1
|
Patel MV, McNiel D, Brunson C, Kuo PH, Hennemeyer CT, Woodhead G, McGregor H. Prior ablation and progression of disease correlate with higher tumor-to-normal liver 99mTc-MAA uptake ratio in hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:752-757. [PMID: 36344658 DOI: 10.1007/s00261-022-03718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Factors affecting tumor-to-normal tissue ratio (T:N) have implications for patient selection, dosimetry, and outcomes when considering radioembolization for HCC. This study sought to evaluate patient, disease specific, and technical parameters that predict T:N as measured on planning pre-90Y radioembolization 99mTc-MAA scintigraphy for hepatocellular carcinoma (HCC). METHODS 99mTc-MAA hepatic angiography procedures with SPECT/CT over a 4-year period were reviewed. Data recorded included patient demographics, details of underlying liver disease, tumor size, history of prior treatments for HCC and technical parameters from angiography. Anatomic-based segmentation was performed in 93 cases for measurement of tumor and perfused liver volumes and SPECT counts. T:N were calculated and correlated with collected variables. RESULTS Mean calculated T:N was 2.52. History of prior ablation was significantly correlated with higher T:N (mean 3.39 vs 2.24, p = 0.003). Cases in which mapping was being performed for treatment of disease progression was significantly correlated with higher T:N (mean 3.35 vs 2.14, p = 0.001). Larger tumor size trended toward lower T:N (p = 0.052). CONCLUSION Patients with history of ablation and those undergoing treatment for disease progression have higher T:N and, therefore, could be considered for radioembolization preferentially over alternative treatments.
Collapse
Affiliation(s)
- Mikin V Patel
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, MC 2026, Chicago, IL, 60637, USA.
| | - David McNiel
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Christopher Brunson
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Phillip H Kuo
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Charles T Hennemeyer
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Gregory Woodhead
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Hugh McGregor
- Department of Radiology, University of Washington Medicine, Seattle, WA, USA
| |
Collapse
|
2
|
Webster LA, Villalobos A, Cheng B, Xing M, Majdalany BS, Bercu ZL, Cristescu MM, Brandon D, Schuster D, Baum Y, Loya MF, Kokabi N. Correlation of Non-tumoral Liver Dose with Treatment-Related Adverse Events in Patients with Hepatocellular Carcinoma Treated with Glass-Based Yttrium-90 Radioembolization. Cardiovasc Intervent Radiol 2023; 46:60-68. [PMID: 36450996 DOI: 10.1007/s00270-022-03314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/28/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE To evaluate the relationship between non-tumor liver (NTL) dose and adverse events (AE) in patients with hepatocellular carcinoma (HCC) treated with glass-based Yttrium-90 radioembolization (Y90-RE). MATERIALS AND METHODS A retrospective analysis of patients with HCC treated with Y90-RE between 2013 and 2018 was performed. Baseline characteristics including demographics and Y90-RE treatment approach were captured. Common Terminology Criteria for Adverse Events v5 was assessed at months 3 and 6 post-treatment. Using voxel-based dosimetry with MIM Software V. 6.9, dose-volume histograms of treated area of liver were created. Receiver operator characteristic curve was used to determine NTL dose threshold predicting AEs. Multivariate analysis was used to determine independent clinical factors of predicting severe AEs. Chi-square analysis was used to compare proportions. RESULTS Two hundred and twenty-nine consecutive patients (115(50.2%) lobar and 114(49.8%) segmental) were included. At 3 months, there was a lower rate of any grade AE (55(46%) segmental and 36(31%) lobar, p = 0.009) and increased rate of severe AEs for lobar compared to segmental (2(2%) segmental and 9(8%) lobar, p = 0.029). At 6 months, severe AEs were greater for lobar than segmental (1(1%) segmental vs 10(9%) lobar, p = 0.005). For lobar Y90-RE, mean NTL dose of 112 Gy predicted severe AE (89% sensitivity and 91% specificity (AUC = 0.95, p = < 0.0001) at 3 and 6 months. For the segmental group, no significant association was found between NTL dose and severe treatment-related AE at 3 and 6 months. CONCLUSION In patients with HCC undergoing glass-based lobar Y90-RE, NTL dose of > 112 Gy is associated with severe treatment-related AEs at 3-6 months.
