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Bastiaannet R, Lin M, Frey EC, de Jong HW. Intraprocedural C-arm dual-phase cone-beam enhancement patterns correlate with tumor absorbed dose after radioembolization. Med Phys 2024; 51:3045-3052. [PMID: 38064591 PMCID: PMC10994751 DOI: 10.1002/mp.16882] [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: 03/30/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Recent studies have shown a clear relationship between absorbed dose and tumor response to treatment after hepatic radioembolization. These findings help to create more personalized treatment planning and dosimetry. However, crucial to this goal is the ability to predict the dose distribution prior to treatment. The microsphere distribution is ultimately determined by (i) the hepatic vasculature and the resulting blood flow dynamics and (ii) the catheter position. PURPOSE To show that pretreatment, intra-procedural imaging of blood flow patterns, as quantified by catheter-directed intra-arterial contrast enhancement, correlate with posttreatment microsphere accumulation and, consequently, absorbed dose. MATERIALS AND METHODS Patients who participated in a clinical trial (NCT01177007) and for whom both a pretreatment dual-phase contrast-enhanced cone-beam CT (CBCT) and a posttreatment 90Y PET/CT scan were available were included in this retrospective study. Tumors and perfused volumes were manually delineated on the CBCT by an experienced radiologist. The mean, sum, and standard deviation of the voxels in each volume were recorded. The delineations were transferred to the PET-based absorbed dose maps by coregistration of the corresponding CTs. Linear multiple regression was used to correlate pretreatment CBCT enhancement to posttreatment 90Y PET/CT-based absorbed dose in each region. Leave-one-out cross-validation and Bland-Altman analyses were performed on the predicted versus measured absorbed doses. RESULTS Nine patients, with a total of 23 tumors were included. All presented with hepatocellular carcinoma (HCC). Visually, all patients had a clear correspondence between CBCT enhancement and absorbed dose. The correlation between CBCT enhancement and posttherapy absorbed tumor dose based was strong (R2 = 0.91), and moderate for the non-tumor liver tissue (R2 = 0.61). Limits of agreement were approximately ±55 Gray for tumor tissue. CONCLUSION There is a linear relationship between pretreatment blood dynamics in HCC tumors and posttreatment absorbed dose, which, if shown to be generalizable, allows for pretreatment tumor absorbed dose prediction.
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Affiliation(s)
- Remco Bastiaannet
- The Russell H Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Eric C. Frey
- The Russell H Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Hugo W.A.M. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Ingenerf M, Grawe F, Winkelmann M, Karim H, Ruebenthaler J, Fabritius MP, Ricke J, Seidensticker R, Auernhammer CJ, Zacherl MJ, Seidensticker M, Schmid-Tannwald C. Neuroendocrine liver metastases treated using transarterial radioembolization: Identification of prognostic parameters at 68Ga-DOTATATE PET/CT. Diagn Interv Imaging 2024; 105:15-25. [PMID: 37453859 DOI: 10.1016/j.diii.2023.06.007] [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: 04/03/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To identify prognostic clinical and imaging parameters for patients with neuroendocrine liver metastases (NELMs) undergoing transarterial radioembolization (TARE). MATERIALS AND METHODS Forty-seven patients (27 men; mean age, 64 years) with NELMs who received TARE, along with pre-procedure liver MRI and 68Ga-DOTATATE positron emission tomography/computed tomography were included. Apparent diffusion coefficient and standardized uptake value (SUV) of three liver metastases, normal spleen and liver were measured. SUVmax or SUVmean were used for the calculation of tumor-to-organ ratios (tumor-to-spleen and tumor-to-liver ratios) using all possible combinations (including SUVmax/SUVmax, SUVmax/SUVmean, and SUVmean/SUVmean). Clinical parameters (hepatic tumor-burden, presence of extra-hepatic metastases, chromograninA, Ki-67 and bilirubin levels) were assessed. Overall survival, progression-free survival (PFS) and hepatic progression-free survival (HPFS) were calculated using Kaplan-Meier curves. RESULTS Median overall survival, PFS and HPFS were 49.6, 13.1 and 28.3 months, respectively. In multivariable Cox regression analysis, low Ki-67 (≤ 5%), low hepatic tumor-burden (< 10%), absence of extrahepatic metastases, and increased Tmean/Lmax ratio were significant prognostic factors of longer overall survival and HPFS. High baseline chromograninA (> 1330 ng/mL) was associated with shorter HPFS. Tmean/Lmax > 1.9 yielded a median overall survival of 69 vs. 33 months (P < 0.04), and a median HPFS of 30 vs. 19 months (P = 0.09). For PFS, high baseline SUVmax of NELMs was the single significant parameter in the multivariable model. SUVmax > 28 resulted in a median PFS of 16.9 vs. 6.5 months, respectively (P = 0.001). CONCLUSION High preinterventional Tmean/Lmax ratios, and high SUVmax on 68Ga-DOTATATE positron emission tomography/computed tomography seem to have prognostic value in patients with NELMs undergoing TARE, potentially aiding patient selection and management alongside conventional variables.
