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Ponsiglione A, Nappi C, Volpe F, Klain M. Expanding the long-axial field-of-view PET-CT horizons: unveiling new arrows in our quiver. Eur J Nucl Med Mol Imaging 2024; 51:2098-2099. [PMID: 38433150 DOI: 10.1007/s00259-024-06665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Fabio Volpe
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Kim TP, Enger SA. Characterizing the voxel-based approaches in radioembolization dosimetry with reDoseMC. Med Phys 2024; 51:4007-4027. [PMID: 38703394 DOI: 10.1002/mp.17054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Yttrium-90 (90 Y $^{90}{\rm {Y}}$ ) represents the primary radioisotope used in radioembolization procedures, while holmium-166 (166 Ho $^{166}{\rm {Ho}}$ ) is hypothesized to serve as a viable substitute for90 Y $^{90}{\rm {Y}}$ due to its comparable therapeutic potential and improved quantitative imaging. Voxel-based dosimetry for these radioisotopes relies on activity images obtained through PET or SPECT and dosimetry methods, including the voxel S-value (VSV) and the local deposition method (LDM). However, the evaluation of the accuracy of absorbed dose calculations has been limited by the use of non-ideal reference standards and investigations restricted to the liver. The objective of this study was to expand upon these dosimetry characterizations by investigating the impact of image resolutions, voxel sizes, target volumes, and tissue materials on the accuracy of90 Y $^{90}{\rm {Y}}$ and166 Ho $^{166}{\rm {Ho}}$ dosimetry techniques. METHODS A specialized radiopharmaceutical dosimetry software called reDoseMC was developed using the Geant4 Monte Carlo toolkit and validated by benchmarking the generated90 Y $^{90}{\rm {Y}}$ kernels with published data. The decay spectra of both90 Y $^{90}{\rm {Y}}$ and166 Ho $^{166}{\rm {Ho}}$ were also compared. Multiple VSV kernels were generated for the liver, lungs, soft tissue, and bone for isotropic voxel sizes of 1 mm, 2 mm, and 4 mm. Three theoretical phantom setups were created with 20 or 40 mm activity and mass density inserts for the same three voxel sizes. To replicate the limited spatial resolutions present in PET and SPECT images, image resolutions were modeled using a 3D Gaussian kernel with a Full Width at Half Maximum (FWHM) ranging from 0 to 16 mm and with no added noise. The VSV and LDM dosimetry methods were evaluated by characterizing their respective kernels and analyzing their absorbed dose estimates calculated on theoretical phantoms. The ground truth for these estimations was calculated using reDoseMC. RESULTS The decay spectra obtained through reDoseMC showed less than a 1% difference when compared to previously published experimental data for energies below 1.9 MeV in the case of90 Y $^{90}{\rm {Y}}$ and less than 1% for energies below 1.5 MeV for166 Ho $^{166}{\rm {Ho}}$ . Additionally, the validation kernels for90 Y $^{90}{\rm {Y}}$ VSV exhibited results similar to those found in published Monte Carlo codes, with source dose depositions having less than a 3% error margin. Resolution thresholds (FWHM thresh s ${\rm {FWHM}}_\mathrm{thresh}{\rm {s}}$ ), defined as resolutions that resulted in similar dose estimates between the LDM and VSV methods, were observed for90 Y $^{90}{\rm {Y}}$ . They were 1.5 mm for bone, 2.5 mm for soft tissue and liver, and 8.5 mm for lungs. For166 Ho $^{166}{\rm {Ho}}$ , the accuracy of absorbed dose deposition was found to be dependent on the contributions of absorbed dose from photons. Volume errors due to variations in voxel size impacted the final dose estimates. Larger target volumes yielded more accurate mean doses than smaller volumes. For both radioisotopes, the radial dose profiles for the VSV and LDM approximated but never matched the reference standard. CONCLUSIONS reDoseMC was developed and validated for radiopharmaceutical dosimetry. The accuracy of voxel-based dosimetry was found to vary widely with changes in image resolutions, voxel sizes, chosen target volumes, and tissue material; hence, the standardization of dosimetry protocols was found to be of great importance for comparable dosimetry analysis.
