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Kim GM, Kim DY, Won JY, Moon S, Kim SU, Kim BK. Outcome of Transarterial Radioembolization in the Treatment of Hepatocellular Carcinoma: Glass Versus Resin Microsphere. Cardiovasc Intervent Radiol 2024; 47:1210-1221. [PMID: 38744685 DOI: 10.1007/s00270-024-03726-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To compare the treatment outcomes of glass and resin microspheres for the treatment of hepatocellular carcinoma (HCC) and evaluate the prognostic factors that influence the outcomes. MATERIALS AND METHODS We retrospectively reviewed 251 consecutive patients who underwent radioembolization for the treatment of HCC at a single tertiary center. Imaging responses after radioembolization were evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) 1.1. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard models were used to identify the prognostic factors. RESULTS A total of 195 patients were included in this study (glass microsphere, n = 75; resin microsphere, n = 120). The complete and objective response rates were 16.0% and 50.7% in the glass microsphere group and 17.5% and 58.3% in the resin microsphere group, respectively. Median PFS was 241 days in the glass microsphere group and 268 days in the resin microsphere group (p = 0.871). Median OS was 29 months in the glass microsphere group and 40 months in the resin microsphere group (p = 0.669). The only significant prognostic factor was bilobar tumor distribution, which favored resin microspheres (p = 0.023). Procedure-related adverse events occurred more frequently in the resin microsphere group (glass, 2.7% vs. resin, 5.0%; p < 0.001). CONCLUSION Glass and resin microspheres for the treatment of HCC did not show a significant difference in survival, though major adverse events occurred more frequently with the use of resin microspheres.
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Affiliation(s)
- Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
| | - Jong Yun Won
- Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Sungmo Moon
- Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
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Cutrì E, Morel-Corlu E, Rolland Y, Saint-Jalmes H, Eliat PA, Garin E, Bezy-Wendling J. A microscopic model of the dose distribution in hepatocellular carcinoma after selective internal radiation therapy. Phys Med 2024; 122:103384. [PMID: 38824827 DOI: 10.1016/j.ejmp.2024.103384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/03/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024] Open
Abstract
The dosimetry evaluation for the selective internal radiation therapy is currently performed assuming a uniform activity distribution, which is in contrast with literature findings. A 2D microscopic model of the perfused liver was developed to evaluate the effect of two different 90Y microspheres distributions: i) homogeneous partitioning with the microspheres equally distributed in the perfused liver, and ii) tumor-clustered partitioning where the microspheres distribution is inferred from the patient specific images. METHODS Two subjects diagnosed with liver cancer were included in this study. For each subject, abdominal CT scans acquired prior to the SIRT and post-treatment 90Y positron emission tomography were considered. Two microspheres partitionings were simulated namely homogeneous and tumor-clustered partitioning. The homogeneous and tumor-clustered partitionings were derived starting from CT images. The microspheres radiation is simulated by means of Russell's law. RESULTS In homogenous simulations, the dose delivery is uniform in the whole liver while in the tumor-clustered simulations a heterogeneous distribution of the delivered dose is visible with higher values in the tumor regions. In addition, in the tumor-clustered simulation, the delivered dose is higher in the viable tumor than in the necrotic tumor, for all patients. In the tumor-clustered case, the dose delivered in the non-tumoral tissue (NTT) was considerably lower than in the perfused liver. CONCLUSIONS The model proposed here represents a proof-of-concept for personalized dosimetry assessment based on preoperative CT images.
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Affiliation(s)
- Elena Cutrì
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, F-35000, Rennes, France; Université de technologie de Compiègne, CNRS, Biomechanics and Bioengineering, 60203 Compiègne Cedex, France; Inria, Saclay Ile-de-France, Palaiseau, 91120, France.
| | - Ewan Morel-Corlu
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Yan Rolland
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Hervé Saint-Jalmes
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Pierre-Antoine Eliat
- INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, St Gilles, Rennes, France; CNRS, INSERM, Biosit UAR 3480 US_S 018, PRISM, Univ Rennes, Rennes, France
| | - Etienne Garin
- INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, St Gilles, Rennes, France; Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
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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] [Grants] [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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Andel D, Lam MGEH, de Bruijne J, Smits MLJ, Braat AJAT, Moelker A, Vegt E, Ruiter SJS, Noordzij W, Grazi G, Vallati GE, Bennink RJ, van Delden OM, Kranenburg OW, Ijzermans JNM, Nijkamp MW, Erdmann JI, Sciuto R, Hagendoorn J, Borel Rinkes IHM. Dose finding study for unilobar radioembolization using holmium-166 microspheres to improve resectability in patients with HCC: the RALLY protocol. BMC Cancer 2023; 23:771. [PMID: 37596578 PMCID: PMC10436405 DOI: 10.1186/s12885-023-11280-9] [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: 10/26/2022] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND High dose unilobar radioembolization (also termed 'radiation lobectomy')-the transarterial unilobar infusion of radioactive microspheres as a means of controlling tumour growth while concomitantly inducing future liver remnant hypertrophy-has recently gained interest as induction strategy for surgical resection. Prospective studies on the safety and efficacy of the unilobar radioembolization-surgery treatment algorithm are lacking. The RALLY study aims to assess the safety and toxicity profile of holmium-166 unilobar radioembolization in patients with hepatocellular carcinoma ineligible for surgery due to insufficiency of the future liver remnant. METHODS The RALLY study is a multicenter, interventional, non-randomized, open-label, non-comparative safety study. Patients with hepatocellular carcinoma who are considered ineligible for surgery due to insufficiency of the future liver remnant (< 2.7%/min/m2 on hepatobiliary iminodiacetic acid scan will be included. A classical 3 + 3 dose escalation model will be used, enrolling three to six patients in each cohort. The primary objective is to determine the maximum tolerated treated non-tumourous liver-absorbed dose (cohorts of 50, 60, 70 and 80 Gy). Secondary objectives are to evaluate dose-response relationships, to establish the safety and feasibility of surgical resection following unilobar radioembolization, to assess quality of life, and to generate a biobank. DISCUSSION This will be the first clinical study to assess the unilobar radioembolization-surgery treatment algorithm and may serve as a stepping stone towards its implementation in routine clinical practice. TRIAL REGISTRATION Netherlands Trial Register NL8902 , registered on 2020-09-15.
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Affiliation(s)
- Daan Andel
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Joep de Bruijne
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simeon J S Ruiter
- Department of HPB & Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Gianluca Grazi
- Hepatopancreatobiliary Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giulio E Vallati
- Interventional Radiology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Roel J Bennink
- Department of Radiology and Nuclear Medicine, Cancer Center, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Cancer Center, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Onno W Kranenburg
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten W Nijkamp
- Department of HPB & Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris I Erdmann
- Department of Surgery, Cancer Center, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rosa Sciuto
- Nuclear Medicine, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Jeroen Hagendoorn
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
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Pinaquy JB, Lapuyade B, Blanc JF, Hindié E, Papadopoulos P, Debordeaux F. Personalized 90 Y-resin microspheres dose determination: a retrospective study on the impact of dosimetry software on the treatment of patients with selective internal radiotherapy. Nucl Med Commun 2023; 44:358-365. [PMID: 36862426 DOI: 10.1097/mnm.0000000000001673] [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: 03/03/2023]
Abstract
INTRODUCTION The calculation of resin yttrium-90 ( 90 Y-) microspheres activity for selective internal radiotherapy (SIRT) needs to be investigated. METHODS AND MATERIALS Analyses using Simplicit 90 Y (Boston Scientific, Natick, Massachusetts, USA) dosimetry software were performed to determine the concordance between the absorbed doses to the tumor (D T1 and D T2 ) and healthy liver (D N1 and D N2 ) during the pre-treatment and the post-treatment phases. An optimized calculation of the activity of 90 Y-microspheres performed using dosimetry software was applied retrospectively to assess the impact of this calculation method on the treatment. RESULTS D T1 ranged from 38.8 to 372 Gy, with a mean value of 128.9 ± 73.6 Gy and median of 121.2 Gy [interquartile range (IQR): 81.7-158.8 Gy]. The median D N1 and D N2 was 10.5 Gy (IQR: 5.8-17.6). A significant correlation was between D T1 and D T2 ( r = 0.88, P < 0.001) and D N1 and D N2 ( r = 0.96, P < 0.001). The optimized activities were calculated; the target dose to the tumor compartment was 120 Gy. No activity reduction was applied in accordance with the tolerance of the healthy liver. Optimization of the microspheres dosages would have resulted in a significant increase in activity for nine treatments (0.21-2.54 GBq) and a reduction for seven others (0.25-0.76 GBq). CONCLUSIONS The development of customized dosimetry software adapted to clinical practice makes it possible to use dosimetry to optimize the dosage for each patient.