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Affiliation(s)
- Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Freba Grawe
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Michael Winkelmann
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Homeira Karim
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Johannes Ruebenthaler
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Christoph Josef Auernhammer
- Department of Internal Medicine 4, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Christine Schmid-Tannwald
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; Interdisciplinary Centre of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospital, LMU Munich, 81377 Munich, Germany
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Kedra A, Dohan A, Biau D, Belbachir A, Dautry R, Lucas A, Aissaoui M, Feydy A, Soyer P, Barat M. Preoperative Arterial Embolization of Musculoskeletal Tumors: A Tertiary Center Experience. Cancers (Basel) 2023; 15:cancers15092657. [PMID: 37174122 PMCID: PMC10177012 DOI: 10.3390/cancers15092657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and functional outcomes. Patients who underwent preoperative TAE of hypervascular musculoskeletal tumors between January 2018 and December 2021 were retrospectively included. The patients' characteristics, TAE procedure details, degree of post-TAE devascularization, surgical outcomes in terms of red blood cell transfusion and functional results were collected. The degree of devascularization was compared between patients who had peri-operative transfusion and those who did not. Thirty-one patients were included. The 31 TAE procedures led to complete (58%) or near-complete (42%) tumor devascularization. Twenty-two patients (71%) had no blood transfusion during surgery. Nine patients (29%) had a blood transfusion, with a median number of red blood cell packs of three (q1, 2; q3, 4; range: 1-4). Eight patients (27%) had complete improvement of the initial musculoskeletal symptoms at the end of the follow-up, 15 (50%) had partially satisfying improvement, 4 (13%) had partially unsatisfying improvement and 3 (10%) had no improvement. Our study suggests that preoperative TAE of hypervascular musculoskeletal tumors allowed for bloodless surgery in 71% of patients and minimal transfusion needs for the remaining 29%.
