatment activity for resin [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough minimally invasive, SIRT is not without adverse effects. Laboratory toxicity in terms of elevated liver enzymes can be expected. Patients should be monitored after the therapy with liver function tests, because this may be an early indicator of radiation-induced liver disease. There is extensive data in the literature regarding the efficacy of intra-arterial radionuclide therapies. However, there is little data directly comparing the two available forms in terms of liver and hematological toxicity. Thus, the objective of this study was to compare the acute (within 30 days of treatment) laboratory toxicities of glass and resin microspheres.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients and Data Collection\u003c/h2\u003e \u003cp\u003e This study was approved by the local institutional ethical board of Hacettepe University Faculty of Medicine (Approval Number: 2020/10\u0026ndash;25). Patients with primary and metastatic liver tumors treated with SIRT using either Y-90 labelled resin or glass microspheres at Hacettepe University between April 2008 and December 2018 were retrospectively reviewed. Data were extracted from the database and separated based on treatment modality (resin vs. glass), including demographics, patients\u0026rsquo; diagnoses, and the presence of extrahepatic metastases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSelective Intraarterial Radionuclide Therapy Technique\u003c/h2\u003e \u003cp\u003eAll patients underwent a clinical and laboratory evaluation. Planning angiography 1\u0026ndash;3 weeks before SIRT was performed to evaluate tumoral arterial anatomy, detect anatomic variants, determine optimal placement of the microcatheter, and embolize any vessels that could allow leakage of microspheres into the gastrointestinal tract. Technetium-99m macroaggregated albumin (99mTc-MAA) was delivered through the hepatic artery. Hepatic artery perfusion scintigraphy (whole body planar views and abdominal SPECT/CT) was performed within 1 hour to evaluate radioactivity distribution in the tumoral and healthy liver tissue, detect extrahepatic leakage, and calculate the hepatopulmonary shunt ratio. Once the procedure was deemed safe, patients were referred to SIRT with either resin or glass microspheres.\u003c/p\u003e \u003cp\u003eTreatment doses of Y-90 resin were calculated according to manufacturer guidelines using the body surface area method [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The doses of Y-90 glass were calculated by using the target liver lobe or segment volume and hepatopulmonary shunt ratio in the program recommended by the manufacturer based on this formula: Activity (GBq)\u0026thinsp;=\u0026thinsp;Desired dose (Gy) \u0026times; mass of selected liver target lobe (kg)/50 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor both microsphere types, dose reduction was made according to the hepatopulmonary shunt ratio. All 99mTc-MAA and SIRT procedures were performed by experienced nuclear medicine physicians and interventional radiologists. The administered SIRT activity, number, and route of treatments were obtained from patients\u0026rsquo; records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eBiochemical and Hematological Follow-up\u003c/h2\u003e \u003cp\u003eLiver function tests [aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, total bilirubin] and total blood counts were obtained at baseline, at one week and one month follow-up. Serum levels of laboratory data were compared before and after treatment for each group. Changes in percentage of serum level were calculated as one week/one month serum level minus baseline serum level, divided by baseline level. Also, albumin-bilirubin (ALBI) score was calculated as (log\u003csub\u003e10\u003c/sub\u003e bilirubin [\u0026micro;mol/L] \u0026times; 0.66) + (albumin [g/L] \u0026times; \u0026minus;0.0852) and graded as follows: ALBI score\u0026thinsp;\u0026le;\u0026thinsp;\u0026minus;\u0026thinsp;2.60 (grade 1), \u0026gt; \u0026minus;2.60 to \u0026le;\u0026thinsp;\u0026minus;\u0026thinsp;1.39 (grade 2), and \u0026gt;\u0026thinsp;\u0026minus;\u0026thinsp;1.39 (grade 3) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Patients without baseline and/or follow-up laboratory investigations were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS software version 23.0 (IBM, NY, USA), and p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used for statistical significance. Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median (min-max) for continuous variables and as frequencies (percentages) for categorical variables. All continuous variables were tested for normal distribution using the Kolmogorov-Smirnov test.\u003c/p\u003e \u003cp\u003eNormally distributed continuous variables from two independent groups were compared using the independent sample T-test. Nonnormally distributed continuous data were compared using the Mann-Whitney U test. If the variables were categorical, the Pearson Chi-square test was performed. Comparisons of laboratory data before and after treatment were made using a paired sample T-test for normal distribution or Wilcoxon test for nonnormally distribution.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; Demographics and SIRT Characteristics\u003c/h2\u003e \u003cp\u003eFive hundred forty treatments were applied to 428 patients between 2008 and 2018, but a total of 219 treatments of 177 patients with complete laboratory follow-ups were included in this study.\u003c/p\u003e \u003cp\u003eSixty-six (37%) of the patients were female, and the mean age was 58\u0026thinsp;\u0026plusmn;\u0026thinsp;11 years. The majority of patients had colon cancer (n: 64, 36.2%). As primary pathology, 40 (22.6%) patients had HCC, and 16 (9%) patients had cholangiocellular carcinoma.\u003c/p\u003e \u003cp\u003ePatient characteristics of the two microsphere groups were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no difference in age, liver pathologies, extrahepatic disease, baseline liver function tests, and total blood counts between the two microsphere groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of patients\u0026rsquo; characteristics according to treatment modality.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eResin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eGlass\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e35 (31.