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Kokabi N, Webster LA, Dabbous H, Shah A, Brandon D, Galt J, Xing M, Villalobos A, Davarpanahfakhr A, Kappadath SC, Schuster DM. Resin-Based 90Y Tumor Dose as a Predictor of Duration of Response and Survival in Patients With Surgically Unresectable Hepatocellular Carcinoma: A Prospective Single-Arm Study. Clin Nucl Med 2024:00003072-990000000-01124. [PMID: 38861361 DOI: 10.1097/rlu.0000000000005198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND Personalized dosimetry improves overall survival (OS) in patients with hepatocellular carcinoma (HCC) treated with glass 90Y radioembolization. This study evaluated personalized tumor dose (TD) as a predictor of OS, progression-free survival (PFS), and local duration of response (DOR) in patients with surgically unresectable HCC treated with resin 90Y radioembolization. PATIENTS AND METHODS This prospective, single-center, single-arm clinical trial (NCT04172714) evaluated the efficacy of scout activity of resin 90Y versus 99mTc-MAA for treatment planning. A secondary aim of this study was to evaluate personalized dosimetry as a predictor of OS, PFS, and DOR. Partition dosimetry model was utilized for nonsegmental therapies with targeted TD >200 Gy and nontumoral liver dose <70 Gy. Single compartment dose of 200 Gy was used for segmentectomies. OS, PFS, and local DOR from 90Y was estimated using Kaplan-Meier estimation with log-rank analysis used to determine predictors of prolonged survival. FINDINGS Thirty patients with treatment-naive HCC and 33 tumors (19 segmental and 14 nonsegmental) were included. Overall, 18 patients underwent segmental Y90-RE and 12 underwent non-segmental/lobar therapies. The mean 90Y TD was 493 Gy. The median follow-up since enrollment into the study was 37 months. The mean OS was 32.2 months for the entire cohort. A total of 5 patients underwent orthotopic liver transplantation post 90Y and were excluded from further survival analysis. The mean OS for the remainder of the cohort was 30.1 months (median not reached). The mean TD >250 Gy resulted in prolonged mean OS and PFS. The median local DOR was 32.7 months with mean TD 330 Gy predicting prolonged DOR. INTERPRETATION For patients with surgically unresectable HCC treated with resin 90Y, there is mean TD threshold predicting prolonged OS, PFS, and local DOR. Therefore, there should be further emphasis on personalized dosimetry for optimization of patient outcomes.
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Affiliation(s)
| | - Linzi A Webster
- Division of Interventional Radiology, Department of Radiology, Mount Sinai School of Medicine, New York, NY
| | - Howard Dabbous
- From the Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Anand Shah
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - James Galt
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Minzhi Xing
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Alexander Villalobos
- Division of Interventional Radiology, Department of Radiology, University of North Carolina, Chapel Hill, NC
| | | | - S Cheenu Kappadath
- Division of Nuclear Medicine, Department of Radiology, MD Anderson Cancer Center, University of Texas at Houston, Houston, TX
| | - David M Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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Chen K, Shuen TWH, Chow PKH. The association between tumour heterogeneity and immune evasion mechanisms in hepatocellular carcinoma and its clinical implications. Br J Cancer 2024:10.1038/s41416-024-02684-w. [PMID: 38760445 DOI: 10.1038/s41416-024-02684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/19/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide. The emergence of combination therapy, atezolizumab (anti-PDL1, immune checkpoint inhibitor) and bevacizumab (anti-VEGF) has revolutionised the management of HCC. Despite this breakthrough, the best overall response rate with first-line systemic therapy is only about 30%, owing to intra-tumoural heterogeneity, complex tumour microenvironment and the lack of predictive biomarkers. Many groups have attempted to classify HCC based on the immune microenvironment and have consistently observed better outcomes in immunologically "hot" HCC. We summarised possible mechanisms of tumour immune evasion based on the latest literature and the rationale for combination/sequential therapy to improve treatment response. Lastly, we proposed future strategies and therapies to overcome HCC immune evasion to further improve treatment outcomes of HCC.