Collapse
Affiliation(s)
- Linzi A Webster
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Alex Villalobos
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Bernard Cheng
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Minzhi Xing
- Office of Epidemiology, Dekalb Country Board of Health, Atlanta, GA, USA
| | - Bill S Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Zachary L Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mircea M Cristescu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - David Brandon
- Department of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - David Schuster
- Department of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Yoram Baum
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammed F Loya
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
3
|
Trans-arterial Radioembolization Dosimetry in 2022. Cardiovasc Intervent Radiol 2022; 45:1608-1621. [PMID: 35982334 DOI: 10.1007/s00270-022-03215-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/26/2022] [Indexed: 11/02/2022]
Abstract
Trans-arterial radioembolization is currently performed using 90Y-loaded glass or resin microspheres and also using 166Ho-loaded microspheres. The goal of this review is to present dosimetry and radiobiology concepts, the different dosimetry approaches available (simulation-based dosimetry and post-treatment dosimetry), main confounding factors as main clinical dosimetry results provided during the last decade for both hepatocellular carcinoma (HCC) and metastases of colorectal carcinoma (mCRC). Based on the different number of microspheres or different isotope used, radiobiology of the three devices is different, meaning that tumouricidal doses and maximal tolerated doses are different. Tumouricidal doses described for HCCs were 100-120 grays (Gy) with 90Y resin microspheres and 205 Gy with 90Y glass microspheres. For mCRC, it is 39-60 with 90Y resin microspheres, 139 Gy with 90Y glass microspheres and 90 Gy with 166Ho microspheres. An impact of tumoural doses with overall survival has also been reported. Personalised dosimetry has been developed and is now recommended by several international expert groups. Level-one evidence of the major impact of personalised dosimetry on response and overall survival in HCC is now available, bringing a new standard approach for TARE in clinical practice as well as for trial design.
Collapse
|
4
|
Filippi L, Braat AJ. Theragnostics in primary and secondary liver tumors: the need for a personalized approach. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:353-370. [PMID: 34881847 DOI: 10.23736/s1824-4785.21.03407-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Primary and secondary hepatic tumors have a dramatic impact in oncology. Despite many advances in diagnosis and therapy, the management of hepatic malignancies is still challenging, ranging from various loco-regional approaches to system therapies. In this scenario, theragnostic approaches, based on the administration of a radiopharmaceuticals' pair, the first labeled with a radionuclide suitable for the diagnostic phase and the second one bound to radionuclide emitting particles for therapy, is gaining more and more importance. Selective internal radiation therapy (SIRT) with microspheres labeled with 90Y or 166Ho is widely used as a loco-regional treatment for primary and secondary hepatic tumors. While 166Ho presents both gamma and beta emission and can be therefore considered a real "theragnostic" agent, for 90Y-microspheres theragnostic approach is realized at the diagnostic phase through the utilization of macroaggregates of human albumin, labeled with 99mTc as "biosimilar" agent respect to microspheres. The aim of the present review was to cover theragnostic applications of 90Y/166Ho-labeled microspheres in clinical practice. Furthermore, we report the preliminary data concerning the potential role of some emerging theragnostic biomarkers for hepatocellular carcinoma, such as glypican-3 (GPC3) and prostate specific membrane antigen (PSMA).