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Affiliation(s)
| | - Bruno Lapuyade
- CHU de Bordeaux, Service de radiologie et d'imagerie diagnostique et interventionnelle
| | - Jean-Frederic Blanc
- CHU de Bordeaux, Service d'hépato-gastro-entérologie et oncologie digestive, Bordeaux, France
| | - Elif Hindié
- CHU de Bordeaux, Service de Médecine nucléaire
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Chen G, Lu Z, Jiang H, Lin KH, Mok GSP. Voxel-S-Value based 3D treatment planning methods for Y-90 microspheres radioembolization based on Tc-99m-macroaggregated albumin SPECT/CT. Sci Rep 2023; 13:4020. [PMID: 36899031 PMCID: PMC10006243 DOI: 10.1038/s41598-023-30824-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
Partition model (PM) for Y-90 microsphere radioembolization is limited in providing 3D dosimetrics. Voxel-S-Values (VSV) method has good agreement with Monte Carlo (MC) simulations for 3D absorbed dose conversion. We propose a new VSV method and compare its performance along with PM, MC and other VSV methods for Y-90 RE treatment planning based on Tc-99m MAA SPECT/CT. Twenty Tc-99m-MAA SPECT/CT patient data are retrospectively analyzed. Seven VSV methods are implemented: (1) local energy deposition; (2) liver kernel; (3) liver kernel and lung kernel; (4) liver kernel with density correction (LiKD); (5) liver kernel with center voxel scaling (LiCK); (6) liver kernel and lung kernel with density correction (LiLuKD); (7) proposed liver kernel with center voxel scaling and lung kernel with density correction (LiCKLuKD). Mean absorbed dose and maximum injected activity (MIA) obtained by PM and VSV are evaluated against MC results, and 3D dosimetrics generated by VSV are compared with MC. LiKD, LiCK, LiLuKD and LiCKLuKD have the smallest deviation in normal liver and tumors. LiLuKD and LiCKLuKD have the best performance in lungs. MIAs are similar by all methods. LiCKLuKD could provide MIA consistent with PM, and precise 3D dosimetrics for Y-90 RE treatment planning.
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Affiliation(s)
- Gefei Chen
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| | - Zhonglin Lu
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| | - Han Jiang
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| | - Ko-Han Lin
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Greta S P Mok
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China. .,Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Macau, SAR, China.
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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.
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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
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Yu CY, Huang PH, Tsang LLC, Hsu HW, Lim WX, Weng CC, Huang TL, Hsu CC, Chen CL, Ou HY, Cheng YF. Yttrium-90 Radioembolization as the Major Treatment of Hepatocellular Carcinoma. J Hepatocell Carcinoma 2023; 10:17-26. [PMID: 36660410 PMCID: PMC9843618 DOI: 10.2147/jhc.s385478] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
Background The purpose of this study was to assess the safety and efficacy of Yttrium-90 radioembolization using in unresectable hepatocellular carcinoma. Methods From 2017 to 2021, 32 patients with unresectable hepatocellular carcinoma, with mean tumor diameter about 7cm (21 males, 11 females; median age, 57.5 years of age), treated with Yttrium-90 radioembolization using resin microspheres were reviewed at pre-Yttrium-90 and post-Yttrium-90 follow-up. Tumor response was assessed according to the modified Response Evaluation Criteria in Solid Tumors. Outcomes including overall survival and progression-free survival were reported. Results Median follow-up was 18 months. At follow-up examinations at 3-, 6-, and 12-months follow-up, the overall survival rates were 94%, 87% and 59%, and the progression-free survival rates were 78%, 64% and 60%, respectively. Complete response, partial response, stable disease, and progressive disease were noted in 7 (21.9%), 14 (43.7%), 4 (12.5%), and 7 (21.9%) patients, respectively. The disease control rate was 78.1%, the objective response rate was 65.6%, and the successful downstage rate was 34.4% (11 of 32). Nine of thirty-two patients underwent resection or transplantation after Yttrium-90 radioembolization with 2-year overall survival being 100%. No serious adverse events occurred after Yttrium-90 treatment. Worse overall survival was related to the larger tumor, higher stage, Eastern Cooperative Oncology Group performance status, and Child-Pugh score. And worse progression-free survival was related to the higher tumor burden, and pre-Yttrium-90 serum α-fetoprotein level >100. Conclusion Yttrium-90 Radioembolization can control hepatocellular carcinoma well even in advanced diseases. Patients successfully downstaging/bridging to resection or transplantation have excellent overall survival.
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Affiliation(s)
- Chun-Yen Yu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Hsun Huang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Leo Leung-Chit Tsang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsien-Wen Hsu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Xiong Lim
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Chun Weng
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tung-Liang Huang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Chin Hsu
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-You Ou
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan,Correspondence: Yu-Fan Cheng; Hsin-You Ou, Tel/Fax +88677317123-3027, Email ;
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Kolligs F, Arnold D, Golfieri R, Pech M, Peynircioglu B, Pfammatter T, Ronot M, Sangro B, Schaefer N, Maleux G, Munneke G, Pereira H, Zeka B, de Jong N, Helmberger T, Neukölln VK, D’Archambeau O, Balli T, Bilgic S, Bloom A, Cioni R, Fischbach R, Altona AK, Flamen P, Gerard L, Grözinger G, Katoh M, Koehler M, Kröger JR, Kuhl C, Orsi F, Özgün M, Reimer P, Ronot M, Schmid A, Vit A. Factors impacting survival after transarterial radioembolization in patients with hepatocellular carcinoma: Results from the prospective CIRT study. JHEP Rep 2022; 5:100633. [PMID: 36593888 PMCID: PMC9804139 DOI: 10.1016/j.jhepr.2022.100633] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background & Aims Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is an established treatment option for patients with hepatocellular carcinoma (HCC). However, optimising treatment application and patient selection remains challenging. We report here on the effectiveness, safety and prognostic factors, including dosing methods, associated with TARE for HCC in the prospective observational CIRT study. Methods We analysed 422 patients with HCC enrolled between Jan 2015 and Dec 2017, with follow-up visits every 3 months for up to 24 months after first TARE. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every 3-month follow-up visit. We used the multivariable Cox proportional hazard model and propensity score matching to identify independent prognostic factors for effectiveness outcomes. Results The median OS was 16.5 months, the median PFS was 6.1 months, and the median hepatic PFS was 6.7 months. Partition model dosimetry resulted in improved OS compared to body surface area calculations on multivariable analysis (hazard ratio 0.65; 95% CI 0.46-0.92; p = 0.0144), which was confirmed in the exact matching propensity score analysis (hazard ratio 0.56; 95% CI 0.35-0.89; p = 0.0136). Other independent prognostic factors for OS were ECOG-performance status >0 (p = 0.0018), presence of ascites (p = 0.0152), right-sided tumours (p = 0.0002), the presence of portal vein thrombosis (p = 0.0378) and main portal vein thrombosis (p = 0.0028), ALBI grade 2 (p = 0.0043) and 3 (p = 0.0014). Adverse events were recorded in 36.7% of patients, with 9.7% of patients experiencing grade 3 or higher adverse events. Conclusions This large prospective observational dataset shows that TARE is an effective and safe treatment in patients with HCC. Using partition model dosimetry was associated with a significant improvement in survival outcomes. Impact and implications Transarterial radioembolization (TARE) is a form of localised radiation therapy and is a potential treatment option for primary liver cancer. We observed how TARE was used in real-life clinical practice in various European countries and if any factors predict how well the treatment performs. We found that when a more complex but personalised method to calculate the applied radiation activity was used, the patient responded better than when a more generic method was used. Furthermore, we identified that general patient health, ascites and liver function can predict outcomes after TARE. Clinical trial number NCT02305459.
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Key Words
- ALBI, albumin-bilirubin
- BCLC, Barcelona Clinic Liver Cancer
- BSA, body surface area
- CIRSE, Cardiovascular and Interventional Radiological Society of Europe
- CIRT, CIRSE Registry for SIR-Spheres Therapy
- ECOG, Eastern Cooperative Oncology Group
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- INR, international normalized ratio
- IPTW, inverse probability of treatment weighting
- OS, overall survival
- PFS, progression-free survival
- PVT, portal vein thrombosis
- REILD, radioembolization-induced liver disease
- SIRT
- TACE, transcatheter arterial chemoembolization
- TARE, transarterial radioembolization
- Y90, Yttrium-90
- dosimetry
- hPFS, hepatic progression-free survival
- liver
- mBSA, modified body surface area
- observational
- radioembolization
- registry
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Affiliation(s)
- Frank Kolligs
- Department of Internal Medicine and Gastroenterology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Dirk Arnold
- Oncology and Hematology, Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Bora Peynircioglu
- Department of Radiology, School of Medicine, Hacettepe University, Sihhiye Campus, Ankara, Turkey
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, Universitätsspital Zürich, Zürich, Switzerland
| | - Maxime Ronot
- Université Paris Cité, Paris & Service de Radiologie, APHP Nord, Hôpital Beaujon, Clichy, France
| | - Bruno Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Niklaus Schaefer
- Service de médecine nucléaire et imagerie moléculaire, CHUV, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Geert Maleux
- Radiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Graham Munneke
- Interventional Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France,INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria
| | - Niels de Jong
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Vienna, Austria,Corresponding author. Address: Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna Austria; Tel.: +43 1904200347
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Minimal-Invasive Therapy, Klinikum Bogenhausen, Munich, Germany
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Balli HT, Aikimbaev K, Burak IG, Pehlivan UA, Piskin FC, Sozutok S. Reduction of Hepatopulmonary and Intrahepatic Shunts after Treatment with Sorafenib in Hepatocellular Carcinoma Patients. Cardiovasc Intervent Radiol 2022; 45:1842-1847. [PMID: 36175653 DOI: 10.1007/s00270-022-03283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the reduction of elevated shunts after treatment with sorafenib in hepatocellular carcinoma (HCC) patients planned for transarterial radioembolization (TARE). MATERIALS AND METHODS Sixteen HCC patients treated with sorafenib were investigated. Shunts were evaluated by SPECT/CT after Technetium-99 m Tc-macroaggregated albumin injection. RESULTS All patients had high LSF (median 43.5%, range 28-86), and two (12.5%) of them had widespread intrahepatic shunts with concomitants elevated (36%) and acceptable (18%) lung shunt fraction (LSF). The mean duration of the sorafenib use was 134.4 ± 59.2 days. While one patient (6.25%) developed hand-foot syndrome, minor side effects were seen in all patients. After sorafenib use, LSF fell below 20% in eight patients, and TARE was applied to all of them. There was strong negative correlation between the failure of shunt reduction and presence of macrovascular invasion (ρ = - 0.775) and infiltrative tumour type (ρ = - 0.775). CONCLUSION Sorafenib use may be beneficial in some selected HCC patients with elevated shunts. Expected results may not be obtained in patients with infiltrative tumour type or macrovascular invasion, but patients with nodular tumour type with the absence of macrovascular invasion may be appropriate candidates for shunt reduction with ensuring subsequent TARE. Further investigations with sufficient patient population and standardized protocols of follow-up periods are needed to clarify the values for sorafenib use in HCC patients with evaluated shunts.
