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Kim TP, Gandhi RT, Tolakanahalli R, Herrera R, Chuong MD, Gutierrez AN, Alvarez D. Establishing Updated Safety Standards for Independent 99mTc-MAA SPECT/CT Treatment Planning in Radioembolization. Int J Radiat Oncol Biol Phys 2024; 119:1285-1296. [PMID: 38925768 DOI: 10.1016/j.ijrobp.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 06/28/2024]
Abstract
PURPOSE Significant improvements within radioembolization imaging and dosimetry permit the development of an accurate and personalized pretreatment plan using technetium 99m-labeled macroaggregated albumin (99mTc-MAA) and single-photon emission computed tomography (SPECT) combined with anatomical CT (SPECT/CT). Despite these potential advantages, the clinical transition to pretreatment protocols with SPECT/CT is hindered by their unknown safety constraints. This study aimed to address this issue by establishing novel dose limits for 99mTc-MAA SPECT/CT to enable quantitative pretreatment planning. METHODS AND MATERIALS Stratification criteria to determine images most viable for dosimetry analysis were created from a cohort of 85 patients. SPECT/CT, cone beam CT, and activity calculations derived from the local deposition method were used to create an accurate pretreatment protocol. Planar and SPECT/CT images were compared using linear regression and modified Bland-Altman analyses to convert accepted planar dose limits to SPECT/CT. To validate these new dose limits, activity calculations based on SPECT/CT were compared with those calculated with the body surface area and planar methods for three treatment plans. RESULTS A total of 38 of 85 patients were deemed viable for dosimetry analysis. SPECT yielded greater lung shunt fractions (LSFs) than planar imaging when LSFs were <4.89%, whereas SPECT yielded lower LSFs than planar imaging when LSFs were >4.89%. Planar to SPECT/CT dose conversions were 0.76×, 0.70×, and 0.55× for the whole liver, normal liver, and lungs, respectively. Patients with SPECT LSFs ≤4.89% were safely treated with the direct application of planar lung dose limits. Activity calculations with the newly established SPECT/CT dose limits were greater than those of the body surface area method by a median range of 33.1% to 61.9% and were lower than planar-based activity calculations by a median range of 12.5% to 13.7% for the whole liver and by 29.4% to 32.2% for the normal liver. CONCLUSIONS This study demonstrated a safe method for translating dose limits from 99mTc-MAA planar imaging to SPECT/CT. A robust pretreatment protocol was further developed guided by the current knowledge in the field. Established SPECT/CT dose limits safely treated 97.5% of patients and permitted the application of independent pretreatment planning with 99mTc-MAA SPECT/CT.
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Affiliation(s)
| | - Ripal T Gandhi
- Radiation Oncology Department, Miami Cancer Institute, Miami, Florida; Interventional Radiology Department, Miami Cardiac and Vascular Institute, Miami, Florida
| | | | - Robert Herrera
- Radiation Oncology Department, Miami Cancer Institute, Miami, Florida
| | - Michael D Chuong
- Radiation Oncology Department, Miami Cancer Institute, Miami, Florida
| | | | - Diane Alvarez
- Radiation Oncology Department, Miami Cancer Institute, Miami, Florida
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Kovan B, Denizmen D, Civan C, Kuyumcu S, Isik EG, Has Simsek D, Ozkan ZG, Poyanli A, Demir B, Sanli Y. Influence of Early Versus Delayed Hepatic Artery Perfusion Scan on 90Y Selective Internal Radiation Therapy Planning. Cancer Biother Radiopharm 2024; 39:330-336. [PMID: 38265813 DOI: 10.1089/cbr.2023.0149] [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] [Indexed: 01/25/2024] Open
Abstract
Purpose: This study evaluated the effect of an increase in the time interval between hepatic intra-arterial injection of 99mTc-macroaggregated albumin (MAA) and hepatic artery perfusion scintigraphy (HAPS) on the lung shunt fraction (LSF) and perfused volume (PV) calculations in the treatment planning of selective internal radiation therapy (SIRT). Methods: The authors enrolled 51 HAPS sessions from 40 patients diagnosed with primary or metastatic liver malignancy. All patients underwent scan at the first and fourth hour after hepatic arterial injection of 99mTc-MAA. Based on single-photon emission computed tomography images, LSF values were measured from each patient's first and fourth hour images. PV1 and PV4 were also calculated based on three-dimensional images using 5% and 10% cutoff threshold values and compared with each other. Results: The authors found that the median of LSF4 was statistically significantly higher than LSF1 (3.05 vs. 4.14, p ≤ 0.01). There was no statistically significant difference between PV1 and PV4 on the 10% (p = 0.72) thresholds. Conclusions: LSF values can be overestimated in case of delayed HAPS, potentially leading to treatment cancellation due to incorrectly high results in patients who could benefit from SIRT. Threshold-based PV values do not significantly change over time; nevertheless, keeping the short interval time would be safer.