Collapse
Affiliation(s)
- Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy -
| | - Arthur J Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
5
|
Relationship of radiation dose to efficacy of radioembolization of liver metastasis from breast cancer. Eur J Radiol 2021; 136:109539. [PMID: 33476965 DOI: 10.1016/j.ejrad.2021.109539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the relationship of tumoral and nontumoral radiation dose to response and toxicity after transarterial radioembolization (TARE) of breast cancer liver metastasis. METHODS This retrospective study evaluated all patients with breast cancer liver metastases treated with TARE (2/2011-6/2019). Extent of disease was measured as unilobar or bilobar on baseline PET/CT prior to TARE. Response was assessed for targeted regions with modified PERCIST criteria on first follow-up PET/CT. Tumoral and nontumoral liver dosimetry was evaluated by performing volumetric segmentation on post-TARE Bremsstrahlung SPECT/CT. ≥Grade 3 hepatotoxicity was defined as ≥grade 3 bilirubin/AST/ALT elevation or ascites requiring intervention. Fisher's exact tests, Wilcoxon rank sum tests, and Kaplan-Meier survival analysis were performed. RESULTS Among 64 women, 60 patients had pre- and post-TARE PET/CT, of whom 46/60 (77 %) achieved objective response (OR). Responders received higher tumoral dose with a median (interquartile range) of 167 (96-217) vs. 54 (45-62) Gy (p < 0.001). ≥Grade 3 hepatotoxicity occurred in 8/64 (12.5 %) and was associated with higher pre-treatment bilirubin levels of 0.9 (0.9-1.1) vs. 0.5 (0.4-0.7) mg/dL (p = 0.013). Median overall survival (OS) was 11 (95 % CI 10-19) months. Bilobar disease (Hazard Ratio [HR]: 2.77, 95 % CI 1.11-6.89, p = 0.028) and elevated pre-TARE AST (HR 1.02, 95 % CI 1.01-1.03, p < 0.001) were independently associated with shorter survival. ≥Grade 3 hepatotoxicity was associated with reduced survival (p < 0.001). OR was associated with longer OS of 17 months, compared with 10 months (p = 0.027). CONCLUSION In TARE for breast cancer liver metastasis, higher tumoral radiation dose (>79.5 Gy) was associated with OR, which was associated with longer survival. Pre-existing liver dysfunction was associated with hepatotoxicity, which was associated with decreased survival.
Collapse
|
6
|
Personalised Dosimetry in Radioembolisation for HCC: Impact on Clinical Outcome and on Trial Design. Cancers (Basel) 2020; 12:cancers12061557. [PMID: 32545572 PMCID: PMC7353030 DOI: 10.3390/cancers12061557] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022] Open
Abstract
Selective internal radiation therapy (SIRT) of hepatocellular carcinoma (HCC) has been used for many years, usually without any specific dosimetry endpoint. Despite good clinical results in early phase studies or in cohort studies, three randomized trials in locally advanced HCC available failed to demonstrate any improvement of overall overall survival (OS) in comparison with sorafenib. In recent years, many studies have evaluated the dosimetry of SIRT using either a simulation-based dosimetry (macroaggregated albumin (MAA)-based) or a post-therapy-based one (90Y-based). The goal of this review is to present the dosimetry concept, tools available, its limitations, and main clinical results described for HCC patients treated with 90Y-loaded resin or glass microspheres. With MAA-based dosimetry, the threshold tumor doses allowing for a response were between 100 and 210 Gy for resin microspheres and between 205 and 257 Gy for glass microspheres. The significant impact of the tumor dose on OS was reported with both devices. The correlation between 90Y-based dosimetry and response was also reported. Regarding the safety, preliminary results are available for both products but with a larger range of normal liver doses values correlated with liver toxicities due to numerous confounding factors. Based on those results, international expert group recommendations for personalized dosimetry have been provided for both devices. The clinical impact of personalized dosimetry has been recently confirmed in a multicenter randomized study demonstrating a doubling of the response rate and an OS of 150% while using personalized dosimetry. Even if technical dosimetry improvements are still under investigation, the use of personalized dosimetry has to be generalized for both clinical practice and trial design.
Collapse
|
7
|
Mikell JK, Dewaraja YK, Owen D. Transarterial Radioembolization for Hepatocellular Carcinoma and Hepatic Metastases: Clinical Aspects and Dosimetry Models. Semin Radiat Oncol 2020; 30:68-76. [PMID: 31727302 DOI: 10.1016/j.semradonc.2019.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Transarterial radioembolization (TARE) with Yttrium-90 (90Y) microspheres is a liver-directed therapy for primary and metastatic disease. This manuscript provides a review of the clinical literature on TARE indications and efficacy with overviews of patient-selection and toxicity. Current dosimetry models used in practice are safe, relatively simple, and easy for clinicians to use. Planning currently relies on the imperfect surrogate, 99mTc macroaggregated albumin. Post-therapy quantitative imaging (90Y SPECT/CT or 90Y PET/CT) of microspheres can be used to calculate the macroscopic in vivo absorbed dose distribution. Similar to the evolution of other brachytherapy dose calculations, TARE is moving toward more patient-specific dosimetry that includes calculating and reporting nonuniform dose distributions throughout tumors and normal uninvolved liver.