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Affiliation(s)
- Huseyin Tugsan Balli
- Department of Radiology, Balcali Hospital, Cukurova University Medical School, Adana, Turkey
| | - Kairgeldy Aikimbaev
- Department of Radiology, Balcali Hospital, Cukurova University Medical School, Adana, Turkey.
| | - Isa Guney Burak
- Department of Nuclear Medicine, Balcali Hospital, Cukurova University Medical School, Adana, Turkey
| | - Umur Anil Pehlivan
- Medical Faculty Radiology Department, Balcali Hospital, Cukurova University, Adana, Turkey
| | - Ferhat Can Piskin
- Medical Faculty Radiology Department, Balcali Hospital, Cukurova University, Adana, Turkey
| | - Sinan Sozutok
- Medical Faculty Radiology Department, Balcali Hospital, Cukurova University, Adana, Turkey
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Effect of tumour involvement on activity determination of resin Yttrium-90 in selective internal radiation therapy of metastatic liver cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction:
The study was aimed to evaluate the effect of tumour involvement on resin Yttrium-90 (Y90) activity determination for metastatic liver cancer treatment.
Methods:
One hundred and two cases of resin Y90 microsphere treatment were retrospectively studied. Body surface area (BSA) method was used in the calculation of resin Y90 activity. The total activity (TA) was calculated as a summation of activities obtained from BSA-based calculation and tumour involvement (TI). TI and TA of each case were evaluated. The contributions of TI to TA were calculated with the ratio of TI/TA.
Results:
The average contribution of TI to TA was 4·1%. The contributions were < 5·8% in 75% of the cases, < 2·2% in 50% of the cases and < 1·0% in 25% of the cases.
Conclusions:
Overall the effect of tumour involvement on the activity determination was small. The activity calculation could be simplified by neglecting TI in 25% of the cases where the activity contribution from TI was less than 1%. Contouring tumour and liver structures for TI calculation could be avoided in these cases, and the efficiency of the workflow for resin Y90 procedures could be improved.
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12
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Boral B, Ballı HT, Sözütok S, Pehlivan UA, Aikimbaev K. Clinical and prognostic significance of CD14 (+) HLA-DR (-/low) myeloid-derived suppressor cells in patients with hepatocellular carcinoma received transarterial radioembolization with Yttrium-90. Scand J Immunol 2021; 95:e13132. [PMID: 34936119 DOI: 10.1111/sji.13132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/21/2021] [Accepted: 12/15/2021] [Indexed: 01/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. For unresectable HCC, transarterial radioembolization (TARE) with Yttrium-90 is a widely used treatment. The aim of this study was to investigate whether monocytic myeloid-derived suppressor cells (M-MDSC) and CD39+ T cells can be non-invasive predictive biomarkers of radiological response and prognosis in patients with HCC treated with TARE. This study was conducted on 39 patients with HCC who were treated with TARE between August 2018 and December 2019 and the control group consisted of 23 healthy volunteers. CD4+, CD8+, CD39+ T cells, Natural killer (NK) cells, myeloid cells (MC) and M-MDSC parameters are examined in the course of TARE treatment with student t test and Kaplan-Meier method. There were statistically significant differences in M-MDSC, CD39+ T cells and MC values between healthy controls and HCC patients. A statistically significant difference was found in M-MDSC and CD4+ T cells values in the HCC patient group who responded to the treatment compared to those who did not. Survival analysis found that patients with lower frequencies (under 3.81%) of M-MDSC showed more prominent differences of overall survival (OS) compared to patients with all high groups. We found that M-MDSC in the peripheral blood might be a useful non-invasive biomarker to predict OS. We have shown for the first time that M-MDSC is correlated with treatment response in HCC patients treated with TARE. Additionally, we have found that the percentage of CD39+ T cells is high in HCC patients and these cells are positively correlated with M-MDSC.
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Affiliation(s)
- Barış Boral
- Department of Immunology, Adana Health Practice and Research Center, University of Health Sciences, Adana, Turkey
| | | | - Sinan Sözütok
- Department of Radiology, Çukurova University School of Medicine, Adana, Turkey
| | - Umur Anıl Pehlivan
- Department of Radiology, Çukurova University School of Medicine, Adana, Turkey
| | - Kairgeldy Aikimbaev
- Department of Radiology, Çukurova University School of Medicine, Adana, Turkey
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13
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Keane G, Lam M, de Jong H. Beyond the MAA-Y90 Paradigm: The Evolution of Radioembolization Dosimetry Approaches and Scout Particles. Semin Intervent Radiol 2021; 38:542-553. [PMID: 34853500 DOI: 10.1055/s-0041-1736660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radioembolization is a well-established treatment for primary and metastatic liver cancer. There is increasing interest in personalized treatment planning supported by dosimetry, as it provides an opportunity to optimize dose delivery to tumor and minimize nontarget deposition, which demonstrably increases the efficacy and safety of this therapy. However, the optimal dosimetry procedure in the radioembolization setting is still evolving; existing data are limited as few trials have prospectively tailored dose based on personalized planning and predominantly semi-empirical methods are used for dose calculation. Since the pretreatment or "scout" procedure forms the basis of dosimetry calculations, an accurate and reliable technique is essential. 99m Tc-MAA SPECT constitutes the current accepted standard for pretreatment imaging; however, inconsistent patterns in published data raise the question whether this is the optimal agent. Alternative particles are now being introduced to the market, and early indications suggest use of an identical scout and treatment particle may be superior to the current standard. This review will undertake an evaluation of the increasingly refined dosimetric methods driving radioembolization practices, and a horizon scanning exercise identifying alternative scout particle solutions. Together these constitute a compelling vision for future treatment planning methods that prioritize individualized care.
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Affiliation(s)
- Grace Keane
- Nuclear Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Marnix Lam
- Nuclear Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Hugo de Jong
- Nuclear Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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14
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Webster LA, Villalobos A, Majdalany BS, Bercu ZL, Gandhi RT, Kokabi N. Standard Radiation Dosimetry Models: What Interventional Radiologists Need to Know. Semin Intervent Radiol 2021; 38:405-411. [PMID: 34629706 DOI: 10.1055/s-0041-1732323] [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] [Indexed: 12/23/2022]
Abstract
Thoughtful and accurate dosimetry is critical to obtain the safest and most efficacious yttrium-90 (Y90) radioembolization of primary and secondary liver cancers. Three dosimetry models are currently used in clinical practice, namely, body surface area model, medical internal radiation dose model, and the partition model. The objective of this review is to briefly outline the history behind Y90 dosimetry and the difference between the aforementioned models. When applying these three models to a single case, the differences between them are further demonstrated. Each dosimetry model in clinical practice has its own benefits and limitations. Therefore, it is incumbent upon practicing interventional radiologists to be aware of these differences to optimize treatment outcomes for their patients.
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Affiliation(s)
- Linzi Arndt Webster
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Alexander Villalobos
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bill S Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary L Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ripal T Gandhi
- Miami Cardiac and Vascular Institute, Miami Cancer Institute, Miami, FL
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University School of Medicine, Atlanta, Georgia
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15
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Plachouris D, Tzolas I, Gatos I, Papadimitroulas P, Spyridonidis T, Apostolopoulos D, Papathanasiou N, Visvikis D, Plachouri KM, Hazle JD, Kagadis GC. A deep-learning-based prediction model for the biodistribution of 90 Y microspheres in liver radioembolization. Med Phys 2021; 48:7427-7438. [PMID: 34628667 DOI: 10.1002/mp.15270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radioembolization with 90 Y microspheres is a treatment approach for liver cancer. Currently, employed dosimetric calculations exhibit low accuracy, lacking consideration of individual patient, and tissue characteristics. PURPOSE The purpose of the present study was to employ deep learning (DL) algorithms to differentiate patterns of pretreatment distribution of 99m Tc-macroaggregated albumin on SPECT/CT and post-treatment distribution of 90 Y microspheres on PET/CT and to accurately predict how the 90 Y-microspheres will be distributed in the liver tissue by radioembolization therapy. METHODS Data for 19 patients with liver cancer (10 with hepatocellular carcinoma, 5 with intrahepatic cholangiocarcinoma, 4 with liver metastases) who underwent radioembolization with 90 Y microspheres were used for the DL training. We developed a 3D voxel-based variation of the Pix2Pix model, which is a special type of conditional GANs designed to perform image-to-image translation. SPECT and CT scans along with the clinical target volume for each patient were used as inputs, as were their corresponding post-treatment PET scans. The real and predicted absorbed PET doses for the tumor and the whole liver area were compared. Our model was evaluated using the leave-one-out method, and the dose calculations were measured using a tissue-specific dose voxel kernel. RESULTS The comparison of the real and predicted PET/CT scans showed an average absorbed dose difference of 5.42% ± 19.31% and 0.44% ± 1.64% for the tumor and the liver area, respectively. The average absorbed dose differences were 7.98 ± 31.39 Gy and 0.03 ± 0.25 Gy for the tumor and the non-tumor liver parenchyma, respectively. Our model had a general tendency to underpredict the dosimetric results; the largest differences were noticed in one case, where the model underestimated the dose to the tumor area by 56.75% or 72.82 Gy. CONCLUSIONS The proposed deep-learning-based pretreatment planning method for liver radioembolization accurately predicted 90 Y microsphere biodistribution. Its combination with a rapid and accurate 3D dosimetry method will render it clinically suitable and could improve patient-specific pretreatment planning.