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Affiliation(s)
- Bilal Kovan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Dilara Denizmen
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Caner Civan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Serkan Kuyumcu
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Emine Goknur Isik
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Duygu Has Simsek
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Zeynep Gozde Ozkan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Arzu Poyanli
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Bayram Demir
- Department of Physics, Faculty of Science, Istanbul University, Fatih/İstanbul, Turkey
| | - Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
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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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Zeimpekis KG, Mercolli L, Conti M, Sari H, Rominger A, Rathke H. 90Y post-radioembolization clinical assessment with whole-body Biograph Vision Quadra PET/CT: image quality, tumor, liver and lung dosimetry. Eur J Nucl Med Mol Imaging 2024; 51:2100-2113. [PMID: 38347299 PMCID: PMC11139701 DOI: 10.1007/s00259-024-06650-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/07/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Evaluation of 90Y liver radioembolization post-treatment clinical data using a whole-body Biograph Vision Quadra PET/CT to investigate the potential of protocol optimization in terms of scan time and dosimetry. METHODS 17 patients with hepatocellular carcinoma with median (IQR) injected activity 2393 (1348-3298) MBq were included. Pre-treatment dosimetry plan was based on 99mTc-MAA SPECT/CT with Simplicit90Y™ and post-treatment validation with Quadra using Simplicit90Y™ and HERMIA independently. Regarding the image analysis, mean and peak SNR, the coefficient of variation (COV) and lesion-to-background ratio (LBR) were evaluated. For the post-treatment dosimetry validation, the mean tumor, whole liver and lung absorbed dose evaluation was performed using Simplicit90Y and HERMES. Images were reconstructed with 20-, 15-, 10-, 5- and 1- min sinograms with 2, 4, 6 and 8 iterations. Wilcoxon signed rank test was used to show statistical significance (p < 0.05). RESULTS There was no difference of statistical significance between 20- and 5- min reconstructed times for the peak SNR, COV and LBR. In addition, there was no difference of statistical significance between 20- and 1- min reconstructed times for all dosimetry metrics. Lung dosimetry showed consistently lower values than the expected. Tumor absorbed dose based on Simplicit90Y™ was similar to the expected while HERMES consistently underestimated significantly the measured tumor absorbed dose. Finally, there was no difference of statistical significance between expected and measured tumor, whole liver and lung dose for all reconstruction times. CONCLUSION In this study we evaluated, in terms of image quality and dosimetry, whole-body PET clinical images of patients after having been treated with 90Y microspheres radioembolization for liver cancer. Compared to the 20-min standard scan, the simulated 5-min reconstructed images provided equal image peak SNR and noise behavior, while performing also similarly for post-treatment dosimetry of tumor, whole liver and lung absorbed doses.
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Affiliation(s)
- Konstantinos G Zeimpekis
- Department of Nuclear Medicine, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland.
| | - Lorenzo Mercolli
- Department of Nuclear Medicine, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland
| | - Maurizio Conti
- Molecular Imaging, Siemens Healthineers, Knoxville, TN, USA
| | - Hasan Sari
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland
| | - Hendrik Rathke
- Department of Nuclear Medicine, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland
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Kim TP, Enger SA. Characterizing the voxel-based approaches in radioembolization dosimetry with reDoseMC. Med Phys 2024; 51:4007-4027. [PMID: 38703394 DOI: 10.1002/mp.17054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Yttrium-90 (90 Y $^{90}{\rm {Y}}$ ) represents the primary radioisotope used in radioembolization procedures, while holmium-166 (166 Ho $^{166}{\rm {Ho}}$ ) is hypothesized to serve as a viable substitute for90 Y $^{90}{\rm {Y}}$ due to its comparable therapeutic potential and improved quantitative imaging. Voxel-based dosimetry for these radioisotopes relies on activity images obtained through PET or SPECT and dosimetry methods, including the voxel S-value (VSV) and the local deposition method (LDM). However, the evaluation of the accuracy of absorbed dose calculations has been limited by the use of non-ideal reference standards and investigations restricted to the liver. The objective of this study was to expand upon these dosimetry characterizations by investigating the impact of image resolutions, voxel sizes, target volumes, and tissue materials on the accuracy of90 Y $^{90}{\rm {Y}}$ and166 Ho $^{166}{\rm {Ho}}$ dosimetry techniques. METHODS A specialized radiopharmaceutical dosimetry software called reDoseMC was developed using the Geant4 Monte Carlo toolkit and validated by benchmarking the generated90 Y $^{90}{\rm {Y}}$ kernels with published data. The decay spectra of both90 Y $^{90}{\rm {Y}}$ and166 Ho $^{166}{\rm {Ho}}$ were also compared. Multiple VSV kernels were generated for the liver, lungs, soft tissue, and bone for isotropic voxel sizes of 1 mm, 2 mm, and 4 mm. Three theoretical phantom setups were created with 20 or 40 mm activity and mass density inserts for the same three voxel sizes. To replicate the limited spatial resolutions present in PET and SPECT images, image resolutions were modeled using a 3D Gaussian kernel with a Full Width at Half Maximum (FWHM) ranging from 0 to 16 mm and with no added noise. The VSV and LDM dosimetry methods were evaluated by characterizing their respective kernels and analyzing their absorbed dose estimates calculated on theoretical phantoms. The ground truth for these estimations was calculated using reDoseMC. RESULTS The decay spectra obtained through reDoseMC showed less than a 1% difference when compared to previously published experimental data for energies below 1.9 MeV in the case of90 Y $^{90}{\rm {Y}}$ and less than 1% for energies below 1.5 MeV for166 Ho $^{166}{\rm {Ho}}$ . Additionally, the validation kernels for90 Y $^{90}{\rm {Y}}$ VSV exhibited results similar to those found in published Monte Carlo codes, with source dose depositions having less than a 3% error margin. Resolution thresholds (FWHM thresh s ${\rm {FWHM}}_\mathrm{thresh}{\rm {s}}$ ), defined as resolutions that resulted in similar dose estimates between the LDM and VSV methods, were observed for90 Y $^{90}{\rm {Y}}$ . They were 1.5 mm for bone, 2.5 mm for soft tissue and liver, and 8.5 mm for lungs. For166 Ho $^{166}{\rm {Ho}}$ , the accuracy of absorbed dose deposition was found to be dependent on the contributions of absorbed dose from photons. Volume errors due to variations in voxel size impacted the final dose estimates. Larger target volumes yielded more accurate mean doses than smaller volumes. For both radioisotopes, the radial dose profiles for the VSV and LDM approximated but never matched the reference standard. CONCLUSIONS reDoseMC was developed and validated for radiopharmaceutical dosimetry. The accuracy of voxel-based dosimetry was found to vary widely with changes in image resolutions, voxel sizes, chosen target volumes, and tissue material; hence, the standardization of dosimetry protocols was found to be of great importance for comparable dosimetry analysis.