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e50 (45.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatocellular cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e24 (21.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e23 (21.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholangiocellular cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e10 (9.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e9 (8.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColon cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e42 (38.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e35 (31.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e12 (10.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e12 (11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuroendocrine tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e9 (8.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e12 (11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastric cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3 (2.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e2 (1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e10 (9.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e16 (14.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExtrahepatic disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e35 (31.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e42 (38.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMedian (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eMedian (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.59\u0026thinsp;\u0026plusmn;\u0026thinsp;11.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (20\u0026ndash;91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.61\u0026thinsp;\u0026plusmn;\u0026thinsp;11.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e59 (28\u0026ndash;78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline AST\u003c/b\u003e (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.41\u0026thinsp;\u0026plusmn;\u0026thinsp;30.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.50 (12\u0026ndash;240)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44.84\u0026thinsp;\u0026plusmn;\u0026thinsp;25.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40 (18\u0026ndash;133)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.917\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline ALT\u003c/b\u003e (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.67\u0026thinsp;\u0026plusmn;\u0026thinsp;23.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (7-126)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.99\u0026thinsp;\u0026plusmn;\u0026thinsp;19.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30 (8-116)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline GGT\u003c/b\u003e (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171.55\u0026thinsp;\u0026plusmn;\u0026thinsp;169.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e109 (19\u0026ndash;946)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e174.56\u0026thinsp;\u0026plusmn;\u0026thinsp;150.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e125.50 (14\u0026ndash;876)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline ALP\u003c/b\u003e (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175.45\u0026thinsp;\u0026plusmn;\u0026thinsp;120.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e133 (40\u0026ndash;659)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e194.73\u0026thinsp;\u0026plusmn;\u0026thinsp;135.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e153 (38\u0026ndash;893)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline albumin\u003c/b\u003e (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.86 (2.70\u0026ndash;5.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.71 (2.73\u0026ndash;4.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline total bilirubin\u003c/b\u003e (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.64 (0.10\u0026ndash;2.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.69 (0.18\u0026ndash;2.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline hemoglobin\u003c/b\u003e (g/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.50 (8.20\u0026ndash;16.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.20 (7.50\u0026ndash;16.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline leukocyte\u003c/b\u003e (x10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (2.80\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.40 (2.20\u0026ndash;18.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBaseline platelet\u003c/b\u003e (x10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e212.78\u0026thinsp;\u0026plusmn;\u0026thinsp;117.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e199 (53\u0026ndash;678)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e202.86\u0026thinsp;\u0026plusmn;\u0026thinsp;91.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e196.50 (30\u0026ndash;431)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHundred and ten treatments were done with Y-90 resin (50.2%), and 109 treatments were done with Y-90 glass (49.8%) microspheres. SIRT was applied to 36 (16.4%) patients twice, 5 (2.3%) patients three times, and 1 patient four times. The majority of treatments were given to the right lobe (n: 144, 65%). The routes of treatment were found to be similar (p: 0.951). Administered activity was higher in treatments with Y-90 glass microspheres when compared to Y-90 resin (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of SIRT characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eResin (n: 110)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eGlass (n: 109)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRoute of treatments\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e25 (22.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26 (23.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e72 (65.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e72 (66.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBi-lobar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6 (5.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6 (5.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight lobe\u0026thinsp;+\u0026thinsp;Segment IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7 (6.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5 (4.