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Affiliation(s)
- Dimitris Plachouris
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece
| | - Ioannis Tzolas
- School of Electrical and Computer Engineering, University of Patras, Rion, Greece
| | - Ilias Gatos
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece
| | - Panagiotis Papadimitroulas
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece.,R&D Department, Bioemission Technology Solutions, Athens, Greece
| | - Trifon Spyridonidis
- Department of Nuclear Medicine, School of Medicine, University of Patras, Rion, Greece
| | | | | | | | | | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George C Kagadis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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16
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Accurate non-tumoral 99mTc-MAA absorbed dose prediction to plan optimized activities in liver radioembolization using resin microspheres. Phys Med 2021; 89:250-257. [PMID: 34438353 DOI: 10.1016/j.ejmp.2021.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022] Open
Abstract
AIM The manufacturers' recommended methods to calculate delivered activities in liver radioembolization are simplistic and only slightly personalized. Activity planning could also be based on a 99mTc-macroaggregated albumin SPECT/CT (MAA) using the partition model but its accuracy is controversial. This study evaluates the dose parameters in the normal liver and in the tumor compartments using MAA SPECT/CT (pre-therapeutic imaging) and 90Y TOF-PET/CT (post-therapy imaging). Finally, we propose a prescription of the activity as a function of the normal liver MAA distribution. METHOD 66 procedures of RE (with resin microspheres) corresponding to 171 lesions were analyzed. Tumor to normal targeted liver uptake (T/NTL), tumor absorbed dose (TD) and whole normal liver absorbed (WNLD) were assessed with MAA and 90Y imaging. Secondly, activities were recalculated using the MAA distribution in the normal liver compartment to reach the maximal tolerable liver dose. These Activities were compared to activities defined with the BSA method. RESULTS Compared to 90Y imaging, our study demonstrated an accurate estimation of the WNLD using MAA imaging (Pearson's R = 0.97, p < 0.001). On the contrary, significant variations were found for TD (R = 0.65, p < 0.001). The MAA T/NTL ratio has a 85% positive predictive value in identifying patients who will get a 90Y T/NTL ratio above 1.5. Moreover, activities calculated using the MAA distribution in the normal liver compartment were significantly higher to activities defined with the BSA method. CONCLUSION Whole normal liver absorbed doses are accurately predicted with MAA imaging and could be used to optimize the activity planning.
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Elsayed M, Loya M, Galt J, Schuster DM, Bercu ZL, Newsome J, Brandon D, Benenati S, Behbahani K, Duszak R, Sethi I, Kokabi N. Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond. World J Gastrointest Oncol 2021; 13:440-452. [PMID: 34040704 PMCID: PMC8131908 DOI: 10.4251/wjgo.v13.i5.440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/21/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has made it more challenging for patients to undergo yttrium-90 (Y-90) radioembolization (RE). Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19, thus improving patient access.
AIM To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography (SPECT/CT) in order to optimize therapy.
METHODS All patients were selected for Y-90 RE through a multidisciplinary tumor board, and were screened and tested for COVID-19 infection per institutional protocol. A same day procedure was developed, consisting of angiography, imaging, and Y-90 resin particle delivery. Routine SPECT/CT after technetium-99m macroaggregated albumin (Tc-99m MAA) administration was performed for assessment of arterial supply, personalized dosimetry, and extrahepatic activity. Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery, by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles.
RESULTS A total of 14 patients underwent same day Y-90 RE between March and June 2020. Mean lung shunt fraction was 6.13% (range 3.5%-13.1%). Y-90 RE was performed for a single lesion in 7 patients, while the remaining 7 patients had treatment of multifocal lesions. The largest lesion measured 8.3 cm. All patients tolerated the procedure well and were discharged the same day.
CONCLUSION Same day Y-90 RE with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond. We recommend consideration of SPECT/CT, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.
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Affiliation(s)
- Mohammad Elsayed
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Mohammad Loya
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - James Galt
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - David M Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Zachary L Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Janice Newsome
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Sonia Benenati
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Keywan Behbahani
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Richard Duszak
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
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Abstract
The fundamental premise of yttrium-90 radioembolisation is to balance safety with efficacy. To achieve this, dose-response guidance must be provided. This is a tabulation of published data of key dose-response metrics for yttrium-90 resin microsphere radioembolisation of liver malignancies. Metrics are expressed in terms of mean radiation absorbed doses (Gy), dose-volume histograms, Biologically Effective Doses, Normal Tissue Complication Probability and Tumour Control Probability.
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Affiliation(s)
- Yung Hsiang Kao
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Victoria, Australia
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19
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Yttrium-90 Hepatic Radioembolization for Advanced Chemorefractory Metastatic Colorectal Cancer: Survival Outcomes Based on Right- Versus Left-Sided Primary Tumor Location. AJR Am J Roentgenol 2021; 217:1141-1152. [PMID: 33594907 DOI: 10.2214/ajr.20.25315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND. Primary colon cancer location affects survival of patients with metastatic colorectal cancer (mCRC). Outcomes based on primary tumor location after salvage hepatic radioembolization with 90Y resin microspheres are not well studied. OBJECTIVE. The objectives of this study are to assess the survival outcomes of patients with advanced chemorefractory mCRC treated with 90Y radioembolization, as stratified by primary tumor location, and to explore potential factors that are predictive of survival. METHODS. A total of 99 patients who had progressive mCRC liver metastases while receiving systemic therapy and who were treated with 90Y radioembolization at a single center were retrospectively analyzed. For 89 patients, tumor response on the first imaging follow-up examination (CT or MRI performed at a mean [± SD] of 1.9 ± 0.9 months after 90Y radioembolization) was evaluated using RECIST. Overall survival (OS), OS after 90Y radioembolization, and hepatic progression-free survival (PFS) were calculated using the Kaplan-Meier method. Outcomes and associations of outcomes with tumor response were compared between patients with left- and right-sided tumors. RESULTS. A total of 74 patients had left-sided colon cancer, and 25 patients had right-sided colon cancer. Median OS from the time of mCRC diagnosis was 37.2 months, median OS after 90Y radioembolization was 5.8 months, and median hepatic PFS was 3.3 months. Based on RECIST, progressive disease on first imaging follow-up was observed in 38 patients (43%) after 90Y radioembolization and was associated with shorter OS after 90Y radioembolization compared with observation of disease control on first imaging follow-up (4.0 vs 10.5 months; p < .001). Patients with right-sided primary tumors showed decreased median OS after 90Y radioembolization compared with patients with left-sided primary tumors (5.4 vs 6.2 months; p = .03). Right- and left-sided primary tumors showed no significant difference in RECIST tumor response, hepatic PFS, or extrahepatic disease progression (p > .05). Median survival after 90Y radioembolization was significantly lower among patients with progressive disease than among those with disease control in the group with left-sided primary tumors (4.2 vs 13.9 months; p < .001); however, this finding was not observed in the group with right-sided primary tumors (3.3 vs 7.2 months; p = .05). CONCLUSION. Right-sided primary tumors were independently associated with decreased survival among patients with chemorefractory mCRC after 90Y radioembolization, despite these patients having a similar RECIST tumor response, hepatic PFS, and extrahepatic disease progression compared with patients with left-sided primary tumors. CLINICAL IMPACT. Primary colon cancer location impacts outcomes after salvage 90Y radioembolization and may help guide patient selection.