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Affiliation(s)
- Taehyung Peter Kim
- Medical Physics Unit, Department of Oncology, McGill University, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Shirin A Enger
- Medical Physics Unit, Department of Oncology, McGill University, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
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Shea C, Lamberg H, Turk S, Sanogo M, Turgeon D, Nojkov B, Frey K, Raffel D. Extrahepatic 90Y Complication; Gastric Ulcer Secondary to 90Y Therapy for Liver Metastasis Despite Negative Preprocedural Imaging. Nucl Med Mol Imaging 2024; 58:86-91. [PMID: 38510819 PMCID: PMC10948730 DOI: 10.1007/s13139-023-00828-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: 05/14/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 03/22/2024] Open
Abstract
Transarterial radioembolization using yttrium-90 (90Y) therapy has become a standard modality of treatment for primary and metastatic liver malignancies due to its high efficacy rate and relatively low risk of adverse effects compared to other forms of locoregional and systemic therapies. Non-target distribution of radio embolic beads and adjacent structure radiation are the two most common adverse effects. However, these are rarely encountered due to thorough imaging and mapping studies prior to 90Y therapy. We present the case of a 66-year-old male who developed a radiation-induced gastric ulcer following 90Y therapy with negative pre-procedural imaging and mapping who was retrospectively found to have an accessory artery from the left hepatic artery to the gastric antrum.
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Affiliation(s)
- Connor Shea
- Central Michigan University College of Medicine, 1280 E. Campus Drive, Mt. Pleasant, MI 48858 USA
| | - Hannah Lamberg
- University of Michigan Medical School, Ann Arbor, MI USA
| | - Sevcan Turk
- University of Michigan Medical School, Ann Arbor, MI USA
| | - Mamadou Sanogo
- University of Michigan Medical School, Ann Arbor, MI USA
| | | | - Broko Nojkov
- University of Michigan Medical School, Ann Arbor, MI USA
| | - Kirk Frey
- University of Michigan Medical School, Ann Arbor, MI USA
| | - David Raffel
- University of Michigan Medical School, Ann Arbor, MI USA
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Beattie BJ, Kirov AS, Kesner AL. Technical Note: Impact of impurities on Yttrium-90 glass microsphere activity quantitation. Med Phys 2024; 51:2306-2310. [PMID: 37956259 PMCID: PMC11327908 DOI: 10.1002/mp.16828] [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: 12/24/2022] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Glass 90 Y microspheres are produced with known radionuclide impurities. These impurities are not independently monitored. Clinical instruments, including ionization chamber dose calibrators and positron emmission tomography (PET) cameras, can be much more sensitive in detecting signals from these impurities than to signals from 90 Y itself. PURPOSE The "typical" levels of 90 Y impurities have been studied to assess their impact on dosimetry during internal implantation, and for the management of waste. However, unaccounted-for decay spectra of impurities can also have an impact on dose calibrator and PET readings. Thus, even what might be considered negligibly small impurity fractions, can in principle cause substantial overestimates of the amount of 90 Y activity present in a sample. To our knowledge, quantitative effects of radionuclide impurities in glass microspheres on activity measurements have not been documented in the field. As activity quantitation for dosimetry and its correlations with outcome becomes more prevalent, the effects of impurities on measurements may remain unaccounted for in dosimetry studies. METHODS In this letter, we review theoretical and physical considerations that will result in asymmetric errors in quantitation from 90 Y impurities and estimate their typical and potential impact on clinical utilization. Among the common impurities 88 Y is of particular concern for its impact on 90 Y dose measurements because of its decay characteristics, along with other isotopes 91 Y and 46 Sc which can also impact measurements. RESULTS The typical level of 88 Y impurities reported by the manufacturer should only cause small errors in dose calibrator and PET measurements made within the 12-day label-specified use-by period, up to 2.0% and 1.6%, respectively. However, the product specification max allowable impurity levels, specified by the manufacturer, leave open the potential for much greater bias from within the 12-day use-by period, potentially as high as 13.2% for dose calibrator measurements and 10.6% for PET from the 88 Y impurities. CONCLUSIONS While typical levels of impurities appear to have acceptable impact on patient absorbed dose, it should be noted that they can have adverse effects on 90 Y radioactivity measurements. Furthermore, there is currently minimal independent verification and/or monitoring of impurity levels within the field.