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Affiliation(s)
- Kaina Chen
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Timothy W H Shuen
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Pierce K H Chow
- Duke-NUS Medical School, Singapore, Singapore.
- Department of Hepato-pancreato-biliary and Transplant Surgery, National Cancer Centre Singapore and Singapore General Hospital, Singapore, Singapore.
- Program in Translational and Clinical Liver Cancer Research, National Cancer Centre Singapore, Singapore, Singapore.
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Sarwar A, Malik MS, Vo NH, Tsai LL, Tahir MM, Curry MP, Catana AM, Bullock AJ, Parker JA, Eckhoff DE, Nasser IA, Weinstein JL, Ahmed M. Efficacy and Safety of Radiation Segmentectomy with 90Y Resin Microspheres for Hepatocellular Carcinoma. Radiology 2024; 311:e231386. [PMID: 38713023 DOI: 10.1148/radiol.231386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Limited data are available on radiation segmentectomy (RS) for treatment of hepatocellular carcinoma (HCC) using yttrium 90 (90Y) resin microsphere doses determined by using a single-compartment medical internal radiation dosimetry (MIRD) model. Purpose To evaluate the efficacy and safety of RS treatment of HCC with 90Y resin microspheres using a single-compartment MIRD model and correlate posttreatment dose with outcomes. Materials and Methods This retrospective single-center study included adult patients with HCC who underwent RS with 90Y resin microspheres between July 2014 and December 2022. Posttreatment PET/CT and dosimetry were performed. Adverse events were assessed using the Common Terminology Criteria for Adverse Events, version 5.0. Per-lesion and overall response rates (ie, complete response [CR], objective response, disease control, and duration of response) were assessed at imaging using the Modified Response Evaluation Criteria in Solid Tumors, and overall survival (OS) was assessed using Kaplan-Meier analysis. Results Among 67 patients (median age, 69 years [IQR, 63-78 years]; 54 male patients) with HCC, median tumor absorbed dose was 232 Gy (IQR, 163-405 Gy). At 3 months, per-lesion and overall (per-patient) CR was achieved in 47 (70%) and 41 (61%) of 67 patients, respectively. At 6 months (n = 46), per-lesion rates of objective response and disease control were both 94%, and per-patient rates were both 78%. A total of 88% (95% CI: 79 99) and 72% (95% CI: 58, 90) of patients had a per-lesion and overall duration of response of 1 year or greater. At 1 month, a grade 3 clinical adverse event (abdominal pain) occurred in one of 67 (1.5%) patients. Median posttreatment OS was 26 months (95% CI: 20, not reached). Disease progression at 2 years was lower in the group that received 300 Gy or more than in the group that received less than 300 Gy (17% vs 61%; P = .047), with no local progression in the former group through the end of follow-up. Conclusion Among patients with HCC who underwent RS with 90Y resin microspheres, 88% and 72% achieved a per-lesion and overall duration of response of 1 year or greater, respectively, with one grade 3 adverse event. In patients whose tumors received 300 Gy or more according to posttreatment dosimetry, a disease progression benefit was noted. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Ammar Sarwar
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - M Saad Malik
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Nhi H Vo
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Leo L Tsai
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Muhammad M Tahir
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Michael P Curry
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Andreea M Catana
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Andrea J Bullock
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - John A Parker
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Devin E Eckhoff
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Imad A Nasser
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Jeffrey L Weinstein
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
| | - Muneeb Ahmed
- From the Division of Interventional Radiology, Department of Radiology (A.S., M.S.M., N.H.V., M.M.T., J.L.W., M.A.); Department of Radiology (L.L.T.); Division of Hepatology and Gastroenterology, Department of Internal Medicine (M.P.C., A.M.C.); Division of Hematology and Medical Oncology (A.J.B.); Division of Nuclear Medicine, Department of Radiology (J.A.P.); Division of Transplantation, Department of Surgery (D.E.E.); and Department of Pathology (I.A.N.), Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215