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdministered activity\u003c/b\u003e (GBq)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMedian (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMedian (min-max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55 (0.30\u0026ndash;1.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.39 (0.41\u0026ndash;3.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight lobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11 (0.59-2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.75 (1.41\u0026ndash;5.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBi-lobar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.56 (1.30-2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.33 (3.08\u0026ndash;3.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight lobe\u0026thinsp;+\u0026thinsp;Segment IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11 (1.00-1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.44 (2.58\u0026ndash;4.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLaboratory Toxicities\u003c/h2\u003e \u003cp\u003eThe mean serum AST and ALT levels were not statistically different in the Y-90 resin group after treatment compared to baseline (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). But a significant rise in serum AST and ALT levels was observed after Y-90 glass treatment (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In patients treated with Y-90 glass microspheres, the percentage increase of AST and ALT was found to be higher when compared to the Y-90 resin group at one-week follow-up. One month after treatment, there was no significant difference between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of follow-up liver function tests and total blood counts with baseline in Y-90 resin group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7th day\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e30th day\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAST (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46.41\u0026thinsp;\u0026plusmn;\u0026thinsp;30.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e43.14\u0026thinsp;\u0026plusmn;\u0026thinsp;28.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e45.86\u0026thinsp;\u0026plusmn;\u0026thinsp;22.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALT (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e33.67\u0026thinsp;\u0026plusmn;\u0026thinsp;23.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e35.39\u0026thinsp;\u0026plusmn;\u0026thinsp;28.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e33.12\u0026thinsp;\u0026plusmn;\u0026thinsp;22.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.927\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGGT (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e171.55\u0026thinsp;\u0026plusmn;\u0026thinsp;169.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e191.92\u0026thinsp;\u0026plusmn;\u0026thinsp;168.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e187.41\u0026thinsp;\u0026plusmn;\u0026thinsp;153.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALP (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e175.45\u0026thinsp;\u0026plusmn;\u0026thinsp;120.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e197.95\u0026thinsp;\u0026plusmn;\u0026thinsp;133.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e203.11\u0026thinsp;\u0026plusmn;\u0026thinsp;129.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlbumin (g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal bilirubin (mg/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.025*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.025*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemoglobin (g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e12.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeukocyte (x10\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.037*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e6.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.017*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatelet (x10\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e212.78\u0026thinsp;\u0026plusmn;\u0026thinsp;117.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e231.64\u0026thinsp;\u0026plusmn;\u0026thinsp;132.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e199.46\u0026thinsp;\u0026plusmn;\u0026thinsp;126.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of follow-up liver function tests and total blood counts with baseline in Y-90 glass group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7th day\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e30th day\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAST (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e44.84\u0026thinsp;\u0026plusmn;\u0026thinsp;25.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e55.22\u0026thinsp;\u0026plusmn;\u0026thinsp;34.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e50.14\u0026thinsp;\u0026plusmn;\u0026thinsp;25.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALT (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.99\u0026thinsp;\u0026plusmn;\u0026thinsp;19.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e44.90\u0026thinsp;\u0026plusmn;\u0026thinsp;37.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e37.40\u0026thinsp;\u0026plusmn;\u0026thinsp;37.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGGT (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e174.56\u0026thinsp;\u0026plusmn;\u0026thinsp;150.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e224.59\u0026thinsp;\u0026plusmn;\u0026thinsp;180.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e225.73\u0026thinsp;\u0026plusmn;\u0026thinsp;179.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALP (U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e194.73\u0026thinsp;\u0026plusmn;\u0026thinsp;135.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e235.82\u0026thinsp;\u0026plusmn;\u0026thinsp;203.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e241.84\u0026thinsp;\u0026plusmn;\u0026thinsp;150.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlbumin (g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e3.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal bilirubin (mg/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemoglobin (g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e12.