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Affiliation(s)
- Bradley J Beattie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Assen S Kirov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Adam L Kesner
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
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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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Mercolli L, Zeimpekis K, Prenosil GA, Sari H, Rathke HG, Rominger A, Shi K. Phantom study for 90Y liver radioembolization dosimetry with a long axial field-of-view PET/CT. Phys Med 2024; 118:103296. [PMID: 38281409 DOI: 10.1016/j.ejmp.2024.103296] [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: 04/30/2023] [Revised: 11/20/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024] Open
Abstract
PURPOSE The physical properties of yttrium-90 (90Y) allow for imaging with positron emission tomography/computed tomography (PET/CT). The increased sensitivity of long axial field-of-view (LAFOV) PET/CT scanners possibly allows to overcome the small branching ratio for positron production from 90Y decays and to improve for the post-treatment dosimetry of 90Y of selective internal radiation therapy. METHODS For the challenging case of an image quality body phantom, we compare a full Monte Carlo (MC) dose calculation with the results from the two commercial software packages Simplicit90Y and Hermes. The voxel dosimetry module of Hermes relies on the 90Y images taken with a LAFOV PET/CT, while the MC and Simplicit90Y dose calculations are image independent. RESULTS The resulting doses from the MC calculation and Simplicit90Y agree well within the error margins. The image-based dose calculation with Hermes, however, consistently underestimates the dose. This is due to the mismatch of the activity distribution in the PET images and the size of the volume of interest. We found that only for the smallest phantom sphere there is a statistically significant dependence of the Hermes dose on the image reconstruction parameters and scan time. CONCLUSION Our study shows that Simplicit90Y's local deposition model can provide a reliable dose estimate. On the other hand, the image based dose calculation suffers from the suboptimal reconstruction of the 90Y distribution in small structures.
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Affiliation(s)
- Lorenzo Mercolli
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland.
| | - Konstantinos Zeimpekis
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - George A Prenosil
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Hasan Sari
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Hendrik G Rathke
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Kunagyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
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Busse NC, Al‐Ghazi MSAL, Abi‐Jaoudeh N, Alvarez D, Ayan AS, Chen E, Chuong MD, Dezarn WA, Enger SA, Graves SA, Hobbs RF, Jafari ME, Kim SP, Maughan NM, Polemi AM, Stickel JR. AAPM Medical Physics Practice Guideline 14.a: Yttrium-90 microsphere radioembolization. J Appl Clin Med Phys 2024; 25:e14157. [PMID: 37820316 PMCID: PMC10860558 DOI: 10.1002/acm2.14157] [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: 04/13/2023] [Revised: 06/19/2023] [Accepted: 08/25/2023] [Indexed: 10/13/2023] Open
Abstract
Radioembolization using Yttrium-90 (90 Y) microspheres is widely used to treat primary and metastatic liver tumors. The present work provides minimum practice guidelines for establishing and supporting such a program. Medical physicists play a key role in patient and staff safety during these procedures. Products currently available are identified and their properties and suppliers summarized. Appropriateness for use is the domain of the treating physician. Patient work up starts with pre-treatment imaging. First, a mapping study using Technetium-99m (Tc-99m ) is carried out to quantify the lung shunt fraction (LSF) and to characterize the vascular supply of the liver. An MRI, CT, or a PET-CT scan is used to obtain information on the tumor burden. The tumor volume, LSF, tumor histology, and other pertinent patient characteristics are used to decide the type and quantity of 90 Y to be ordered. On the day of treatment, the appropriate dose is assayed using a dose calibrator with a calibration traceable to a national standard. In the treatment suite, the care team led by an interventional radiologist delivers the dose using real-time image guidance. The treatment suite is posted as a radioactive area during the procedure and staff wear radiation dosimeters. The treatment room, patient, and staff are surveyed post-procedure. The dose delivered to the patient is determined from the ratio of pre-treatment and residual waste exposure rate measurements. Establishing such a treatment modality is a major undertaking requiring an institutional radioactive materials license amendment complying with appropriate federal and state radiation regulations and appropriate staff training commensurate with their respective role and function in the planning and delivery of the procedure. Training, documentation, and areas for potential failure modes are identified and guidance is provided to ameliorate them.