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Taebi A, Vu CT, Roncali E. Multiscale Computational Fluid Dynamics Modeling for Personalized Liver Cancer Radioembolization Dosimetry. J Biomech Eng 2021; 143:011002. [PMID: 32601676 PMCID: PMC7580665 DOI: 10.1115/1.4047656] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 06/17/2020] [Indexed: 12/13/2022]
Abstract
Yttrium-90 (90Y) radioembolization is a minimally invasive procedure increasingly used for advanced liver cancer treatment. In this method, radioactive microspheres are injected into the hepatic arterial bloodstream to target, irradiate, and kill cancer cells. Accurate and precise treatment planning can lead to more efficient and safer treatment by delivering a higher radiation dose to the tumor while minimizing the exposure of the surrounding liver parenchyma. Treatment planning primarily relies on the estimated radiation dose delivered to tissue. However, current methods used to estimate the dose are based on simplified assumptions that make the dosimetry results unreliable. In this work, we present a computational model to predict the radiation dose from the 90Y activity in different liver segments to provide a more realistic and personalized dosimetry. Computational fluid dynamics (CFD) simulations were performed in a 3D hepatic arterial tree model segmented from cone-beam CT angiographic data obtained from a patient with hepatocellular carcinoma (HCC). The microsphere trajectories were predicted from the velocity field. 90Y dose distribution was then calculated from the volumetric distribution of the microspheres. Two injection locations were considered for the microsphere administration, a lobar and a selective injection. Results showed that 22% and 82% of the microspheres were delivered to the tumor, after each injection, respectively, and the combination of both injections ultimately delivered 49% of the total administered 90Y microspheres to the tumor. Results also illustrated the nonhomogeneous distribution of microspheres between liver segments, indicating the importance of developing patient-specific dosimetry methods for effective radioembolization treatment.
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Affiliation(s)
- Amirtahà Taebi
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616
| | - Catherine T. Vu
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817
| | - Emilie Roncali
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616
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Alsultan AA, Braat AJAT, Smits MLJ, Barentsz MW, Bastiaannet R, Bruijnen RCG, de Keizer B, de Jong HWAM, Lam MGEH, Maccauro M, Chiesa C. Current Status and Future Direction of Hepatic Radioembolisation. Clin Oncol (R Coll Radiol) 2020; 33:106-116. [PMID: 33358630 DOI: 10.1016/j.clon.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 02/08/2023]
Abstract
Radioembolisation is a locoregional treatment modality for hepatic malignancies. It consists of several stages that are vital to its success, which include a pre-treatment angiographic simulation followed by nuclear medicine imaging, treatment activity choice, treatment procedure and post-treatment imaging. All these stages have seen much advancement over the past decade. Here we aim to provide an overview of the practice of radioembolisation, discuss the limitations of currently applied methods and explore promising developments.
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Affiliation(s)
- A A Alsultan
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - A J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M W Barentsz
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Bastiaannet
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R C G Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H W A M de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M Maccauro
- Nuclear Medicine Division, Foundation IRCCS National Cancer Institute, Milan, Italy
| | - C Chiesa
- Nuclear Medicine Division, Foundation IRCCS National Cancer Institute, Milan, Italy
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22
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Morán V, Prieto E, Sancho L, Rodríguez-Fraile M, Soria L, Zubiria A, Martí-Climent JM. Impact of the dosimetry approach on the resulting 90Y radioembolization planned absorbed doses based on 99mTc-MAA SPECT-CT: is there agreement between dosimetry methods? EJNMMI Phys 2020; 7:72. [PMID: 33284389 PMCID: PMC7721939 DOI: 10.1186/s40658-020-00343-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prior radioembolization, a simulation using 99mTc-macroaggregated albumin as 90Y-microspheres surrogate is performed. Gamma scintigraphy images (planar, SPECT, or SPECT-CT) are acquired to evaluate intrahepatic 90Y-microspheres distribution and detect possible extrahepatic and lung shunting. These images may be used for pre-treatment dosimetry evaluation to calculate the 90Y activity that would get an optimal tumor response while sparing healthy tissues. Several dosimetry methods are available, but there is still no consensus on the best methodology to calculate absorbed doses. The goal of this study was to retrospectively evaluate the impact of using different dosimetry approaches on the resulting 90Y-radioembolization pre-treatment absorbed dose evaluation based on 99mTc-MAA images. METHODS Absorbed doses within volumes of interest resulting from partition model (PM) and 3D voxel dosimetry methods (3D-VDM) (dose-point kernel convolution and local deposition method) were evaluated. Additionally, a new "Multi-tumor Partition Model" (MTPM) was developed. The differences among dosimetry approaches were evaluated in terms of mean absorbed dose and dose volume histograms within the volumes of interest. RESULTS Differences in mean absorbed dose among dosimetry methods are higher in tumor volumes than in non-tumoral ones. The differences between MTPM and both 3D-VDM were substantially lower than those observed between PM and any 3D-VDM. A poor correlation and concordance were found between PM and the other studied dosimetry approaches. DVH obtained from either 3D-VDM are pretty similar in both healthy liver and individual tumors. Although no relevant global differences, in terms of absorbed dose in Gy, between both 3D-VDM were found, important voxel-by-voxel differences have been observed. CONCLUSIONS Significant differences among the studied dosimetry approaches for 90Y-radioembolization treatments exist. Differences do not yield a substantial impact in treatment planning for healthy tissue but they do for tumoral liver. An individual segmentation and evaluation of the tumors is essential. In patients with multiple tumors, the application of PM is not optimal and the 3D-VDM or the new MTPM are suggested instead. If a 3D-VDM method is not available, MTPM is the best option. Furthermore, both 3D-VDM approaches may be indistinctly used.
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Affiliation(s)
- Verónica Morán
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Madrid, Spain
| | - Elena Prieto
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Lidia Sancho
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Madrid, Spain
| | - Macarena Rodríguez-Fraile
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain.,Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Leticia Soria
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Madrid, Spain
| | - Arantxa Zubiria
- Department of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Josep M Martí-Climent
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain. .,IdisNA, Navarra Institute for Health Research, Pamplona, Spain.
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Villalobos A, Soliman MM, Majdalany BS, Schuster DM, Galt J, Bercu ZL, Kokabi N. Yttrium-90 Radioembolization Dosimetry: What Trainees Need to Know. Semin Intervent Radiol 2020; 37:543-554. [PMID: 33328711 PMCID: PMC7732571 DOI: 10.1055/s-0040-1720954] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alexander Villalobos
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamed M. Soliman
- Weill Cornell Medicine – Qatar School of Medicine, Education City, Al Luqta St, Ar-Rayyan, Qatar
| | - Bill S. Majdalany
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David M. Schuster
- Division of Nuclear and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - James Galt
- Division of Nuclear and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary L. Bercu
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Brosch J, Gosewisch A, Kaiser L, Seidensticker M, Ricke J, Zellmer J, Bartenstein P, Ziegler S, Ilhan H, Todica A, Böning G. 3D image-based dosimetry for Yttrium-90 radioembolization of hepatocellular carcinoma: Impact of imaging method on absorbed dose estimates. Phys Med 2020; 80:317-326. [PMID: 33248338 DOI: 10.1016/j.ejmp.2020.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To improve therapy outcome of Yttrium-90 selective internal radiation therapy (90Y SIRT), patient-specific post-therapeutic dosimetry is required. For this purpose, various dosimetric approaches based on different available imaging data have been reported. The aim of this work was to compare post-therapeutic 3D absorbed dose images using Technetium-99m (99mTc) MAA SPECT/CT, Yttrium-90 (90Y) bremsstrahlung (BRS) SPECT/CT, and 90Y PET/CT. METHODS Ten SIRTs of nine patients with unresectable hepatocellular carcinoma (HCC) were investigated. The 99mTc SPECT/CT data, obtained from 99mTc-MAA-based treatment simulation prior to 90Y SIRT, were scaled with the administered 90Y therapy activity. 3D absorbed dose images were generated by dose kernel convolution with scaled 99mTc/90Y SPECT/CT, 90Y BRS SPECT/CT, and 90Y PET/CT data of each patient. Absorbed dose estimates in tumor and healthy liver tissue obtained using the two SPECT/CT methods were compared against 90Y PET/CT. RESULTS The percentage deviation of tumor absorbed dose estimates from 90Y PET/CT values was on average -2 ± 18% for scaled 99mTc/90Y SPECT/CT, whereas estimates from 90Y BRS SPECT/CT differed on average by -50 ± 13%. For healthy liver absorbed dose estimates, all three imaging methods revealed comparable values. CONCLUSION The quantification capabilities of the imaging data influence 90Y SIRT tumor dosimetry, while healthy liver absorbed dose values were comparable for all investigated imaging data. When no 90Y PET/CT image data are available, the proposed scaled 99mTc/90Y SPECT/CT dosimetry method was found to be more appropriate for HCC tumor dosimetry than 90Y BRS SPECT/CT based dosimetry.
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Affiliation(s)
- Julia Brosch
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Astrid Gosewisch
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lena Kaiser
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Johannes Zellmer
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sibylle Ziegler
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Guido Böning
- Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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25
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Toxicity and dosimetry in SORAMIC study. J Hepatol 2020; 73:734-735. [PMID: 32622664 DOI: 10.1016/j.jhep.2020.03.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/10/2020] [Accepted: 03/26/2020] [Indexed: 12/04/2022]
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26
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Chandra P, Nath S, Jain D. Complete Pathological Response Noted in Explanted Liver After Y90-SIR-Spheres Therapy for Hepatocellular Carcinoma. Indian J Nucl Med 2020; 35:267-268. [PMID: 33082694 PMCID: PMC7537917 DOI: 10.4103/ijnm.ijnm_23_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
In the treatment of hepatocellular carcinoma, achieving complete pathological response (CPR) in explanted liver specimens following any locoregional treatments is associated with reduced recurrence rates and better posttransplant survival compared to the incomplete response. Here, we present the imaging findings of a patient who achieved CPR in the explanted liver following Y-90 SIR-Spheres® therapy.
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Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
| | - Satish Nath
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
| | - Deepti Jain
- Department of Pathology, MIOT International, Chennai, Tamil Nadu, India
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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.