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Coskun N, Kartal MO, Kartal AS, Cayhan V, Ozdemir M, Canyigit M, Ozdemir E. Use of dose-volume histograms for metabolic response prediction in hepatocellular carcinoma patients undergoing transarterial radioembolization with Y-90 resin microspheres. Ann Nucl Med 2024:10.1007/s12149-024-01926-4. [PMID: 38647875 DOI: 10.1007/s12149-024-01926-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Voxel-based dosimetry offers improved outcomes in the treatment of hepatocellular carcinoma (HCC) with transarterial radioembolization (TARE) using glass microspheres. However, the adaptation of voxel-based dosimetry to resin-based microspheres has been poorly studied, and the prognostic relevance of heterogeneous dose distribution remains unclear. This study aims to explore the use of dose-volume histograms for resin microspheres and to determine thresholds for objective metabolic response in HCC patients treated with resin-based TARE. METHODS We retrospectively reviewed HCC patients who underwent TARE with Y-90-loaded resin microspheres in our institution between January 2021 and December 2022. Voxel-based dosimetry was performed on post-treatment Y-90 PET/CT images to extract parameters including mean dose absorbed by the tumor (mTD), the percentage of the targeted tumor volume (pTV), and the minimum doses absorbed by consecutive percentages within the tumor volume (D10, D25, D50, D75, D90). Assessment of metabolic response was done according to PERCIST criteria with F-18 FDG PET/CT imaging at 8-12 weeks after the treatment. RESULTS This study included 35 lesions targeted with 22 TARE sessions in 19 patients (15 males, 4 females, mean age 60 ± 13 years). Objective metabolic response was achieved in 43% of the lesions (n = 15). Responsive lesions had significantly higher mTD, pTV, and D25-D90 values (all p < 0.05). Optimal cut-off values for mTD, pTV, and D50 were 94.6 Gy (sensitivity 73%, specificity 70%, AUC 0.72), 94% (sensitivity 73%, specificity 55%, AUC 0.64), and 91 Gy (sensitivity 80%, specificity 80%, AUC 0.80), respectively. CONCLUSION Parameters derived from dose-volume histograms could offer valuable insights for predicting objective metabolic response in HCC patients treated with resin-based TARE. If verified with larger prospective cohorts, these parameters could enhance the precision of dose distribution and potentially optimize treatment outcomes.
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Affiliation(s)
- Nazim Coskun
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey.
| | - Mehmet Oguz Kartal
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Aysenur Sinem Kartal
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Velihan Cayhan
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Mustafa Ozdemir
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
- Department of Interventional Radiology, University of Health Sciences, Ankara, Turkey
| | - Murat Canyigit
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
- Department of Interventional Radiology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Elif Ozdemir
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
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Marquis H, Ocampo Ramos JC, Carter LM, Zanzonico P, Bolch WE, Laforest R, Kesner AL. MIRD Pamphlet No. 29: MIRDy90-A 90Y Research Microsphere Dosimetry Tool. J Nucl Med 2024; 65:jnumed.123.266743. [PMID: 38388514 PMCID: PMC11064830 DOI: 10.2967/jnumed.123.266743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
90Y-microsphere radioembolization has become a well-established treatment option for liver malignancies and is one of the first U.S. Food and Drug Administration-approved unsealed radionuclide brachytherapy devices to incorporate dosimetry-based treatment planning. Several different mathematical models are used to calculate the patient-specific prescribed activity of 90Y, namely, body surface area (SIR-Spheres only), MIRD single compartment, and MIRD dual compartment (partition). Under the auspices of the MIRDsoft initiative to develop community dosimetry software and tools, the body surface area, MIRD single-compartment, MIRD dual-compartment, and MIRD multicompartment models have been integrated into a MIRDy90 software worksheet. The worksheet was built in MS Excel to estimate and compare prescribed activities calculated via these respective models. The MIRDy90 software was validated against available tools for calculating 90Y prescribed activity. The results of MIRDy90 calculations were compared with those obtained from vendor and community-developed tools, and the calculations agreed well. The MIRDy90 worksheet was developed to provide a vetted tool to better evaluate patient-specific prescribed activities calculated via different models, as well as model influences with respect to varying input parameters. MIRDy90 allows users to interact and visualize the results of various parameter combinations. Variables, equations, and calculations are described in the MIRDy90 documentation and articulated in the MIRDy90 worksheet. The worksheet is distributed as a free tool to build expertise within the medical physics community and create a vetted standard for model and variable management.