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Affiliation(s)
| | | | - Nadine Abi‐Jaoudeh
- Department of Radiological SciencesUniversity of CaliforniaIrvineCaliforniaUSA
| | - Diane Alvarez
- Baptist HospitalMiami Cancer InstituteMiamiFloridaUSA
| | - Ahmet S. Ayan
- Department of Radiation OncologyOhio State UniversityColumbusOhioUSA
| | - Erli Chen
- Department of Radiation OncologyCheshire Medical CenterKeeneNew HampshireUSA
| | - Michael D. Chuong
- Department of Radiation OncologyMiami Cancer InstituteMiamiFloridaUSA
| | - William A. Dezarn
- Department of Radiation OncologyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | | | - Robert F. Hobbs
- Department of Radiation OncologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Mary Ellen Jafari
- Diagnostic Physics, Atlantic Health SystemMorristown Medical CenterMorristownNew JerseyUSA
| | - S. Peter Kim
- Medical Physics UnitMcGill UniversityMontrealCanada
| | - Nichole M. Maughan
- Department of Radiation OncologyWashington University in St. LouisSaint LouisMissouriUSA
| | - Andrew M. Polemi
- Department of RadiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Alexander ES, Petre EN, Zhao K, Sotirchos V, Namakydoust A, Moussa A, Yuan G, Sofocleous CT, Solomon SB, Ziv E. Yttrium-90 Transarterial Radioembolization of Primary Lung Cancer Metastases to the Liver. J Vasc Interv Radiol 2024; 35:214-225.e2. [PMID: 37923172 PMCID: PMC11323230 DOI: 10.1016/j.jvir.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Abstract
PURPOSE To assess whether yttrium-90 transarterial radioembolization (TARE) is safe and effective in the treatment of primary lung cancer metastases to the liver (LCML). METHODS AND METHODS This retrospective study included 57 patients with LCML who were treated with 79 TARE treatments. Histology included non-small cell lung cancer (NSCLC) (n = 27), small cell lung cancer (SCLC) (n = 17), and lung carcinoid (LC) (n = 13). Survival was calculated using Kaplan-Meier method; differences between groups were estimated using log rank test. Cox proportional hazards model was used to determine factors influencing survival. Adverse events were graded using the Society of Interventional Radiology Adverse Events Classification. RESULTS Median overall survival (OS) was as follows: NSCLC, 8.3 months (95% confidence interval [CI], 6.3-16.4 months); SCLC, 4.1 months (95% CI, 1.9-6.6 months); and LC, 43.5 months (95% CI, 7.8-61.4 months). For NSCLC, presence of bilobar vs unilobar disease (hazard ratio [HR], 5.24; 95% CI, 1.64-16.79; P = .002); more tumors, 2-5 vs 1 (HR, 4.88; 95% CI, 1.17-20.37; P = .003) and >5 vs 1 (HR, 3.75; 95% CI, 0.95-6.92; P = .05); and lobar vs segmental treatment (HR, 2.56; 95% CI, 0-NA; P = .002) were negative predictors of OS. For SCLC, receipt of >2 lines of chemotherapy vs ≤2 lines (HR, 3.16; 95% CI, 0.95-10.47; P = .05) was a negative predictor of OS. For LC, tumor involvement of >50% was a negative predictor of OS (HR, 3.77 × 1015; 95% CI, 0-NA; P = .002). There were 11 of 79 severe or life-threatening adverse events within 30 days (abdominal pain, altered mental status, nausea/vomiting, acalculous/aseptic cholecystitis, hyponatremia, pancreatitis, renal failure, and death from pneumonia). CONCLUSIONS TARE has an acceptable safety profile for the treatment of LCML, with survival benefits best seen in LC tumors.
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Affiliation(s)
- Erica S Alexander
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ken Zhao
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vlasios Sotirchos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Azadeh Namakydoust
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amgad Moussa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gavin Yuan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Etay Ziv
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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12
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Kang M, Shin Y, Kim Y, Ha S, Sung W. Modeling the Synergistic Impact of Yttrium 90 Radioembolization and Immune Checkpoint Inhibitors on Hepatocellular Carcinoma. Bioengineering (Basel) 2024; 11:106. [PMID: 38391592 PMCID: PMC10886259 DOI: 10.3390/bioengineering11020106] [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: 12/22/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
The impact of yttrium 90 radioembolization (Y90-RE) in combination with immune checkpoint inhibitors (ICIs) has recently gained attention. However, it is unclear how sequencing and dosage affect therapeutic efficacy. The purpose of this study was to develop a mathematical model to simulate the synergistic effects of Y90-RE and ICI combination therapy and find the optimal treatment sequences and dosages. We generated a hypothetical patient cohort and conducted simulations to apply different treatments to the same patient. The compartment of models is described with ordinary differential equations (ODEs), which represent targeted tumors, non-targeted tumors, and lymphocytes. We considered Y90-RE as a local treatment and ICIs as a systemic treatment. The model simulations show that Y90-RE and ICIs administered simultaneously yield greater benefits than subsequent sequential therapy. In addition, applying Y90-RE before ICIs has more benefits than applying ICIs before Y90-RE. Moreover, we also observed that the median PFS increased up to 31~36 months, and the DM rates at 3 years decreased up to 36~48% as the dosage of the two drugs increased (p < 0.05). The proposed model predicts a significant benefit of Y90-RE with ICIs from the results of the reduced irradiated tumor burden and the associated immune activation and suppression. Our model is expected to help optimize complex strategies and predict the efficacy of clinical trials for HCC patients.