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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
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A guide to 90Y radioembolization and its dosimetry. Phys Med 2019; 68:132-145. [DOI: 10.1016/j.ejmp.2019.09.236] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 01/14/2023] Open
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Repeated Treatment with 90Y-Microspheres in Intrahepatic Cholangiocarcinoma Relapsed After the First Radioembolization. Cancer Biother Radiopharm 2019; 34:231-237. [DOI: 10.1089/cbr.2018.2718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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30
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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.
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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.
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Allimant C, Kafrouni M, Delicque J, Ilonca D, Cassinotto C, Assenat E, Ursic-Bedoya J, Pageaux GP, Mariano-Goulart D, Aho S, Guiu B. Tumor Targeting and Three-Dimensional Voxel-Based Dosimetry to Predict Tumor Response, Toxicity, and Survival after Yttrium-90 Resin Microsphere Radioembolization in Hepatocellular Carcinoma. J Vasc Interv Radiol 2018; 29:1662-1670.e4. [DOI: 10.1016/j.jvir.2018.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 12/21/2022] Open
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Bastiaannet R, Kappadath SC, Kunnen B, Braat AJAT, Lam MGEH, de Jong HWAM. The physics of radioembolization. EJNMMI Phys 2018; 5:22. [PMID: 30386924 PMCID: PMC6212377 DOI: 10.1186/s40658-018-0221-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/19/2018] [Indexed: 12/11/2022] Open
Abstract
Radioembolization is an established treatment for chemoresistant and unresectable liver cancers. Currently, treatment planning is often based on semi-empirical methods, which yield acceptable toxicity profiles and have enabled the large-scale application in a palliative setting. However, recently, five large randomized controlled trials using resin microspheres failed to demonstrate a significant improvement in either progression-free survival or overall survival in both hepatocellular carcinoma and metastatic colorectal cancer. One reason for this might be that the activity prescription methods used in these studies are suboptimal for many patients.In this review, the current dosimetric methods and their caveats are evaluated. Furthermore, the current state-of-the-art of image-guided dosimetry and advanced radiobiological modeling is reviewed from a physics' perspective. The current literature is explored for the observation of robust dose-response relationships followed by an overview of recent advancements in quantitative image reconstruction in relation to image-guided dosimetry.This review is concluded with a discussion on areas where further research is necessary in order to arrive at a personalized treatment method that provides optimal tumor control and is clinically feasible.
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Affiliation(s)
- Remco Bastiaannet
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - S. Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, TX 77030 USA
| | - Britt Kunnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Arthur J. A. T. Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Hugo W. A. M. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Kafrouni M, Allimant C, Fourcade M, Vauclin S, Delicque J, Ilonca AD, Guiu B, Manna F, Molinari N, Mariano-Goulart D, Ben Bouallègue F. Retrospective Voxel-Based Dosimetry for Assessing the Ability of the Body-Surface-Area Model to Predict Delivered Dose and Radioembolization Outcome. J Nucl Med 2018; 59:1289-1295. [DOI: 10.2967/jnumed.117.202937] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/30/2017] [Indexed: 01/24/2023] Open
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Samim M, van Veenendaal LM, Braat MNGJA, van den Hoven AF, Van Hillegersberg R, Sangro B, Kao YH, Liu D, Louie JD, Sze DY, Rose SC, Brown DB, Ahmadzadehfar H, Kim E, van den Bosch MAAJ, Lam MGEH. Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel. Eur Radiol 2017; 27:4923-4930. [PMID: 28674968 PMCID: PMC5674129 DOI: 10.1007/s00330-017-4889-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 03/15/2017] [Accepted: 05/11/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation (90Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres 90Y-RE, and to draw recommendations on activity prescription based on an expert consensus. METHODS The variability in activity prescription between centres was investigated by a survey of international experts in the field of 90Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients' disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated. RESULTS Ten experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18-55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum DTarget of 50 Gy was recommended. CONCLUSION With a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing 90Y-RE exists. In consensus, DTarget ≤50 Gy is recommended. KEY POINTS • BSA method does not account for a decreased remnant liver volume after surgery. • In post-surgical patients, a volume-based activity determination method is recommended. • In post-surgical patients, a mean D Target of ≤ 50Gy should be aimed for.
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Affiliation(s)
- Morsal Samim
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Linde M van Veenendaal
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon N G J A Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andor F van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain
| | - Yung Hsiang Kao
- Department of Nuclear Medicine, Cabrini Hospital, Melbourne, Australia
| | - Dave Liu
- Department of Radiology, Vancouver General Hospital. University of British Columbia, Vancouver, British Columbia, Canada
| | - John D Louie
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, USA
| | - Daniel Y Sze
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, USA
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, USA
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University, Medical Center North, Nashville, USA
| | | | - Edward Kim
- Division of Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Mañeru F, Abós D, Bragado L, Fuentemilla N, Caudepón F, Pellejero S, Miquelez S, Rubio A, Goñi E, Hernández-Vitoria A. Dosimetry and prescription in liver radioembolization with 90Y microspheres: 3D calculation of tumor-to-liver ratio from global 99mTc-MAA SPECT information. Phys Med Biol 2017; 62:9099-9111. [DOI: 10.1088/1361-6560/aa9536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Low-dose 90Y PET/CT imaging optimized for lesion detectability and quantitative accuracy. Nucl Med Commun 2017; 38:985-997. [DOI: 10.1097/mnm.0000000000000742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spahr N, Schilling P, Thoduka S, Abolmaali N, Schenk A. Predictive SIRT dosimetry based on a territorial model. EJNMMI Phys 2017; 4:25. [PMID: 29090358 PMCID: PMC5663990 DOI: 10.1186/s40658-017-0192-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/17/2017] [Indexed: 01/21/2023] Open
Abstract
Background In the planning of selective internal radiation therapy (SIRT) for liver cancer treatment, one major aspect is to determine the prescribed activity and to estimate the resulting absorbed dose inside normal liver and tumor tissue. An optimized partition model for SIRT dosimetry based on arterial liver territories is proposed. This model is dedicated to characterize the variability of dose within the whole liver. For an arbitrary partition, the generalized absorbed dose is derived from the classical partition model. This enables to consider normal liver partitions for each arterial perfusion supply area and one partition for each tumor for activity and dose calculation. The proposed method excludes a margin of 11 mm emitting range around tumor volumes from normal liver to investigate the impact on activity calculation. Activity and dose calculation was performed for five patients using the body-surface-area (BSA) method, the classical and territorial partition model. Results The territorial model reaches smaller normal liver doses and significant higher tumor doses compared to the classical partition model. The exclusion of a small region around tumors has a significant impact on mean liver dose. Determined tumor activities for the proposed method are higher in all patients when limited by normal liver dose. Activity calculation based on BSA achieves in all cases the lowest amount. Conclusions The territorial model provides a more local and patient-individual dose distribution in normal liver taking into account arterial supply areas. This proposed arterial liver territory-based partition model may be used for SPECT-independent activity calculation and dose prediction under the condition of an artery-based simulation for particle distribution.
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Affiliation(s)
- Nadine Spahr
- Fraunhofer Institute for Medical Image Computing MEVIS, Lübeck, Maria-Goeppert-Straße 3, Lübeck, 23562, Germany.
| | - Philipp Schilling
- Ressort TuW, Abt. MIT, FB Strahlenphysik, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstraße 41, Dresden, 01067, Germany
| | - Smita Thoduka
- Department of Radiology, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstraße 41, Dresden, 01067, Germany
| | - Nasreddin Abolmaali
- Department of Radiology, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstraße 41, Dresden, 01067, Germany
| | - Andrea Schenk
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359, Bremen, Germany
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Safety and Efficacy of Transarterial Radioembolization Combined with Chemoembolization for Bilobar Hepatocellular Carcinoma: A Single-Center Retrospective Study. Cardiovasc Intervent Radiol 2017; 41:459-465. [PMID: 29067511 DOI: 10.1007/s00270-017-1826-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radioembolization induced liver disease (REILD) is a possible sequela of transarterial radioembolization (TARE), particularly in cases of whole-liver treatment. To mitigate this problem, the safety and efficacy of combined transarterial chemoembolization (TACE) and TARE were evaluated for patients with bilobar hepatocellular carcinoma (HCC). MATERIALS AND METHODS Nineteen patients (mean age 60 years; range 27-82 years) treated for HCC between June 2012 and September 2014 were included in the analysis. Each patient was treated with combined TARE and TACE for bilobar HCC, with or without portal vein thrombosis. The hepatic lobe with large HCC was treated with TARE, and the other lobe with small HCC(s) was treated with TACE. Laboratory and clinical data were investigated to determine REILD occurrence. Survival data were analyzed to compare the treatment efficacy of alternative treatment modalities, including TACE and sequential TARE. RESULTS All patients underwent TARE for a dominant tumor in one lobe and TACE for small nodule(s) in the other lobe of the liver. The mean yttrium-90 microspheres used in TARE were 2.8 GBq (range; 1.0-3.5 GBq), and the mean doses of doxorubicin and iodized oil were 24.5 mg and 5.2 mL, respectively, for TACE. No statistical differences were noted between laboratory data measured before and after treatment, and no procedure-related major clinical complications occurred. The median time-to-progression of patients was 10.0 months, and the median overall survival was 27.3 months. CONCLUSION Combined radioembolization and chemoembolization appears to be a safe and effective treatment modality for bilobar HCC.