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Affiliation(s)
- Alice Kedra
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - David Biau
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Orthopedic Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anissa Belbachir
- Department of Anesthesiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Raphael Dautry
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Alexandre Lucas
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Mathilde Aissaoui
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Antoine Feydy
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Musculoskeletal Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Philippe Soyer
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Maxime Barat
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
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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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The evaluation of DLCO changes in patients with relatively higher lung shunt fractions receiving TARE. Ann Nucl Med 2023; 37:131-138. [PMID: 36436111 DOI: 10.1007/s12149-022-01810-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Transarterial radioembolization (TARE) with Yttrium-90 (90Y) labeled microspheres is an effective locoregional treatment option for patients with primary and metastatic liver cancer. However, TARE is also associated with radiation-induced lung injury due to hepatopulmonary shunting. If a large proportion of the injected radionuclide microspheres (more than 15%) is shunted, a rare but lethal complication may develop: radiation-induced pneumonitis (RP). Diffusion capacity of the lungs for carbon monoxide (DLCO) is a valuable test to assess lung function and a decrease in DLCO may indicate an impairment in gas exchange caused by the lung injury. Some previous researches have been reported the most consistent changes in pulmonary function tests after external beam radiotherapy are recorded with DLCO. This study aimed to examine the changes in DLCO after TARE with glass microspheres in newly treated and retreated patients with relatively higher lung shunt fractions. METHODS We prospectively analyzed forty consecutive patients with liver malignancies who underwent lobar or superselective TARE with 90Y glass microspheres. DLCO tests were performed at baseline and on days 15, 30, and 60 after the treatment. All patients were followed up clinically and radiologically for the development of RP. RESULTS A statistically significant decrease was found in the DLCO after the first treatment (81.4 ± 13.66 vs. 75.25 ± 13.22, p = 0.003). The frequency of the patients with impaired DLCO at baseline was significantly increased after the first treatment (37.5 vs 57.5% p < 0.05). In the retreated group (n = 8), neither the DLCO (71.5 ± 10.82 vs. 67.50 ± 11.24, p = 0.115) nor the frequency of patients with impaired DLCO (25 vs 25%, p = 1) did not significantly change. Also, the change in DLCO values did not significantly correlate with lung shunt fraction, administered radiation dose, and absorbed lung dose after the first and second treatments (p > 0.05 for all). None of the patients developed RP. CONCLUSION Our study showed that a significant reduction in DLCO after TARE may occur in patients with relatively higher lung shunt fractions. Further studies with larger sample sizes are needed to better investigate the changes in DLCO in patients with high lung shunt fractions.
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Young S, Flanagan S, D'Souza D, Todatry S, Ragulojan R, Sanghvi T, Golzarian J. Lung shunt fraction calculations before Y-90 transarterial radioembolization: Comparison of accuracy and clinical significance of planar scintigraphy and SPECT/CT. Diagn Interv Imaging 2023; 104:185-191. [PMID: 36604211 DOI: 10.1016/j.diii.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To determine the accuracy and clinical significance of planar scintigraphy lung shunt fraction (PLSF) and single-photon emission computerized tomography (SPECT) computed tomography (CT) lung shunt fraction (SLSF) before Y-90 transarterial radioembolization. MATERIALS AND METHODS Seventy patients (46 men, 24 women; mean age, 64 ± 9.5 [SD] years) who underwent 83 treatments with Y-90 transarterial radioembolization for primary or secondary malignancies of the liver with a PLSF ≥ 7.5% were retrospectively evaluated. The patients mapping technetium 99 m (Tc-99 m) macroaggregated albumin (MAA) PLSF and SLSF were calculated and compared to the post Y-90 delivery SLSF. A model using modern dose thresholds was created to identify patients who would require dose reduction due to a lung dose ≥ 30 Gy, with patients who required >50% dose reduction considered to be delivery cancelations. RESULTS A significant difference was found between mean PLSF (14.7 ± 11.6 [SD]%; range: 7.5-84.1%) and mean SLSF (8.7 ± 8.5 [SD]%; range: 1.7-73.5) (P < 0.001). The mean realized LSF (7.1 ± 3 [SD]%; range:1.5-17.6) was significantly less than the PLSF (P <0.001) but not the SLSF (P = 0.07). PLSF significantly overestimated the realized LSF by more than the SLSF (8.5 ± 5.3 [SD] % [range: -0.1-21.7] vs. 0.8 ± 3.6 [SD] % [range: -5-13.2], respectively) (P < 0.001). Based on the clinical significance model, 20 patients (20/83, 24.1%) would have required dose reduction or cancelation when using PLSF but would not require even a dose reduction when using the SLSF. Significantly more deliveries would have been be canceled if PLSF was used as compared to SLSF (22/83 [26.5%] vs. 6/83 [7.2%], respectively) (P < 0.001). CONCLUSION SLSF is significantly more accurate at predicting realized LSF than PLSF and this difference is of clinical significance in a number of patients with a PLSF ≥ 7.5%.