Collapse
Affiliation(s)
- Justin K Mikell
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI.
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI
| |
Collapse
|
8
|
Meyers N, Jadoul A, Bernard C, Delwaide J, Lamproye A, Detry O, Honoré P, Gerard L, Hustinx R. Inter-observer variability of 90Y PET/CT dosimetry in hepatocellular carcinoma after glass microspheres transarterial radioembolization. EJNMMI Phys 2020; 7:29. [PMID: 32399636 PMCID: PMC7218042 DOI: 10.1186/s40658-020-00302-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/29/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Strong correlation has been demonstrated between tumor dose and response and between healthy liver dose and side effects. Individualized dosimetry is increasingly recommended in the current clinical routine. However, hepatic and tumor segmentations could be complex in some cases. The aim of this study is to assess the reproducibility of the tumoral and non-tumoral liver dosimetry in selective internal radiation therapy (SIRT). MATERIAL AND METHODS Twenty-three patients with hepatocellular carcinoma (HCC) who underwent SIRT with glass microspheres were retrospectively included in the study. Tumor (TV) and total liver volumes (TLV), and mean absorbed doses in tumoral liver (TD) and non-tumoral liver (THLD) were determined on the 90Y PET/CT studies using Simplicit90YTM software, by three independent observers. Dosimetry datasets were obtained by a medical physicist helped by a nuclear medicine (NM) physician with 10 years of experience (A), by a NM physician with 4-year experience (B), and by a resident who first performed 10 dosimetry assessments as a training (C). Inter-observer agreement was evaluated using intra-class correlation coefficients (ICC), coefficients of variation (CV), Bland-Altman plots, and reproducibility coefficient (RDC). RESULTS A strong agreement was observed between all three readers for estimating TLV (ICC 0.98) and THLD (ICC 0.97). Agreement was lower for TV delineation (ICC 0.94) and particularly for TD (ICC 0.73), especially for the highest values. Regarding TD, the CV (%) was 26.5, 26.9, and 20.2 between observers A and B, A and C, and B and C, respectively, and the RDC was 1.5. Regarding THLD, it was 8.5, 12.7, and 9.4, and the RDC was 1.3. CONCLUSION Using a standardized methodology, and regardless of the different experiences of the observers, the estimation of THLD is highly reproducible. Although the reproducibility of the assessment of tumor irradiation is overall quite high, large variations may be observed in a limited number of patients.
Collapse
Affiliation(s)
- Nicolas Meyers
- Division of Nuclear Medicine and Oncological Imaging, CHU de Liege, University Hospital of Liege, B35 Domaine Universitaire du Sart-Tilman, 4000, Liege, Belgium.
| | - Alexandre Jadoul
- Division of Nuclear Medicine and Oncological Imaging, CHU de Liege, University Hospital of Liege, B35 Domaine Universitaire du Sart-Tilman, 4000, Liege, Belgium
| | - Claire Bernard
- Division of Nuclear Medicine and Oncological Imaging, CHU de Liege, University Hospital of Liege, B35 Domaine Universitaire du Sart-Tilman, 4000, Liege, Belgium
| | - Jean Delwaide
- Division of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Liege, Liege, Belgium
| | - Anne Lamproye
- Division of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Liege, Liege, Belgium
| | - Olivier Detry
- Division of Abdominal Surgery and Transplantation, University Hospital of Liege, Liege, Belgium
| | - Pierre Honoré
- Division of Abdominal Surgery and Transplantation, University Hospital of Liege, Liege, Belgium
| | - Laurent Gerard
- Division of Radiology, University Hospital of Liege, Liege, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, CHU de Liege, University Hospital of Liege, B35 Domaine Universitaire du Sart-Tilman, 4000, Liege, Belgium
| |
Collapse
|
9
|