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeukocyte (x10\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e6.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.035*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatelet (x10\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e/\u0026micro;L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e202.86\u0026thinsp;\u0026plusmn;\u0026thinsp;91.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e212.19\u0026thinsp;\u0026plusmn;\u0026thinsp;95.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e200.48\u0026thinsp;\u0026plusmn;\u0026thinsp;99.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.737\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of percentage change in serum levels of liver function tests and total blood counts between two microspheres group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e7th day\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e30th day\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlass\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGlass\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (min-max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (min-max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian (min-max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMedian (min-max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAST\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-1.08 (-90.16\u0026ndash;510.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e17.07 (-75\u0026ndash;844.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e10.24 (-80.67\u0026ndash;234.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e12.12 (-79.17\u0026ndash;291.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0 (-72.29\u0026ndash;583.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e22.96 (-57.53\u0026ndash;1450)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e0 (-86.67\u0026ndash;408.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e3.78 (-81.82\u0026ndash;525)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGGT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e21.05 (-54.22\u0026ndash;483.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e27.68 (-34.71\u0026ndash;364.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e27.69 (-91.56\u0026ndash;510.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e32.18 (-83.93\u0026ndash;1113.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e13.82 (-48.01\u0026ndash;220.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e18.13 (-89.81\u0026ndash;1668.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e17.28 (-76.63\u0026ndash;298.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e22.27 (-87.88\u0026ndash;681.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlbumin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0 (-38.38\u0026ndash;25.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-1.13 (-37.78\u0026ndash;26.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-0.13 (-34.78\u0026ndash;23.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e-2.80 (-54.63\u0026ndash;27.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal bilirubin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e3.16 (-83.33\u0026ndash;397.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e17.13 (-45.21\u0026ndash;900)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e9.12 (-75 \u0026minus;\u0026thinsp;1500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e14.15 (-57.14\u0026ndash;1259.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemoglobin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e0 (-22.12\u0026ndash;43.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e1.96 (-28.99\u0026ndash;29.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e1.71 (-26.92\u0026ndash;42.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e2.06 (-27.74\u0026ndash;41.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeukocyte\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-5.31 (-58.24\u0026ndash;165.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-1.74 (-62.14\u0026ndash;114.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-6.82 (-72\u0026ndash;184.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e-8.81 (-58.24\u0026ndash;166.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.887\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatelet\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e6.55 (-56.39\u0026ndash;206.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e6.55 (-79.20\u0026ndash;106.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c5\"\u003e \u003cp\u003e-6.43 (-72.46\u0026ndash;163.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e-0.23 (-71.16\u0026ndash;129.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAlthough there was a significant rise in serum GGT and ALP levels after both treatments (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), no difference was detected between the groups (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was no significant decrease in serum albumin level after SIRT compared to baseline. But, an increase in serum total bilirubin levels was observed both at one week and one month follow-up after both types of treatment (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). No statistical difference in percentage change of albumin and total bilirubin was found between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was no significant decrease in hemoglobin and platelet levels after both treatments, and no difference between the two microsphere groups was observed. A decrease in leukocyte count was detected after treatment, which did not differ between groups.\u003c/p\u003e \u003cp\u003eThere was no difference in ALBI grade between microsphere groups at baseline or after SIRT (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). During the follow-up, the number of patients with an increase (resin n: 24 (24.7%) vs. glass n: 26 (27.1%), p: 0.711), and a decrease (resin n: 13 (13.4%) vs. glass n: 8 (8.3%), p: 0.258) in ALBI grade were similar.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of ALBI grades of Y-90 resin and glass group at baseline and during follow-up.