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Affiliation(s)
- Harry Marquis
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juan C Ocampo Ramos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lukas M Carter
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pat Zanzonico
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Wesley E Bolch
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida; and
| | - Richard Laforest
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Adam L Kesner
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York;
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Villalobos A, Pisanie JLD, Gandhi RT, Kokabi N. Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips. Semin Intervent Radiol 2024; 41:63-78. [PMID: 38495257 PMCID: PMC10940044 DOI: 10.1055/s-0044-1779715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Alexander Villalobos
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Johannes L. du Pisanie
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ripal T. Gandhi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nima Kokabi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Doyle PW, Workman CS, Grice JV, McGonigle TW, Huang S, Borgmann AJ, Baker JC, Duncan DP, Taylor JE, Brown DB. Predictive Dosimetry and Outcomes of Hepatocellular Carcinoma Treated by Yttrium-90 Resin Microsphere Radioembolization: A Retrospective Analysis Using Technetium-99m Macroaggregated Albumin Single Photon Emission CT/CT and Planning Software. J Vasc Interv Radiol 2024:S1051-0443(24)00026-5. [PMID: 38246416 DOI: 10.1016/j.jvir.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 11/11/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To characterize estimated mean absorbed tumor dose (ADT), objective response (OR), and estimated target dose of hepatocellular carcinoma (HCC) after resin microsphere yttrium-90 (90Y) radioembolization using partition dosimetry. MATERIALS AND METHODS In this retrospective, single-center study, multicompartment dosimetry of index tumors receiving 90Y radioembolization between October 2015 and June 2022 was performed using a commercial software package and pretreatment technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT)/computed tomography (CT). In total, 101 patients with HCC underwent 102 treatments of 127 index tumors. Patients underwent imaging every 2-3 months after treatment to determine best response per modified Response Evaluation Criteria in Solid Tumors (mRECIST). Best response was defined as the greatest response category per mRECIST and categorized as OR or nonresponse (NR). A Cox proportional hazards model evaluated the probability of tumor OR and progression-free survival using ADT. RESULTS The median follow-up period was 148 days (interquartile range [IQR], 92-273 days). The median ADT of OR was 141.9 Gy (IQR, 89.4-215.8 Gy) compared with the median ADT of NR treatments of 70.8 Gy (IQR, 42.0-135.3 Gy; P < .001). Only ADT was predictive of response (hazard ratio = 2.79 [95% confidence interval {CI}: 1.44-5.40]; P = .003). At 6 months, an ADT of 157 Gy predicted 90.0% (95% CI: 41.3%-98.3%) probability of OR. At 1 year, an ADT of 157 Gy predicted 91.6% (95% CI: 78.3%-100%) probability of progression-free survival. Partition modeling and delivered activity were predictive of progression (P = .021 and P = .003, respectively). CONCLUSIONS For HCC treated with resin microspheres, tumors receiving higher ADT exhibited higher rates of OR. An ADT of 157 Gy predicted 90.0% OR at 6 months.