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Affiliation(s)
- Minah Kang
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yerim Shin
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yeseul Kim
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sangseok Ha
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Wonmo Sung
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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13
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Yeyin N, Kesmezacar FF, Tunçman D, Demir Ö, Uslu-Beşli L, Günay O, Demir M. Hepatopulmonary Shunt Ratio Verification Model for Transarterial Radioembolization. Curr Radiopharm 2024; 17:276-284. [PMID: 38288829 DOI: 10.2174/0118744710284130240108053733] [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: 09/25/2023] [Revised: 12/10/2023] [Accepted: 12/26/2023] [Indexed: 07/23/2024]
Abstract
INTRODUCTION The most important toxicity of transarterial radioembolization therapy applied in liver malignancies is radiation pneumonitis and fibrosis due to hepatopulmonary shunt of Yttrium-90 (90Y) microspheres. Currently, Technetium-99m macroaggregated albumin (99mTc-MAA) scintigraphic images are used to estimate lung shunt fraction (LSF) before treatment. The aim of this study was to create a phantom to calculate exact LFS rates according to 99mTc activities in the phantom and to compare these rates with LSF values calculated from scintigraphic images. MATERIALS AND METHODS A 3D-printed lung and liver phantom containing two liver tumors was developed from Polylactic Acid (PLA) material, which is similar to the normal-sized human body in terms of texture and density. Actual %LSFs were calculated by filling phantoms and tumors with 99mTc radionuclide. After the phantoms were placed in the water tank made of plexiglass material, planar, SPECT, and SPECT/CT images were obtained. The actual LSF ratio calculated from the activity amounts filled into the phantom was used for the verification of the quantification of scintigraphic images and the results obtained by the Simplicity90YTM method. RESULTS In our experimental model, LSFs calculated from 99mTc activities filled into the lungs, normal liver, small tumor, and large tumor were found to be 0%, 6.2%, 10.8%, and 16.9%. According to these actual LSF values, LSF values were calculated from planar, SPECT/CT (without attenuation correction), and SPECT/CT (with both attenuation and scatter correction) scintigraphic images of the phantom. In each scintigraphy, doses were calculated for lung, small tumor, large tumor, normal liver, and Simplicity90YTM. The doses calculated from planar and SPECT/CT (NoAC+NoSC) images were found to be higher than the actual doses. The doses calculated from SPECT/CT (with AC+with SC) images and Simplicity90YTM were found to be closer to the real dose values. CONCLUSION LSF is critical in dosimetry calculations of 90Y microsphere therapy. The newly introduced hepatopulmonary shunt phantom in this study is suitable for LSF verification for all models/brands of SPECT and SPECT/CT devices.
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Affiliation(s)
- Nami Yeyin
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih/Istanbul, Turkey
| | | | - Duygu Tunçman
- Vocational School of Health Service, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Özge Demir
- Department of Chemical Engineering, Engineering Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Lebriz Uslu-Beşli
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih/Istanbul, Turkey
| | - Osman Günay
- Department of Biomedical Engineering, Faculty of Electrical and Electronics Engineering, Yıldız Technical University, Istanbul, Turkey
| | - Mustafa Demir
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih/Istanbul, Turkey
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14
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Bui KC, Nguyen TML, Barat S, Scholta T, Xing J, Bhuria V, Sipos B, Wilkens L, Nguyen LT, Le HS, Velavan TP, Bozko P, Plentz RR. Novel Adiponectin Receptor Agonist Inhibits Cholangiocarcinoma via Adenosine Monophosphate-activated Protein Kinase. Curr Med Chem 2024; 31:4534-4548. [PMID: 38361349 DOI: 10.2174/0109298673254969231122114107] [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: 03/25/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Cholangiocarcinoma (CCA) has a poor prognosis and only limited palliative treatment options. The deficiency of adiponectin and adenosine monophosphate-activated protein kinase (AMPK) signaling was reported in several malignancies, but the alteration of these proteins in CCA is still unclear. OBJECTIVES This study aimed to assess the role of adiponectin and AMPK signaling in CCA. Furthermore, AdipoRon, a novel adiponectin receptor (AdipoR) agonist, was evaluated in vitro and in vivo as a new anti-tumor therapy for CCA. METHODS The expression of AdipoR1 and p-AMPKα in human tissue microarrays (TMAs) was evaluated by immunohistochemistry staining (IHC). The effect of 2-(4-Benzoylphenoxy)-N-[1-(phenylmethyl)-4-piperidinyl]-acetamide (AdipoRon) was investigated in vitro with proliferation, crystal violet, migration, invasion, colony formation, senescence, cell cycle and apoptosis assays and in vivo using a CCA engineered mouse model (AlbCre/LSL-KRASG12D/p53L/L). RT-qPCR and western blot methods were applied to study molecular alterations in murine tissues. RESULTS AdipoR1 and p-AMPKα were impaired in human CCA tissues, compared to adjacent non-tumor tissue. There was a positive correlation between the AdipoR1 and p-AMPKα levels in CCA tissues. Treatment with AdipoRon inhibited proliferation, migration, invasion and colony formation and induced apoptosis in a time- and dose-dependent manner in vitro (p<0.05). In addition, AdipoRon reduced the number of CCA and tumor volume, prolonged survival, and decreased metastasis and ascites in the treated group compared to the control group (p<0.05). CONCLUSIONS AdipoR1 and p-AMPKα are impaired in CCA tissues, and AdipoRon effectively inhibits CCA in vitro and in vivo. Thus, AdipoRon may be considered as a potential anti-tumor therapy in CCA.