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e7th day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e30th day\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResin (n: 97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlass (n: 96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResin (n: 97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGlass (n: 96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResin (n: 97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGlass (n: 96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, there is little data in the literature directly comparing the laboratory toxicity of two microspheres, as we have done in this study [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It may be due to the small number of institutions that have access to both microspheres. Our institution has the opportunity to obtain both modalities, which allow a direct comparison to be done.\u003c/p\u003e \u003cp\u003eWe found that there was a significant increase in serum GGT, ALP, and total bilirubin levels at one week and one month follow-up in both groups. In addition to that, in the Y-90 glass group a significant rise in serum AST and ALT levels was observed. Between the two groups, no significant difference in liver and hematological data was detected during follow-up, except that the percentage increase of AST and ALT were higher at the first week in the Y-90 glass group.\u003c/p\u003e \u003cp\u003eIn a retrospective study of 28 patients with colorectal liver metastases, Srinivas et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] identified similar liver toxicities for both microsphere types within 90 days after treatment. Additionally, Braat et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] found comparable biochemical and hematological toxicities for both microspheres in 85 patients with primary and metastatic liver disease. However, in these studies, toxicity comparisons were made three months after treatment. This study compared the early changes in biochemical and hematological parameters. Higher activity doses given in the Y-90 glass treatment group may be the reason for the higher percentage increase of AST and ALT in patients treated with Y-90 glass microspheres.\u003c/p\u003e \u003cp\u003eSince one of the other expected laboratory toxicities was thrombocytopenia, a total blood count evaluation was also performed. Thrombocytopenia can be seen mostly three months after the therapy. As Y-90 microsphere therapy is locally administered only to the liver tissue and it has high in vivo stability, thrombocytopenia is not expected to originate from the direct radiation effect on bone marrow, but it is postulated to occur because of the insufficient production of some blood proteins that are needed for thrombocytes by the liver due to malfunction and transient failure secondary to the therapy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Another hypothesis is that splenomegaly, which is a result of portal hypertension, is an independent risk factor for low platelet count [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the current study, no significant decrease was observed in platelet count within early period after SIRT.\u003c/p\u003e \u003cp\u003eIn recent years, the ALBI score, which was based on serum bilirubin and albumin levels, acted as a novel model for liver function assessment [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This score was initially applied to evaluate the severity of liver dysfunction in liver cancer patients and demonstrated its usefulness for predicting the prognosis of HCC patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Recent studies suggest that the ALBI score seems to be more accurate in evaluating liver function and prognosis than the Child-Pugh grading system [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Accordingly, some scholars advocate that the ALBI score can replace the Child-Pugh system as a tool for evaluating liver function. Moreover, recent studies have also indicated that the ALBI score has a prognostic value for non-small cell lung cancer, pancreatic cancer, intrahepatic cholangiocarcinoma, advanced gastric cancer, colorectal cancer, and breast cancer [\u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. To our knowledge, there is currently no research in the literature to compare the change in ALBI grade between two microspheres. In this study, we did not observe any differences in ALBI grade after SIRT between groups.\u003c/p\u003e \u003cp\u003eThe most important limitation of this study was its retrospective design. Secondly, there was no data about the distribution of tumor burden among the microsphere groups and the actual radiation dose to tumor and healthy liver tissue. Thirdly, we did not evaluate the tumor response to therapy. So, rises in liver function tests could be the result of tumor progression instead of treatment-related toxicity. Even so, this study has larger patient population than prior ones for specifically comparing liver and hematological toxicities of both microspheres in primary and metastatic liver disease in early post-treatment period.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, a significant increase in liver enzymes was observed after SIRT with both microspheres. The difference between the treatment groups was the higher percentage increase of AST and ALT at the first week following Y-90 glass treatment. No significant difference in percentage change of other laboratory parameters was detected between the two microsphere groups. After SIRT, the change in ALBI grade was found to be similar among groups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eThe type of article:\u003c/strong\u003e Original article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of funding:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBozkurt MF, Salanci BV, Uğur \u0026Ouml;. Intra-arterial radionuclide therapies for liver tumors. Semin Nucl Med. 2016;46:324\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBreedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol. 1954;30:969.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurnett NP, Akinwande O, Scoggins CR, McMasters KM, Philips P, Martin RC. Comparison of Yttrium-90 therapy for unresectable liver metastasis: glass versus biocompatible resin microspheres. J Radiat Oncol. 2017;6:101\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKulik LM, Atassi B, Van Holsbeeck L, Souman T, Lewandowski RJ, Mulcahy MF, et al. Yttrium-90 microspheres (TheraSphere\u0026reg;) treatment of unresectable hepatocellular carcinoma: downstaging to resection, RFA and bridge to transplantation. J S Oncol. 