Incidence of Radioembolization-Induced Liver Disease and Liver Toxicity Following Repeat 90Y-Radioembolization: Outcomes at a Large Tertiary Care Center. Clin Nucl Med 2020; 45:100-104. [PMID: 31876805 DOI: 10.1097/rlu.0000000000002828] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The complication profile following repeat Y-radioembolization (RE) is not well understood, and repeat RE is sometimes avoided because of concerns for RE-induced liver disease (REILD) and liver toxicity. The purpose of this study was to examine the incidence of REILD and liver toxicity following repeat Y-RE and to identify potential risk factors. METHODS A retrospective analysis of patients undergoing repeat RE to the same hepatic lobe between 2013 and 2018 was performed. Baseline factors were evaluated as predictors of liver toxicity, mortality, and REILD, which was defined as the presence symptomatic ascites or jaundice in the absence of biliary obstruction within 8 weeks following RE. Post-RE complications were graded according to the Common Terminology Criteria for Adverse Events version 5. RESULTS A total of 39 patients underwent repeat RE with 14 (35.9%) experiencing Common Terminology Criteria for Adverse Events toxicity of grade 2 or greater, 3 (10.3%) grade 3, and no grade 4 or greater. A Model for End Stage Liver Disease score of 8 or greater was associated with grade 2 toxicity or greater (26.7% vs 75%; P = 0.013). Only 3 patients (7.7%) experienced REILD due to symptomatic ascites without jaundice. Greater than 2 REs were associated with a greater rate of 6-month mortality (12% vs 58.3%, P = 0.003), 12-month mortality (28% vs 75%, P = 0.007), and REILD (0% vs 21.4%, P = 0.016). Age, sex, microsphere type, cirrhosis, Child-Pugh, and Eastern Cooperative Oncology Group status were not significantly associated with complications, REILD, or survival. CONCLUSIONS Repeat Y-RE appears to be well tolerated with a low rate of high-grade adverse events and REILD.
Collapse
|
10
|
Salem R, Padia SA, Lam M, Bell J, Chiesa C, Fowers K, Hamilton B, Herman J, Kappadath SC, Leung T, Portelance L, Sze D, Garin E. Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging 2019; 46:1695-1704. [PMID: 31098749 DOI: 10.1007/s00259-019-04340-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/17/2019] [Indexed: 12/22/2022]
Abstract
The TheraSphere Global Dosimetry Steering Committee was formed in 2017 by BTG International to review existing data and address gaps in knowledge related to dosimetry. This committee is comprised of health care providers with diverse areas of expertise and perspectives on radiation dosimetry. The goal of these recommendations is to optimize glass microspheres radiation therapy for hepatocellular carcinoma while accounting for variables including disease presentation, tumour vascularity, liver function, and curative/palliative intent. The recommendations aim to unify glass microsphere users behind standardized dosimetry methodology that is simple, reproducible and supported by clinical data, with the overarching goal of improving clinical outcomes and advancing the knowledge of dosimetry.
Collapse
Affiliation(s)
- Riad Salem
- Department of Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
| | - Siddharth A Padia
- Department of Radiology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Marnix Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jon Bell
- Department of Radiology, The Christie, Manchester, UK
| | - Carlo Chiesa
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumouri, Milan, Italy
| | - Kirk Fowers
- BTG International, West Conshohocken, PA, USA
| | | | - Joseph Herman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Leung
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | | | - Daniel Sze
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Etienne Garin
- Univ Rennes, INSERM, INRA, Centre de Lutte contre le Cancer Eugène Marquis, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France
| |
Collapse
|
11
|
Abstract
Dosimetry for yttrium-90 radioembolization continues to generate interest and controversy, as multiple approaches have been used effectively. Traditionally, simple formulas primarily based on patients' body weight or perfused liver volume were used. Over the past several years, dosimetry refinements have led to marked improvements in this therapy from both a safety and efficacy standpoint. Technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT) optimizes pretreatment dosimetry to ensure delivery of a therapeutic radiation dose to the tumor while minimizing nontarget radiation to healthy hepatic tissue. Post-treatment yttrium-90 PET utilizing the inherent internal pair production of yttrium-90 accurately calculates the absorbed dose to tumors and to the normal hepatic parenchyma, which correlates with patient outcomes. As dosimetric calculations become more complex, quantitative imaging with Tc-99m SPECT and Y-90 PET may set the new standard for radioembolization dosimetry.
Collapse
Affiliation(s)
- Bashir A Tafti
- Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Siddharth A Padia
- Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
| |
Collapse
|