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Affiliation(s)
- Patrick W Doyle
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C Spencer Workman
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared V Grice
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Trey W McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony J Borgmann
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer C Baker
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Duncan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason E Taylor
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Doyle PW, Workman CS, Shah N, McGonigle TW, Grice JV, Huang S, Borgmann AJ, Baker JC, Guys NP, Taylor JE, Brown DB. Predictive Partition Dosimetry and Outcomes after Yttrium-90 Resin Microsphere Radioembolization of Colorectal Cancer Metastatic to the Liver: A Retrospective Analysis. J Vasc Interv Radiol 2023; 34:2138-2146. [PMID: 37640105 DOI: 10.1016/j.jvir.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE To characterize estimated absorbed tumor dose (ADT), objective response (OR), and estimated target dose of liver metastatic colorectal cancer (mCRC) after resin microsphere yttrium-90 (90Y) radioembolization using partition dosimetry. MATERIALS AND METHODS In this retrospective, single-center study, multicompartment dosimetry of index tumors undergoing 90Y radioembolization from October 2013 to July 2022 was performed using MIM SurePlan and pretreatment technetium-99m macroaggregated albumin infusion data. Thirty-eight patients with mCRC underwent treatments for 59 index tumors. Patients were imaged every 2-3 months after treatment and then every 3-6 months after disease control to determine the best response per Response Evaluation Criteria in Solid Tumors 1.1. Responses were categorized as OR or nonresponse (NR). A Cox proportional hazards model evaluated the probability of tumor OR and local progression-free survival (LPFS) based on ADT. RESULTS Patients had a median follow-up of 116 days (interquartile range [IQR], 69-231 days). The ADT was higher for OR patients than for NR patients (median, 130.8 [IQR, 85.6-239.0] vs 40.6 [IQR, 26.0-66.3] Gy; P < .001). A greater percentage of OR than NR patients were treated with activities calculated by partition modeling (54% vs 12%; P = .005). Only ADT predicted response (P = .032). At 6 months, an ADT of 120 Gy predicted a 55% (95% CI, 0.0%-89%) probability of OR. Only ADT (P = .010) and female sex (P = .014) predicted LPFS. At 1 year, an ADT of 120 Gy predicted a 70% (95% CI, 35%-100%) probability of LPFS. CONCLUSIONS Tumor dose was the strongest predictor of OR for mCRC. Administration of an estimated 120 Gy to mCRC predicted 55% OR with 90Y resin microspheres at 6 months.
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Affiliation(s)
- Patrick W Doyle
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C Spencer Workman
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Neal Shah
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Trey W McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared V Grice
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony J Borgmann
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer C Baker
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas P Guys
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason E Taylor
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Doyle PW, Workman CS, Grice JV, McGonigle TW, Huang S, Borgmann AJ, Baker JC, Taylor JE, Brown DB. Partition Dosimetry and Outcomes of Metastatic Neuroendocrine Tumors after Yttrium-90 Resin Microsphere Radioembolization. J Vasc Interv Radiol 2023:S1051-0443(23)00758-3. [PMID: 37871833 DOI: 10.1016/j.jvir.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE To characterize estimated mean tumor-absorbed dose (ADT) and objective response of metastatic neuroendocrine tumor (NET) after resin microsphere yttrium-90 (90Y) hepatic radioembolization using partition dosimetry. MATERIALS AND METHODS In this retrospective, single-center study, multicompartment dosimetry of index tumors receiving 90Y radioembolization between 2013 and 2022 involved the use of Sureplan (MIM Software, Cleveland, Ohio) and technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT) combined with computed tomography. Thirty-six patients with NET underwent treatment of 56 index tumors. Patients underwent imaging every 3-6 months after treatment to determine best response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) criteria. Responses were categorized as objective response (OR) or nonresponse (NR). Wilcoxon rank sum test evaluated differences in continuous variables, and Pearson χ2 test evaluated differences in categorical variables. RESULTS Median follow-up was 582 days (IQR, 187-1,227 days). Per RECIST 1.1, 27 patients (75%) experienced OR and 9 patients experienced (25%) NR. Of the 36 patients, 33 (92%) showed hypervascular, mRECIST-evaluable tumors. Among them, 28 patients (85%) showed mRECIST OR and 5 patients (15%) showed NR. The mRECIST OR group received a higher ADT than the NR group (median, 107 Gy; IQR, 95.1-154 Gy vs median, 70.4 Gy; IQR, 62.9-87.6 Gy; P = .048). All tumors receiving at least 120 Gy showed mRECIST OR. CONCLUSIONS In hypervascular metastatic NET treated by 90Y resin microsphere radioembolization, higher tumor dose was associated with better tumor response per mRECIST. Doses of ≥120 Gy led to OR.