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Affiliation(s)
- Shamar Young
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona, Tucson, AZ 85724, USA
| | - Siobhan Flanagan
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Donna D'Souza
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Soorya Todatry
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ranjan Ragulojan
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Tina Sanghvi
- Department of Radiology, Arizona Veterans Administration Hospital, Minneapolis, MN 55417, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, Minneapolis, MN 55455, USA
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Semiautomatic Cone-Beam Computed Tomography Virtual Hepatic Volumetry for Intra-Arterial Therapies. J Vasc Interv Radiol 2022; 34:790-798. [PMID: 36563933 DOI: 10.1016/j.jvir.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate a software simulating the perfused liver volume from virtual selected embolization points on proximal enhanced cone-beam computed tomography (CT) liver angiography data set using selective cone-beam CT as a reference standard. MATERIALS AND METHODS Seventy-eight selective/proximal cone-beam CT couples in 46 patients referred for intra-arterial liver treatment at 2 recruiting centers were retrospectively included. A reference selective volume (RSV) was calculated from the selective cone-beam CT by manual segmentation and was used as a reference standard. The virtual perfusion volume (VPV) was then obtained using Liver ASSIST Virtual Parenchyma software on proximal cone-beam CT angiography using the same injection point as for selective cone-beam CT. RSV and VPV were then compared as absolute, relative, and signed volumetric errors (ABSErr, RVErr, and SVErr, respectively), whereas their spatial correspondence was assessed using the Dice similarity coefficient. RESULTS The software was technically successful in automatically computing VPV in 74 of 78 (94.8%) cases. In the 74 analyzed couples, the median RSV was not significantly different from the median VPV (394 mL [196-640 mL] and 391 mL [192-620 mL], respectively; P = .435). The median ABSErr, RVErr, SVErr, and Dice similarity coefficient were 40.9 mL (19.9-97.7 mL), 12.8% (5%-22%), 9.9 mL (-49.0 to 40.4 mL), and 80% (76%-84%), respectively. No significant ABSErr, RVErr, SVErr, and Dice similarity coefficient differences were found between the 2 centers (P = .574, P = .612, P = .416, and P = .674, respectively). CONCLUSIONS Perfusion hepatic volumes simulated on proximal enhanced cone-beam CT using the virtual parenchyma software are numerically and spatially similar to those manually obtained on selective cone-beam CT.
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Trans-arterial Radioembolization Dosimetry in 2022. Cardiovasc Intervent Radiol 2022; 45:1608-1621. [PMID: 35982334 DOI: 10.1007/s00270-022-03215-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/26/2022] [Indexed: 11/02/2022]
Abstract
Trans-arterial radioembolization is currently performed using 90Y-loaded glass or resin microspheres and also using 166Ho-loaded microspheres. The goal of this review is to present dosimetry and radiobiology concepts, the different dosimetry approaches available (simulation-based dosimetry and post-treatment dosimetry), main confounding factors as main clinical dosimetry results provided during the last decade for both hepatocellular carcinoma (HCC) and metastases of colorectal carcinoma (mCRC). Based on the different number of microspheres or different isotope used, radiobiology of the three devices is different, meaning that tumouricidal doses and maximal tolerated doses are different. Tumouricidal doses described for HCCs were 100-120 grays (Gy) with 90Y resin microspheres and 205 Gy with 90Y glass microspheres. For mCRC, it is 39-60 with 90Y resin microspheres, 139 Gy with 90Y glass microspheres and 90 Gy with 166Ho microspheres. An impact of tumoural doses with overall survival has also been reported. Personalised dosimetry has been developed and is now recommended by several international expert groups. Level-one evidence of the major impact of personalised dosimetry on response and overall survival in HCC is now available, bringing a new standard approach for TARE in clinical practice as well as for trial design.