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Venkatanarasimha N, Gogna A, Tong KTA, Damodharan K, Chow PKH, Lo RHG, Chandramohan S. Radioembolisation of hepatocellular carcinoma: a primer. Clin Radiol 2017; 72:1002-1013. [PMID: 29032802 DOI: 10.1016/j.crad.2017.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 05/29/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
Abstract
Transarterial radioembolisation (TARE) has gained increasing acceptance as an additional/alternative locoregional treatment option for hepatocellular carcinoma, and colorectal hepatic metastases that present beyond potentially curative options. This is a catheter-based transarterial selective internal brachytherapy that involves injection of radioactive microspheres (usually Y-90) that are delivered selectively to the liver tumours. Owing to the combined radioactive and microembolic effect, the findings at follow-up imaging are significantly different from that seen with other transarterial treatment options. Considering increasing confidence among clinicians, refinement in techniques and increasing number of ongoing trials, TARE is expected to gain further acceptance and become an important tool in the armamentarium for the treatment of liver malignancies. So it is imperative that all radiologists involved in the management of liver malignancies are well versed with TARE to facilitate appropriate discussion at multidisciplinary meetings to direct further management. In this article, we provide a comprehensive review on various aspects of radioembolisation with Y-90 for hepatocellular carcinoma including the patient selection, treatment planning, radiation dosimetry and treatment, side effects, follow-up imaging and future direction.
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Affiliation(s)
| | - A Gogna
- Department of Diagnostic Radiology, Singapore
| | - K T A Tong
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | | | - P K H Chow
- Division of Surgical Oncology, National Cancer Center, Outram Road, Singapore, 169608
| | - R H G Lo
- Department of Diagnostic Radiology, Singapore
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Sangro B, Martínez-Urbistondo D, Bester L, Bilbao JI, Coldwell DM, Flamen P, Kennedy A, Ricke J, Sharma RA. Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review. Hepatology 2017; 66:969-982. [PMID: 28407278 DOI: 10.1002/hep.29207] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/02/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023]
Abstract
Selective internal radiation therapy (or radioembolization) by intra-arterial injection of radioactive yttrium-90-loaded microspheres is increasingly used for the treatment of patients with liver metastases or primary liver cancer. The high-dose beta-radiation penetrates an average of only 2.5 mm from the source, thus limiting its effects to the site of delivery. However, the off-target diversion of yttrium-90 microspheres to tissues other than the tumor may lead to complications. The most prominent of these complications include radiation gastritis and gastrointestinal ulcers, cholecystitis, radiation pneumonitis, and radioembolization-induced liver disease, which may occur despite careful pretreatment planning. Thus, selective internal radiation therapy demands an expert multidisciplinary team approach in order to provide comprehensive care for patients. This review provides recommendations to multidisciplinary teams on the optimal medical processes in order to ensure the safe delivery of selective internal radiation therapy. Based on the best available published evidence and expert opinion, we recommend the most appropriate strategies for the prevention, early diagnosis, and management of potential radiation injury to the liver and to other organs. (Hepatology 2017;66:969-982).
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Affiliation(s)
- Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Pamplona, Spain
| | - Diego Martínez-Urbistondo
- Liver Unit, Clinica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Lourens Bester
- Department of Interventional Radiology, University of New South Wales St. Vincent's Hospital, Darlinghurst, Australia
| | - Jose I Bilbao
- Department of Radiology, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Douglas M Coldwell
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Patrick Flamen
- Department of Nuclear Medicine, Jules Bordet Institute, Brussels, Belgium
| | - Andrew Kennedy
- Radiation Oncology, Sarah Cannon Research Institute, Nashville, TN
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Ricky A Sharma
- University College London, UCL Cancer Institute, London, UK
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Bastiaannet R, Viergever MA, de Jong HWAM. Impact of respiratory motion and acquisition settings on SPECT liver dosimetry for radioembolization. Med Phys 2017; 44:5270-5279. [PMID: 28736826 DOI: 10.1002/mp.12483] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/29/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Respiratory motion may impose significant inaccuracies on emission activity estimation in quantitative SPECT. This effect may be a major issue in dosimetry as used in the management of liver radioembolization. The purpose of this study was to investigate the impact of respiratory motion on radioembolization liver dosimetry for different SPECT acquisition settings. METHODS In a series of SPECT/CT Monte Carlo simulations using several digital XCAT phantoms, the following parameters were varied: breathing/nonbreathing, liver tumor size (0.3-35 ml) and location, patient properties (body mass index ranging from underweight to obese; male and female), acquisition time (10-30 s/view), collimator setup (High Sensitivity, High Resolution, Ultra High Resolution) and tumor VOI. The effect of applying a respiratory gating scheme was examined as well. RESULTS Breathing decreased activity recovery and tumor/non-tumor (T/N) ratios on average from 90% to 66%. VOIs based on SPECT images instead of breath-hold CT improved T/N values significantly. The most accurate results were obtained using a gating scheme combined with SPECT-based VOIs. Scan duration, body mass index, sex, and location all had a minor effect. Lung shunt fraction estimations were relatively unaffected by any of the varied parameters. CONCLUSIONS Respiratory motion has a large effect on SPECT activity quantitation of liver tumors as used in radioembolization treatment planning and assessment. As compared with the other parameters that were varied in this study, respiration is the predominant degrading effect on image quantitation. Gating alleviates much of this detrimental effect.
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Affiliation(s)
- Remco Bastiaannet
- Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, 3508GA, The Netherlands
| | - Max A Viergever
- Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, 3508GA, The Netherlands
| | - Hugo W A M de Jong
- Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, 3508GA, The Netherlands
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Hashikin NAA, Yeong CH, Guatelli S, Abdullah BJJ, Ng KH, Malaroda A, Rosenfeld A, Perkins AC. Systematic investigation on the validity of partition model dosimetry for90Y radioembolization using Monte Carlo simulation. ACTA ACUST UNITED AC 2017; 62:7342-7356. [DOI: 10.1088/1361-6560/aa7e5b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Van Der Gucht A, Jreige M, Denys A, Blanc-Durand P, Boubaker A, Pomoni A, Mitsakis P, Silva-Monteiro M, Gnesin S, Lalonde MN, Duran R, Prior JO, Schaefer N. Resin Versus Glass Microspheres for 90Y Transarterial Radioembolization: Comparing Survival in Unresectable Hepatocellular Carcinoma Using Pretreatment Partition Model Dosimetry. J Nucl Med 2017; 58:1334-1340. [PMID: 28082436 DOI: 10.2967/jnumed.116.184713] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/20/2016] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to compare survival of patients treated for unresectable hepatocellular carcinoma (uHCC) with 90Y transarterial radioembolization (TARE) using pretreatment partition model dosimetry (PMD). Methods: We performed a retrospective analysis of prospectively collected data on 77 patients consecutively treated (mean age ± SD, 66.4 ± 12.2 y) for uHCC (36 uninodular, 5 multinodular, 36 diffuse) with 90Y TARE (41 resin, 36 glass) using pretreatment PMD. Study endpoints were progression-free survival (PFS) and overall survival (OS) assessed by Kaplan-Meier estimates. Several variables including Barcelona Clinic Liver Cancer (BCLC) staging system, tumor size, and serum α-fetoprotein (AFP) level were investigated using Cox proportional hazards regression. Results: The characteristics of 2 groups were comparable with regard to demographic data, comorbidities, Child-Pugh score, BCLC, serum AFP level, and 90Y global administered activity. The median follow-up time was 7.7 mo (range, 0.4-50.1 mo). Relapse occurred in 44 patients (57%) at a median of 6 mo (range, 0.4-27.9 mo) after 90Y TARE, and 41 patients (53%) died from tumor progression. Comparison between resin and glass microspheres revealed higher but not statistically significantly PFS and OS rates in the 90Y resin group than the 90Y glass group (resin PFS 6.1 mo [95% confidence interval CI, 4.7-7.4] and glass PFS 5 mo [95% CI, 0.9-9.2], P = 0.53; resin OS 7.7 mo [95% CI, 7.2-8.2] and glass OS 7 mo [95% CI 1.6-12.4], P = 0.77). No significant survival difference between both types of 90Y microspheres was observed in any subgroups of patients with early/intermediate or advanced BCLC stages. Among the variables investigated, Cox analyses showed that only in the glass group, the BCLC staging system and the serum AFP level were associated with PFS (P = 0.04) and OS (P = 0.04). Tumor size was a prognostic factor without significant influence on PFS and OS after 90Y TARE. Conclusion: Comparison between resin and glass microspheres revealed no significant survival difference in patients treated for uHCC with 90Y TARE using pretreatment PMD. Further, larger prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Axel Van Der Gucht
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Paul Blanc-Durand
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Ariane Boubaker
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Anastasia Pomoni
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Periklis Mitsakis
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Marina Silva-Monteiro
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Nicod Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
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Padia SA, Lewandowski RJ, Johnson GE, Sze DY, Ward TJ, Gaba RC, Baerlocher MO, Gates VL, Riaz A, Brown DB, Siddiqi NH, Walker TG, Silberzweig JE, Mitchell JW, Nikolic B, Salem R. Radioembolization of Hepatic Malignancies: Background, Quality Improvement Guidelines, and Future Directions. J Vasc Interv Radiol 2017; 28:1-15. [DOI: 10.1016/j.jvir.2016.09.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 02/09/2023] Open
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Hsieh TC, Wu YC, Sun SS, Yen KY, Kao CH. Treating hepatocellular carcinoma with 90Y-bearing microspheres: a review. Biomedicine (Taipei) 2016; 6:19. [PMID: 27848114 PMCID: PMC5138159 DOI: 10.7603/s40681-016-0019-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 08/06/2016] [Indexed: 12/21/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a disease usually diagnosed in its advanced-stage, and is frequently not amenable to curative surgical treatment. Also, HCC is resistant to chemotherapy and less vulnerable to radiation therapy compared to normal hepatic parenchyma. Both of these facts render the efficacy of adjuvant and palliative treatments problematic. Selective internal radiation therapy (SIRT) with 90Y-bearing microspheres is characterized by preferentially delivering substantially high doses of radiation to a liver tumor dose simultaneously limiting the damage to its non-tumorous cells, providing an opportunity for effective local tumor control and even tumor regression therapy. The current article reviews the specific characters, dosimetry, possible applications, and special considerations toward the pre-existing radiation therapy of 90Y microsphere SIRT in treating HCC.