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Affiliation(s)
- Taehyung Peter Kim
- Medical Physics Unit, Department of Oncology, McGill University, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Shirin A Enger
- Medical Physics Unit, Department of Oncology, McGill University, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
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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 90 Y 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 90 Y 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 90 Y radioembolization. PATIENTS AND METHODS This prospective, single-center, single-arm clinical trial (NCT04172714) evaluated the efficacy of scout activity of resin 90 Y versus 99m Tc-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 90 Y 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 90 Y 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 90 Y 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 90 Y, 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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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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Habibollahi P, Mahvash A, Kokabi N, Nezami N. Unlocking Precision in Radioembolization: Navigating the Future of Holmium-166 Radioembolization Mapping and Lung Shunt Study by Implementing Scout Dosimetry. Cardiovasc Intervent Radiol 2024; 47:451-452. [PMID: 38491164 DOI: 10.1007/s00270-024-03697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nima Kokabi
- Department of Radiology, Division of Interventional Radiology, School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Nariman Nezami
- Department of Radiology, Interventional Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, CCC Bldg., Room CG225, Washington, DC, USA.
- Georgetown University School of Medicine, Washington, DC, USA.
- Lombardi Comprehensive Cancer Center, Washington, DC, USA.
- The Fischell Department of Bioengineering, University of Maryland College Park, College Park, MD, USA.
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Wagemans MEHM, Braat AJAT, van Rooij R, Smits MLJ, Bruijnen RCG, Prince JF, Bol GM, de Jong HWAM, Lam MGEH. Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [ 166Ho]-Scout Over [ 99mTc]MAA in a Prospective Cohort Study. Cardiovasc Intervent Radiol 2024; 47:443-450. [PMID: 38326577 PMCID: PMC10997535 DOI: 10.1007/s00270-023-03656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE Radiation pneumonitis is a serious complication of radioembolization. In holmium-166 ([166Ho]) radioembolization, the lung mean dose (LMD) can be estimated (eLMD) using a scout dose with either technetium-99 m-macroaggregated albumin ([99mTc]MAA) or [166Ho]-microspheres. The accuracy of eLMD based on [99mTc]MAA (eLMDMAA) was compared to eLMD based on [166Ho]-scout dose (eLMDHo-scout) in two prospective clinical studies. MATERIALS AND METHODS Patients were included if they received both scout doses ([99mTc]MAA and [166Ho]-scout), had a posttreatment [166Ho]-SPECT/CT (gold standard) and were scanned on the same hybrid SPECT/CT system. The correlation between eLMDMAA/eLMDHo-scout and LMDHo-treatment was assessed by Spearman's rank correlation coefficient (r). Wilcoxon signed rank test was used to analyze paired data. RESULTS Thirty-seven patients with unresectable liver metastases were included. During follow-up, none developed symptoms of radiation pneumonitis. Median eLMDMAA (1.53 Gy, range 0.09-21.33 Gy) was significantly higher than median LMDHo-treatment (0.00 Gy, range 0.00-1.20 Gy; p < 0.01). Median eLMDHo-scout (median 0.00 Gy, range 0.00-1.21 Gy) was not significantly different compared to LMDHo-treatment (p > 0.05). In all cases, eLMDMAA was higher than LMDHo-treatment (p < 0.01). While a significant correlation was found between eLMDHo-scout and LMDHo-treatment (r = 0.43, p < 0.01), there was no correlation between eLMDMAA and LMDHo-treatment (r = 0.02, p = 0.90). CONCLUSION [166Ho]-scout dose is superior in predicting LMD over [99mTc]MAA, in [166Ho]-radioembolization. Consequently, [166Ho]-scout may limit unnecessary patient exclusions and avoid unnecessary therapeutic activity reductions in patients eligible for radioembolization. TRAIL REGISTRATION NCT01031784, registered December 2009. NCT01612325, registered June 2012.