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Falette Puisieux M, Pellat A, Assaf A, Ginestet C, Brezault C, Dhooge M, Soyer P, Coriat R. Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review. Cancers (Basel) 2022; 14:cancers14102357. [PMID: 35625962 PMCID: PMC9139863 DOI: 10.3390/cancers14102357] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) usually occurs in the setting of liver cirrhosis and more rarely in a healthy liver. Its incidence has increased in the past years, especially in western countries with the rising prevalence of non-alcoholic fatty liver disease. The prognosis of advanced HCC is low. In the first-line setting of advanced HCC, sorafenib, a tyrosine kinase inhibitor, was the only validated treatment for many years. In 2020, the combination of atezolizumab, an immune checkpoint inhibitor, and bevacizumab showed superiority to sorafenib alone in survival, making it the first-line recommended treatment. Regorafenib and lenvatinib, other multikinase inhibitors, were also validated in the second and first-line settings, respectively. Transarterial chemoembolization can be an alternative treatment for patients with intermediate-stage HCC and preserved liver function, including unresectable multinodular HCC without extrahepatic spread. The current challenge in advanced HCC lies in the selection of a patient for the optimal treatment, taking into account the underlying liver disease and liver function. Indeed, all trial patients present with a Child-Pugh score of A, and the optimal approach for other patients is still unclear. Furthermore, the combination of atezolizumab and bevacizumab should be considered in the absence of medical contraindication. Many trials testing immune checkpoint inhibitors in association with anti-angiogenic agents are ongoing, and primary results are promising. The landscape in advanced HCC management is undergoing profound change, and many challenges remain for optimal patient management in the years to come. This review aimed to provide an overview of current systemic treatment options for patients with advanced unresectable HCC who are not candidates for liver-directed therapy.
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Affiliation(s)
- Manon Falette Puisieux
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
- Correspondence: ; Tel.: +33-1-58-41-19-52
| | - Anna Pellat
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Antoine Assaf
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Claire Ginestet
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Catherine Brezault
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Marion Dhooge
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Philippe Soyer
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
- Radiology Department, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
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Aujay G, Etchegaray C, Blanc JF, Lapuyade B, Papadopoulos P, Pey MA, Bordenave L, Trillaud H, Saut O, Pinaquy JB. Comparison of MRI-based response criteria and radiomics for the prediction of early response to transarterial radioembolization in patients with hepatocellular carcinoma. Diagn Interv Imaging 2022; 103:360-366. [DOI: 10.1016/j.diii.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
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Subreville C, Pinaquy JB, Lapuyade B, Blanc JF, Bordenave L, Papadopoulos P, Debordeaux F. Key Role of Personalized Dosimetry in Dose Adjustment for Selective Internal Radiotherapy: Retrospective Study of Patients Treated With 90Y Resin Microspheres. Clin Nucl Med 2021; 46:958-964. [PMID: 34507332 DOI: 10.1097/rlu.0000000000003892] [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: 11/26/2022]
Abstract
PURPOSE Selective internal radiotherapy with 90Y microspheres is widely used for the treatment of patients with liver cancer. A dosimetric analysis using the dosimetry software Simplicit90y (Boston Scientific, Natick, MA) was conducted to define doses to the tumor and healthy liver, and to determine a threshold tumor dose that could predict progression-free survival. METHODS Patients experiencing hepatocellular carcinoma and treated with 90Y-labeled resin microspheres were included in a retrospective study. The time-to-progression of the target lesions (TTPLs) and overall survival (OS) were evaluated using Kaplan-Meier tests, and this comparison was based on a log-rank test. RESULTS Twenty-four procedures for patients with portal vein thrombosis were realized. Median follow-up was 16 months. A threshold tumor dose of 125 Gy was determined with a sensitivity of 89% and a specificity of 100%. For patients with a tumor dose of less than 125 Gy, the median OS was 7.5 months (95% confidence interval [CI], 5-14 months) and the TTPL was 3 months (95% CI, 2-6 months) versus 33 months (95% CI, 22-39 months) and 23 months (95% CI, 7-38 months), respectively, for those with a tumor dose of 125 Gy or more (P = 0.002 and P = 0.0004). CONCLUSIONS Personalized dosimetry based on 99mTc-MAA SPECT/CT is predictive of TTPL and OS in patients with hepatocellular carcinoma. Customized dosimetry software is essential to optimize treatment planning.