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Affiliation(s)
- Te-Chun Hsieh
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, No. 2, Yuh-Der Rd., North Dist., Taichung, 404, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, 404, Taichung, Taiwan
| | - Yu-Chin Wu
- Department of Nuclear Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu Branch, No. 25, Ln. 442. Sec. 1, Jingguo Rd., East Dist.,, Hsinchu City, 300, Taiwan.
| | - Shung-Shung Sun
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, No. 2, Yuh-Der Rd., North Dist., Taichung, 404, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, 404, Taichung, Taiwan
| | - Kuo-Yang Yen
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, No. 2, Yuh-Der Rd., North Dist., Taichung, 404, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, 404, Taichung, Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, No. 2, Yuh-Der Rd., North Dist., Taichung, 404, Taiwan. .,School of Medicine, China Medical University, 404, Taichung, Taiwan.
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Ingraham C, Johnson G, Padia SA, Vaidya S. Interventional Radiology for Liver Lesions. Semin Roentgenol 2016; 51:367-377. [PMID: 27743571 DOI: 10.1053/j.ro.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | - Guy Johnson
- Department of Interventional Radiology, University of Washington, Seattle, WA
| | - Siddharth A Padia
- Department of Interventional Radiology, University of Washington, Seattle, WA
| | - Sandeep Vaidya
- Department of Interventional Radiology, University of Washington, Seattle, WA.
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Gnesin S, Canetti L, Adib S, Cherbuin N, Silva Monteiro M, Bize P, Denys A, Prior JO, Baechler S, Boubaker A. Partition Model-Based 99mTc-MAA SPECT/CT Predictive Dosimetry Compared with 90Y TOF PET/CT Posttreatment Dosimetry in Radioembolization of Hepatocellular Carcinoma: A Quantitative Agreement Comparison. J Nucl Med 2016; 57:1672-1678. [PMID: 27307346 DOI: 10.2967/jnumed.116.173104] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/16/2016] [Indexed: 01/10/2023] Open
Abstract
90Y-microsphere selective internal radiation therapy (SIRT) is a valuable treatment in unresectable hepatocellular carcinoma (HCC). Partition-model predictive dosimetry relies on differential tumor-to-nontumor perfusion evaluated on pretreatment 99mTc-macroaggregated albumin (MAA) SPECT/CT. The aim of this study was to evaluate agreement between the predictive dosimetry of 99mTc-MAA SPECT/CT and posttreatment dosimetry based on 90Y time-of-flight (TOF) PET/CT. METHODS We compared the 99mTc-MAA SPECT/CT results for 27 treatment sessions (25 HCC patients, 41 tumors) with 90Y SIRT (7 glass spheres, 20 resin spheres) and the posttreatment 90Y TOF PET/CT results. Three-dimensional voxelized dose maps were computed from the 99mTc-MAA SPECT/CT and 90Y TOF PET/CT data. Mean absorbed dose ([Formula: see text]) was evaluated to compute the predicted-to-actual dose ratio ([Formula: see text]) in tumor volumes (TVs) and nontumor volumes (NTVs) for glass and resin spheres. The Lin concordance ([Formula: see text]) was used to measure accuracy ([Formula: see text]) and precision (ρ). RESULTS Administered activity ranged from 0.8 to 1.9 GBq for glass spheres and from 0.6 to 3.4 GBq for resin spheres, and the respective TVs ranged from 2 to 125 mL and from 6 to 1,828 mL. The mean dose [Formula: see text] was 240 Gy for glass and 122 Gy for resin in TVs and 72 Gy for glass and 47 Gy for resin in NTVs. [Formula: see text] was 1.46 ± 0.58 (0.65-2.53) for glass and 1.16 ± 0.41 (0.54-2.54) for resin, and the respective values for [Formula: see text] were 0.88 ± 0.15 (0.56-1.00) and 0.86 ± 0.2 (0.58-1.35). DR variability was substantially lower in NTVs than in TVs. The Lin concordance between [Formula: see text] and [Formula: see text] (resin) was significantly better for tumors larger than 150 mL than for tumors 150 mL or smaller ([Formula: see text] = 0.93 and [Formula: see text] = 0.95 vs. [Formula: see text] = 0.57 and [Formula: see text] = 0.93; P < 0.05). CONCLUSION In 90Y radioembolization of HCC, predictive dosimetry based on 99mTc-MAA SPECT/CT provided good estimates of absorbed doses calculated from posttreatment 90Y TOF PET/CT for tumor and nontumor tissues. The low variability of [Formula: see text] demonstrates that pretreatment dosimetry is particularly suitable for minimizing radiation-induced hepatotoxicity.
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Affiliation(s)
- Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurent Canetti
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Salim Adib
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Nicolas Cherbuin
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Marina Silva Monteiro
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Pierre Bize
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Alban Denys
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Sebastien Baechler
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Ariane Boubaker
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Lausanne, Switzerland; and
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Transarterial chemoembolization versus transarterial radioembolization in hepatocellular carcinoma: optimization of selecting treatment modality. Hepatol Int 2016; 10:883-892. [PMID: 27126821 DOI: 10.1007/s12072-016-9722-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/04/2016] [Indexed: 12/29/2022]
Abstract
Hepatocellular carcinoma (HCC) of intermediate stage consists of diverse tumor and patient factors in terms of tumor number, size and liver function resulting in various outcomes given by transarterial chemoembolization (TACE). Transarterial radioembolization (TARE) using radioactive isotope, β-ray emitting Yttrium-90 with a short half-life and penetration depth, is an emerging intra-arterial brachytherapy characterized by potent anti-cancer effect given by radiation but minimal embolic effect. Although there is lack of study directly comparing the efficacy and safety between TACE and TARE in patients with unresectable HCC, several retrospective or small-scaled studies suggest that overall efficacy indicated by overall survival and time to progression is similar between two modalities and TARE has a superiority in the safety including postembolization syndrome, hospitalization days and outpatient-based therapy. In advanced HCC with portal vein (PV) invasion, TACE is not consistently recommended due to risk of hepatic decompensation or failure after procedure. On the contrary, available data suggest that TARE might be a promising treatment option in HCC with PV thrombosis if patient's liver function is preserved and the level of PV invasion is less than main trunk. Ongoing trials comparing TARE and sorafenib in advanced HCC would elucidate the role of this locoregional therapy. The need of a multidisciplinary team, complex steps of procedure and high cost of TARE are the hurdles to widespread recommendation of this therapy in intermediate or advanced HCC. The optimization of selection between TACE and TARE might be dependent on availability, experience, tumor factors and patient factors.
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Kao YH, Lichtenstein M. Origin, dosimetric effect and clinical limitations of the semi-empirical body surface area method for radioembolisation using yttrium-90 resin microspheres. J Med Imaging Radiat Oncol 2016; 60:382-5. [DOI: 10.1111/1754-9485.12449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Yung Hsiang Kao
- Department of Nuclear Medicine; The Royal Melbourne Hospital; Parkville Victoria Australia
| | - Meir Lichtenstein
- Department of Nuclear Medicine; The Royal Melbourne Hospital; Parkville Victoria Australia
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Tong AKT, Kao YH, Too CW, Chin KFW, Ng DCE, Chow PKH. Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry. Br J Radiol 2016; 89:20150943. [PMID: 26943239 DOI: 10.1259/bjr.20150943] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In recent years, yttrium-90 ((90)Y) microsphere radioembolization has been establishing itself as a safe and efficacious treatment for both primary and metastatic liver cancers. This extends to both first-line therapies as well as in the salvage setting. In addition, radioembolization appears efficacious for patients with portal vein thrombosis, which is currently a contraindication for surgery, transplantation and transarterial chemoembolization. This article reviews the efficacy and expanding use of (90)Y microsphere radioembolization with an added emphasis on recent advances in personalized dosimetry and interventional radiology techniques. Directions for future research into combination therapies with radioembolization and expansion into sites other than the liver are also explored.
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Affiliation(s)
- Aaron K T Tong
- 1 Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - Yung Hsiang Kao
- 2 Department of Nuclear Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Chow Wei Too
- 3 Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - David C E Ng
- 1 Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - Pierce K H Chow
- 5 Department of Hepato-Pancreato-Biliary (HPB) and Transplant Surgery, Singapore General Hospital Surgical Oncology, National Cancer Centre, Singapore
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