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Affiliation(s)
- Khac Cuong Bui
- Department of Internal Medicine I, Universitätsklinikum Tübingen, Tübingen, Germany
- Department of Pathophysiology, Vietnam Military Medical University, Hanoi, Vietnam
- Laboratory Animal Research Center, Vietnam Military Medical University, Hanoi, Vietnam
- Vietnamese-German Centre for Medical Research (VG-CARE), Hanoi, Vietnam
| | - Thi Mai Ly Nguyen
- Department of Internal Medicine I, Universitätsklinikum Tübingen, Tübingen, Germany
- Vietnamese-German Centre for Medical Research (VG-CARE), Hanoi, Vietnam
- Department of Biochemistry, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Samarpita Barat
- Department of Internal Medicine I, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Tim Scholta
- Department of Internal Medicine I, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jun Xing
- Department of Internal Medicine I, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Vikas Bhuria
- Department of Internal Medicine I, Universitätsklinikum Tübingen, Tübingen, Germany
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Health-Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
- Center for Health and Medical Prevention-ChaMP, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Bence Sipos
- Department of Internal Medicine VIII, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Ludwig Wilkens
- Institute of Pathology, Nordstadt Krankenhaus, Hannover, Germany
| | - Linh Toan Nguyen
- Department of Pathophysiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Huu Song Le
- Vietnamese-German Centre for Medical Research (VG-CARE), Hanoi, Vietnam
- Faculty of Tropical and Infectious Diseases, 108 Military Central Hospital, Hanoi, Vietnam
| | - Thirumalaisamy P Velavan
- Vietnamese-German Centre for Medical Research (VG-CARE), Hanoi, Vietnam
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tübingen, Germany
- Duy Tan University, Da Nang, Vietnam
| | - Przemyslaw Bozko
- Department of Internal Medicine I, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Ruben R Plentz
- Department of Internal Medicine I, Universitätsklinikum Tübingen, Tübingen, Germany
- Department of Internal Medicine, Klinikum Bremen Nord, Bremen, Germany
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15
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Lee JH, Lee CH, Kim M, Song YS, Yoon CJ, Lee WW. CT texture features and lung shunt fraction measured using 99mTc-macroaggregated albumin SPECT/CT before trans-arterial radioembolization for hepatocellular carcinoma patients. Sci Rep 2023; 13:22288. [PMID: 38097801 PMCID: PMC10721865 DOI: 10.1038/s41598-023-49787-7] [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: 05/30/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
The aim of this study is to determine whether contrast-enhanced computed tomography (CECT)-based texture parameters can predict high (> 30 Gy) expected lung dose (ELD) calculated using 99mTc macroaggregated albumin single-photon emission computed tomography/computed tomography (SPECT/CT) for pre-trans-arterial radioembolization (TARE) dosimetry. 35 patients were analyzed, with a treatable planned dose of ≥ 200 Gy for unresectable hepatocellular carcinoma (HCC). Lung shunt fraction (LSF) was obtained from planar and SPECT/CT scans. Texture features of the tumor lesion on CECT before TARE were analyzed. Univariate and multivariate linear regression analyses were performed to determine potential ELD > 30 Gy predictors. Among the 35 patients, nine (25.7%) had ELD > 30 Gy, and had a higher LSF than the ELD ≤ 30 Gy group using the planar (20.7 ± 8.0% vs. 6.3 ± 3.3%; P < 0.001) and SPECT/CT (12.4 ± 5.1% vs. 3.5 ± 2.0%; P < 0.001) scans. The tumor integral total (HU × L) value was a predictor for high LSF using SPECT/CT, with an area under the curve, sensitivity, and specificity of 0.983 (95% confidence interval: 0.869-1.000, P < 0.001), 100%, and 88.5%, respectively. The tumor integral total value is an imaging marker for predicting ELD > 30 Gy. Applying CECT texture analysis may assist in reducing time and cost in patient selection and modifying TARE treatment plans.