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Affiliation(s)
| | | | - Bruno Lapuyade
- Service de Radiologie et d'Imagerie Diagnostique et Interventionnelle
| | - Jean-Frederic Blanc
- Service d'Hépato-Gastro-Entérologie et Oncologie Digestive, CHU de Bordeaux, Bordeaux, France
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Comparison of the Uptake of Hepatocellular Carcinoma on Pre-Therapeutic MDCT, CACT, and SPECT/CT, and the Correlation with Post-Therapeutic PET/CT in Patients Undergoing Selective Internal Radiation Therapy. J Clin Med 2021; 10:jcm10173837. [PMID: 34501284 PMCID: PMC8432038 DOI: 10.3390/jcm10173837] [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: 07/30/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022] Open
Abstract
(1) Background: To comparatively analyze the uptake of hepatocellular carcinoma (HCC) on pre-therapeutic imaging modalities, the arterial phase multi-detector computed tomography (MDCT), the parenchymal phase C-arm computed tomography (CACT), the Technetium99m-macroaggregates of human serum albumin single-photon emission computed tomography/computed tomography (SPECT/CT), and the correlation to the post-therapeutic Yttrium90 positron emission tomography/computed tomography (PET/CT) in patients with selective internal radiation therapy (SIRT). (2) Methods: Between September 2013 and December 2016, 104 SIRT procedures were performed at our institution in 74 patients with HCC not suitable for curative surgery or ablation. Twenty-two patients underwent an identical sequence of pre-therapeutic MDCT, CACT, SPECT/CT, and post-therapeutic PET/CT with a standardized diagnostic and therapeutic protocol. In these 22 patients, 25 SIRT procedures were evaluated. The uptake of the HCC was assessed using tumor-background ratio (TBR). Therefore, regions of interest were placed on the tumor and the adjacent liver tissue on MDCT (TBRMDCT), CACT (TBRCACT), SPECT/CT (TBRSPECT/CT), and PET/CT (TBRPET/CT). Comparisons were made with the Friedman test and the Nemenyi post-hoc test. Correlations were analyzed using Spearman’s Rho and the Benjamini–Hochberg method. The level of significance was p < 0.05. (3) Results: TBR on MDCT (1.4 ± 0.3) was significantly smaller than on CACT (1.9 ± 0.6) and both were significantly smaller compared to SPECT/CT (4.6 ± 2.0) (pFriedman-Test < 0.001; pTBRMDCT/TBRCACT = 0.012, pTBRMDCT/TBRSPECT/CT < 0.001, pTBRCACT/TBRSPECT/CT < 0.001). There was no significant correlation of TBR on MDCT with PET/CT (rTBRMDCT/TBRPET/CT = 0.116; p = 0.534). In contrast, TBR on CACT correlated to TBR on SPECT/CT (rTBRCACT/TBRSPECT/CT = 0.489; p = 0.004) and tended to correlate to TBR on PET/CT (rTBRCACT/TBRPET/CT =0.365; p = 0.043). TBR on SPECT/CT correlated to TBR on PET/CT (rTBRSPECT/CT/TBRPET/CT = 0.706; p < 0.001) (4) Conclusion: The uptake assessment on CACT was in agreement with SPECT/CT and might be consistent with PET/CT. In contrast, MDCT was not comparable to CACT and SPECT/CT, and had no correlation with PET/CT due to the different application techniques. This emphasizes the value of the CACT, which has the potential to improve the dosimetric assessment of the tumor and liver uptake for SIRT.
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