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Gorji L, Aoun H, Critchfield J, Al Hallak N, Beal EW. Locoregional Therapy for Intrahepatic Cholangiocarcinoma: The Role of Intra-Arterial Therapies. Cancers (Basel) 2023; 15:4727. [PMID: 37835420 PMCID: PMC10571998 DOI: 10.3390/cancers15194727] [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: 09/03/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is a rare disease with a rising incidence. While surgical resection is the only curative option, the disease process is often identified in advanced stages, as this malignancy often remains clinically silent in early development. Only one-third of patients are eligible for resection at the time of diagnosis. For patients who cannot undergo resection, intra-arterial therapies are reasonable palliative treatment options; in rare occasions, these may be bridging therapies, as well. The premise of bland embolization and most chemoembolization intra-arterial therapies is that the arterial supply of the tumor is occluded to induce tumor necrosis, while radioembolization utilizes the arterial flow of the tumor to deliver radiation therapy. In this review, we discuss the use of transarterial embolization, transarterial chemoembolization, and selective internal radiation therapy for the treatment of ICC. Phase III randomized controlled clinical trials are difficult to tailor to this extremely rare and aggressive disease, but ultimately, further investigation should be pursued to define the patient population that will derive the greatest benefit from each modality.
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Affiliation(s)
- Leva Gorji
- Department of Surgery, Kettering Health, Dayton, OH 45402, USA;
| | - Hussein Aoun
- Department of Interventional Radiology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA; (H.A.); (J.C.)
| | - Jeffrey Critchfield
- Department of Interventional Radiology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA; (H.A.); (J.C.)
| | - Najeeb Al Hallak
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA;
| | - Eliza W. Beal
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA;
- Department of Surgery, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
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The evaluation of DLCO changes in patients with relatively higher lung shunt fractions receiving TARE. Ann Nucl Med 2023; 37:131-138. [PMID: 36436111 DOI: 10.1007/s12149-022-01810-z] [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: 09/14/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Transarterial radioembolization (TARE) with Yttrium-90 (90Y) labeled microspheres is an effective locoregional treatment option for patients with primary and metastatic liver cancer. However, TARE is also associated with radiation-induced lung injury due to hepatopulmonary shunting. If a large proportion of the injected radionuclide microspheres (more than 15%) is shunted, a rare but lethal complication may develop: radiation-induced pneumonitis (RP). Diffusion capacity of the lungs for carbon monoxide (DLCO) is a valuable test to assess lung function and a decrease in DLCO may indicate an impairment in gas exchange caused by the lung injury. Some previous researches have been reported the most consistent changes in pulmonary function tests after external beam radiotherapy are recorded with DLCO. This study aimed to examine the changes in DLCO after TARE with glass microspheres in newly treated and retreated patients with relatively higher lung shunt fractions. METHODS We prospectively analyzed forty consecutive patients with liver malignancies who underwent lobar or superselective TARE with 90Y glass microspheres. DLCO tests were performed at baseline and on days 15, 30, and 60 after the treatment. All patients were followed up clinically and radiologically for the development of RP. RESULTS A statistically significant decrease was found in the DLCO after the first treatment (81.4 ± 13.66 vs. 75.25 ± 13.22, p = 0.003). The frequency of the patients with impaired DLCO at baseline was significantly increased after the first treatment (37.5 vs 57.5% p < 0.05). In the retreated group (n = 8), neither the DLCO (71.5 ± 10.82 vs. 67.50 ± 11.24, p = 0.115) nor the frequency of patients with impaired DLCO (25 vs 25%, p = 1) did not significantly change. Also, the change in DLCO values did not significantly correlate with lung shunt fraction, administered radiation dose, and absorbed lung dose after the first and second treatments (p > 0.05 for all). None of the patients developed RP. CONCLUSION Our study showed that a significant reduction in DLCO after TARE may occur in patients with relatively higher lung shunt fractions. Further studies with larger sample sizes are needed to better investigate the changes in DLCO in patients with high lung shunt fractions.
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Scarinci I, Valente M, Pérez P. A Machine Learning based model for a Dose Point Kernel calculation. RESEARCH SQUARE 2023:rs.3.rs-2419706. [PMID: 36711517 PMCID: PMC9882689 DOI: 10.21203/rs.3.rs-2419706/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Absorbed dose calculation by kernel convolution requires the prior determination of dose point kernels (DPK). This study shows applications of machine learning to generate the DPKs for monoenergetic sources and a model to obtain DPKs for beta emitters. METHODS DPK for monoenergetic electron sources were calculated using the FLUKA Monte Carlo (MC) code for many materials of clinical interest and initial energies ranging from 10 to 3000 keV. Three machine learning (ML) algorithms were trained using the MC DPKs. Electron monoenergetic scaled DPKs (sDPKs) were used to assess the corresponding sDPKs for beta emitters typically used in nuclear medicine, which were compared against reference published data. Finally, the ML sDPK approach was applied to a patient-specific case calculating the dose voxel kernels (DVK) for a hepatic radioembolization treatment with \(^{90}\)Y. RESULTS The three trained machine learning models demonstrated a promising capacity to predict the sDPK for both monoenergetic emissions and beta emitters of clinical interest attaining differences lower than \(10%\) in the mean average percentage error (MAPE) as compared with previous studies. Furthermore, differences lower than \(7 %\) were obtained for the absorbed dose in patient-specific dosimetry comparing against full stochastic MC calculations. CONCLUSION An ML model was developed to assess dosimetry calculations in nuclear medicine. The implemented approach has shown the capacity to accurately predict the sDPK for monoenergetic beta sources in a wide range of energy in different materials. The ML model to calculate the sDPK for beta-emitting radionuclides allowed to obtain VDK useful to achieve reliable patient-specific absorbed dose distributions required remarkable short computation times.
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Affiliation(s)
- Ignacio Scarinci
- Instituto de Física Enrique Gaviola (IFEG), CONICET, Av. Medina Allende s/n, Córdoba, 5000, Córdoba, Argentina.,Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Av. Medina Allende s/n,, Córdoba, 5000, Córdoba, Argentina
| | - Mauro Valente
- Instituto de Física Enrique Gaviola (IFEG), CONICET, Av. Medina Allende s/n, Córdoba, 5000, Córdoba, Argentina.,Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Av. Medina Allende s/n,, Córdoba, 5000, Córdoba, Argentina.,Centro de Excelencia en Física e Ingeniería en Salud (CFIS) & Departamento de Ciencias Físicas, Universidad de la Frontera, Avenida Francisco Salazar 01145, Temuco, 4811230, Cautín, Chile.,Corresponding author(s).
| | - Pedro Pérez
- Instituto de Física Enrique Gaviola (IFEG), CONICET, Av. Medina Allende s/n, Córdoba, 5000, Córdoba, Argentina.,Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes de Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Av. Medina Allende s/n,, Córdoba, 5000, Córdoba, Argentina
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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.
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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
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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.
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Waddell JJ, Townsend PH, Collins ZS, Walter C. Liver-Directed Therapy for Metastatic Colon Cancer: Update. CURRENT COLORECTAL CANCER REPORTS 2022. [DOI: 10.1007/s11888-022-00474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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