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Affiliation(s)
- Patrick W Doyle
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C Spencer Workman
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared V Grice
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Trey W McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony J Borgmann
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer C Baker
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason E Taylor
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Kappadath SC, Lopez BP. Single-Compartment Dose Prescriptions for Ablative 90Y-Radioembolization Segmentectomy. Life (Basel) 2023; 13:1238. [PMID: 37374021 DOI: 10.3390/life13061238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Yttrium-90 (90Y) radioembolization is increasingly being utilized with curative intent. While single-compartment doses with respect to the perfused volume for the complete pathologic necrosis (CPN) of tumors have been reported, the actual doses delivered to the tumor and at-risk margins that leads to CPN have hitherto not been estimated. We present an ablative dosimetry model that calculates the dose distribution for tumors and at-risk margins based on numerical mm-scale dose modeling and the available clinical CPN evidence and report on the necessary dose metrics needed to achieve CPN following 90Y-radioembolization. METHODS Three-dimensional (3D) activity distributions (MBq/voxel) simulating spherical tumors were modeled with a 121 × 121 × 121 mm3 soft tissue volume (1 mm3 voxels). Then, 3D dose distributions (Gy/voxel) were estimated by convolving 3D activity distributions with a 90Y 3D dose kernel (Gy/MBq) sized 61 × 61 × 61 mm3 (1 mm3 voxels). Based on the published data on single-compartment segmental doses for the resected liver samples of HCC tumors showing CPN after radiation segmentectomy, the nominal voxel-based mean tumor dose (DmeanCPN), point dose at tumor rim (DrimCPN), and point dose 2 mm beyond the tumor boundary (D2mmCPN), which are necessary to achieve CPN, were calculated. The single-compartment dose prescriptions to required achieve CPN were then analytically modeled for more general cases of tumors with diameters dt = 2, 3, 4, 5, 6, and 7 cm and with tumor-to-normal-liver uptake ratios T:N = 1:1, 2:1, 3:1, 4:1, and 5:1. RESULTS The nominal case defined to estimate the doses needed for CPN, based on the previously published clinical data, was a single hyperperfused tumor with a diameter of 2.5 cm and T:N = 3:1, treated with a single-compartment segmental dose of 400 Gy. The voxel-level doses necessary to achieve CPN were 1053 Gy for the mean tumor dose, 860 Gy for the point dose at the tumor boundary, and 561 Gy for the point dose at 2 mm beyond the tumor edge. The single-compartment segmental doses necessary to satisfy the criteria for CPN in terms of the mean tumor dose, point dose at the tumor boundary, and the point dose at 2 mm beyond the tumor edge were tabulated for a range of tumor diameters and tumor-to-normal-liver uptake ratios. CONCLUSIONS The analytical functions that describe the relevant dose metrics for CPN and, more importantly, the single-compartment dose prescriptions for the perfused volume needed to achieve CPN are reported for a large range of conditions in terms of tumor diameters (1-7 cm) and T:N uptake ratios (2:1-5:1).
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Affiliation(s)
- Srinivas Cheenu Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, 1155 Pressler St., Unit 1352, Houston, TX 77030, USA
| | - Benjamin P Lopez
- Department of Imaging Physics, UT MD Anderson Cancer Center, 1155 Pressler St., Unit 1352, Houston, TX 77030, USA
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