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Affiliation(s)
- Martijn E H M Wagemans
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Rob van Rooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Rutger C G Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jip F Prince
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Guus M Bol
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Riveira-Martin M, Akhavanallaf A, Mansouri Z, Bianchetto Wolf N, Salimi Y, Ricoeur A, Mainta I, Garibotto V, López Medina A, Zaidi H. Predictive value of 99mTc-MAA-based dosimetry in personalized 90Y-SIRT planning for liver malignancies. EJNMMI Res 2023; 13:63. [PMID: 37395912 DOI: 10.1186/s13550-023-01011-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Selective internal radiation therapy with 90Y radioembolization aims to selectively irradiate liver tumours by administering radioactive microspheres under the theragnostic assumption that the pre-therapy injection of 99mTc labelled macroaggregated albumin (99mTc-MAA) provides an estimation of the 90Y microspheres biodistribution, which is not always the case. Due to the growing interest in theragnostic dosimetry for personalized radionuclide therapy, a robust relationship between the delivered and pre-treatment radiation absorbed doses is required. In this work, we aim to investigate the predictive value of absorbed dose metrics calculated from 99mTc-MAA (simulation) compared to those obtained from 90Y post-therapy SPECT/CT. RESULTS A total of 79 patients were analysed. Pre- and post-therapy 3D-voxel dosimetry was calculated on 99mTc-MAA and 90Y SPECT/CT, respectively, based on Local Deposition Method. Mean absorbed dose, tumour-to-normal ratio, and absorbed dose distribution in terms of dose-volume histogram (DVH) metrics were obtained and compared for each volume of interest (VOI). Mann-Whitney U-test and Pearson's correlation coefficient were used to assess the correlation between both methods. The effect of the tumoral liver volume on the absorbed dose metrics was also investigated. Strong correlation was found between simulation and therapy mean absorbed doses for all VOIs, although simulation tended to overestimate tumour absorbed doses by 26%. DVH metrics showed good correlation too, but significant differences were found for several metrics, mostly on non-tumoral liver. It was observed that the tumoral liver volume does not significantly affect the differences between simulation and therapy absorbed dose metrics. CONCLUSION This study supports the strong correlation between absorbed dose metrics from simulation and therapy dosimetry based on 90Y SPECT/CT, highlighting the predictive ability of 99mTc-MAA, not only in terms of mean absorbed dose but also of the dose distribution.
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Affiliation(s)
- Mercedes Riveira-Martin
- Genetic Oncology, Radiobiology and Radiointeraction Research Group, Galicia Sur Health Research Institute, Vigo, Spain
- Department of Radiology, Rehabilitation and Physiotherapy, Medicine School, Complutense University of Madrid, Madrid, Spain
| | - Azadeh Akhavanallaf
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Zahra Mansouri
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Nicola Bianchetto Wolf
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Yazdan Salimi
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Alexis Ricoeur
- Service of Radiology, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Ismini Mainta
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, 1211, Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, 1211, Geneva, Switzerland
- Centre for Biomedical Imaging (CIBM), Geneva, Switzerland
- Geneva Neuroscience Centre, Geneva University, Geneva, Switzerland
| | - Antonio López Medina
- Department of Medical Physics and RP, Hospital do Meixoeiro (GALARIA), Vigo, Spain.
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospital, 1211, Geneva, Switzerland.
- Geneva Neuroscience Centre, Geneva University, Geneva, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
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A Theranostic Approach in SIRT: Value of Pre-Therapy Imaging in Treatment Planning. J Clin Med 2022; 11:jcm11237245. [PMID: 36498819 PMCID: PMC9736029 DOI: 10.3390/jcm11237245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Selective internal radiation therapy (SIRT) is one of the treatment options for liver tumors. Microspheres labelled with a therapeutic radionuclide (90Y or 166Ho) are injected into the liver artery feeding the tumor(s), usually achieving a high tumor absorbed dose and a high tumor control rate. This treatment adopts a theranostic approach with a mandatory simulation phase, using a surrogate to radioactive microspheres (99mTc-macroaggregated albumin, MAA) or a scout dose of 166Ho microspheres, imaged by SPECT/CT. This pre-therapy imaging aims to evaluate the tumor targeting and detect potential contraindications to SIRT, i.e., digestive extrahepatic uptake or excessive lung shunt. Moreover, the absorbed doses to the tumor(s) and the healthy liver can be estimated and used for planning the therapeutic activity for SIRT optimization. The aim of this review is to evaluate the accuracy of this theranostic approach using pre-therapy imaging for simulating the biodistribution of the microspheres. This review synthesizes the recent publications demonstrating the advantages and limitations of pre-therapy imaging in SIRT, particularly for activity planning.
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