2006;94:572\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLau W, Ho SK, Simon C, Lai EC, Liew C, Leung TW. Salvage surgery following downstaging of unresectable hepatocellular carcinoma. Ann Surg. 2004;240:299.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Adra D, Gill R, Axford S, Shi X, Kneteman N, Liau S-S. Treatment of unresectable intrahepatic cholangiocarcinoma with yttrium-90 radioembolization: a systematic review and pooled analysis. 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J Surg Oncol. 2018;117:912\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakada K, Takamori S, Shimokawa M, Toyokawa G, Shimamatsu S, Hirai F, et al. Assessment of the albumin-bilirubin grade as a prognostic factor in patients with non-small-cell lung cancer receiving anti-PD-1-based therapy. ESMO open. 2022;7:100348.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImamura T, Okamura Y, Sugiura T, Ito T, Yamamoto Y, Ashida R et al. Clinical significance of preoperative Albumin\u0026ndash;Bilirubin grade in pancreatic cancer. Ann Surg Oncol 2021:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaneko S, Kurosaki M, Tsuchiya K, Yasui Y, Inada K, Kirino S, et al. Prognosis of intrahepatic cholangiocarcinoma stratified by albumin\u0026ndash;bilirubin grade. Hepatol Res. 2021;51:902\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu C, Wang X, Chen S, Yang X, Sun J, Pan B et al. Efficacy of the Preoperative Albumin\u0026ndash;Bilirubin Grade for Predicting Survival and Outcomes of Postoperative Chemotherapy for Advanced Gastric Cancer. Cancer Manag Res 2020:11921\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim D, Lee J-H, Cho E-S, Shin S-J, Lee HS, Koh H-H, et al. Clinical Significance of Combining Preoperative and Postoperative Albumin-Bilirubin Score in Colorectal Cancer. Cancer Res Treat. 2023;55:1261\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen L, Tan C, Li Q, Ma Z, Wu M, Tan X, et al. Assessment of the albumin-bilirubin score in breast cancer patients with liver metastasis after surgery. Heliyon. 2023;9:e21772.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"annals-of-nuclear-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"anme","sideBox":"Learn more about [Annals of Nuclear Medicine](http://link.springer.com/journal/12149)","snPcode":"12149","submissionUrl":"https://www.editorialmanager.com/anme/default2.aspx","title":"Annals of Nuclear Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Yttrium-90, glass, resin, microspheres, toxicity","lastPublishedDoi":"10.21203/rs.3.rs-4421013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4421013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo compare the acute (within 30 days of treatment) laboratory toxicities of Yttrium-90 (Y-90)resin and glass microspheres.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eSelective intra-arterial radionuclide therapies (SIRTs) with Y-90 resin and glass microspheres were retrospectively reviewed. Liver-hematological data were collected at baseline and at one week and one month follow-up. The percentage change of laboratory data and the albumin-bilirubin (ALBI) score were calculated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 219 SIRTs (n: 110 resin, n: 109 glass) from 177 patients were included. There was no difference in age, liver pathologies, extrahepatic disease, baseline liver function tests, and total blood counts between the two microsphere groups. Administered activity was higher in treatments with Y-90 glass microspheres (p\u0026lt;0.001). An increase in serum liver enzymes was observed after treatment with both microspheres. The difference between the treatment groups was the higher percentage increase of AST and ALT at the first week following Y-90 glass treatment (p\u0026lt;0.001). But, this situation was not observed after one month. No difference in the percentage change of other laboratory parameters was found between two groups. The number of patients with an increase (resin n: 24 (24.7%) vs glass n: 26 (27.1%), p: 0.711) and decrease (resin n: 13 (13.4%) vs glass n: 8 (8.3%), p: 0.258) in the ALBI grade after SIRT were similar among groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eAn increase in liver enzymes was observed in the early period after SIRT with both microspheres. No significant difference in liver and hematological data was detected during early follow-up between the two groups, except that the percentage increase of AST and ALT were higher at the first week in the Y-90 glass group.\u003c/p\u003e","manuscriptTitle":"Comparing Laboratory Toxicity of Selective Intraarterial Radionuclide Therapy for Primary and Metastatic Liver Tumors: Resin versus Glass Microspheres","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-29 11:45:15","doi":"10.21203/rs.3.rs-4421013/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-06-10T09:55:39+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-17T05:25:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-15T00:06:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Annals of Nuclear Medicine","date":"2024-05-14T14:37:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"annals-of-nuclear-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"anme","sideBox":"Learn more about [Annals of Nuclear Medicine](http://link.springer.com/journal/12149)","snPcode":"12149","submissionUrl":"https://www.editorialmanager.com/anme/default2.aspx","title":"Annals of Nuclear Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"01e018bc-47ce-4203-a3dd-95960a741f48","owner":[],"postedDate":"May 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T16:10:10+00:00","versionOfRecord":{"articleIdentity":"rs-4421013","link":"https://doi.org/10.1007/s12149-024-02011-6","journal":{"identity":"annals-of-nuclear-medicine","isVorOnly":false,"title":"Annals of Nuclear Medicine"},"publishedOn":"2025-01-17 15:57:42","publishedOnDateReadable":"January 17th, 2025"},"versionCreatedAt":"2024-05-29 11:45:15","video":"","vorDoi":"10.1007/s12149-024-02011-6","vorDoiUrl":"https://doi.org/10.1007/s12149-024-02011-6","workflowStages":[]},"version":"v1","identity":"rs-4421013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4421013","identity":"rs-4421013","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}