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Affiliation(s)
- Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea
| | - Chong-Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Minuk Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea
| | - Won Woo Lee
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Health Science and Technology, The Graduate School of Convergence Science and Technology, Seoul National University, Suwon-si, Gyeonggi-do, Republic of Korea
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Henry EC, Lopez B, Mahvash A, Thomas MA, Kappadath SC. Predicting the net administered activity in 90 Y-radioembolization patients from post-procedure 90 Y-SPECT/CT. Med Phys 2023; 50:7003-7015. [PMID: 37272198 DOI: 10.1002/mp.16540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/17/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The calculation of the net administered activity (Aadmin ) in patients undergoing 90 Y-radioembolization is essential for dosimetry and radiation safety, yet current methods for measuring residual 90 Y activity are often associated with high uncertainty. Therefore, an accurate, robust, and clinically viable method for the determination of Aadmin across approved 90 Y microsphere devices is desirable. PURPOSE We report on a novel method to determine Aadmin by leveraging the quantitative capabilities of SPECT/CT to measure 90 Y-emission in vivo from patients following 90 Y-radioembolization with glass or resin microspheres. METHODS 90 Y-SPECT/CT attenuation-corrected count data from 147 sequential 90 Y-radioembolization patients was used for this analysis. Aadmin was calculated as part of routine clinical practice via the exposure rate differences between the initial 90 Y-vial and the 90 Y-residual jar. This served as our gold standard measure of Aadmin . Patient data for each microsphere device were separated into training and testing cohorts to first develop regression models and then to independently assess model performance. The training cohorts were divided into four groups: first, based on the microsphere device (glass or resin), and second, based on the SPECT volume used to calculate counts (the full SPECT field of view (FOV) or liver only (VOIliver )). Univariate linear regression models were generated for each group to predict Aadmin based on 90 Y-SPECT data from the training cohorts. Leave-one-out cross validation was implemented to estimate variability in model parameters. To assess performance, linear models derived from the training cohort were applied to 90 Y-SPECT data from the testing cohort. A comparison of the models between microspheres devices was also performed. RESULTS Linear models derived from the glass and resin training cohorts demonstrated a strong, positive correlation between 90 Y-SPECT image counts and Aadmin for VOIliver and FOV with R2 > 0.98 in all cases. In the glass training cohort, model accuracy (100%-absolute mean prediction error) and precision (95% prediction intervals of mean prediction error) were 99.0% and 15.4% for the VOIliver and 99.7% and 17.5% for the FOV models, respectively. In the resin training cohort, the corresponding values were 98.6% and 16.7% for VOIliver and > 99.9% and 11.4% for the FOV models, respectively. The application of these linear models to 90 Y-SPECT data from the testing cohort showed Aadmin prediction errors to have high accuracy and precision for both microsphere devices. For the glass testing cohort, accuracy (precision) was 96.9% (19.6%) and 98.8% (21.1%) for the VOIliver and FOV models, respectively. The corresponding values for the resin training cohort were 97.3% (26.2%) and 98.5% (25.7%) for the VOIliver and FOV models, respectively. The slope of the linear models between the two microsphere devices was observed to be significantly different with resin microspheres generating 48%-49% more SPECT counts for equivalent 90 Y activity based on each device manufacturer's activity calibration process. CONCLUSION 90 Y-SPECT image counts can reliably predict (accuracy > 95% and precision < 18%) Aadmin after 90 Y-radioembolization, with performance characteristics essentially equivalent for both glass and resin microspheres. There is a clear indication that activity calibrations are fundamentally different between the two microsphere devices.
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Affiliation(s)
- Eric C Henry
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Benjamin Lopez
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew A Thomas
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Srinivas C Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
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Bozkurt A, Toker GD, Erkilic M. A personalized Monte Carlo study of tumor and critical organ doses for trans-arterial radioembolization patients. Phys Med Biol 2023; 68:195016. [PMID: 37678259 DOI: 10.1088/1361-6560/acf7a7] [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: 02/10/2023] [Accepted: 09/07/2023] [Indexed: 09/09/2023]
Abstract
Trans-arterial radioembolization (TARE) is an intra-arterial treatment method for liver malignancies. In this procedure, the therapeutic tumor dose is significant for predicting the treatment effectiveness while the dose absorbed in an organ at risk provides an understanding of its tolerance to radiation. This study proposes a Monte Carlo (MC) approach for determining absorbed organ doses for patients undergoing TARE treatment. The technique is based on the use of a voxel-based partial body model generated for each patient from his/her anatomical image data to represent the critical body structures more realistically. These structures are first segmented from image slices to create an image block which is then incorporated into a radiation transport package (MCNP6.2) to perform MC simulations. When used along with the parameters specific to a patient's treatment, such as lung-shunt factor, tumor-to-normal liver ratio, fractional uptakes, and administered activity, this approach allowed more accurate simulation of radiation interactions and hence provided absorbed doses specific to a TARE patient. The MC method also calculated the absorbed doses in organs or tissues that were close to target tissues for which the Medical Internal Radiation Dose Committee (MIRD) formalism makes no predictions. MIRD calculations were found to overestimate the absorbed doses by as much as 11% in lungs, 5% in liver, and 20% in tumor volumes. This raises concerns about the treatment's efficacy when estimating the correct activity to be administered to a patient. When each patient simulation was repeated with a90Y source spectrum to reflect the distribution of varying beta energies, the liver and the lungs were observed to receive relatively lower doses than those obtained with monoenergetic beta particles. Thus, it can be stated that the approach adopted in this study offers a more precise model of the patient's critical tissues and serves as a personalized dosimetric tool for TARE treatment planning.
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Affiliation(s)
- Ahmet Bozkurt
- Division of Computational Science and Engineering, Informatics Institute, Istanbul Technical University, 34467 Istanbul, Turkey
| | - Gul Demir Toker
- Department of Nuclear Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Metin Erkilic
- Department of Nuclear Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Gylstorff S, Wilke V, Kraft D, Bertrand J, Pech M, Haag F, Relja B. Selective Internal Radiotherapy Alters the Profiles of Systemic Extracellular Vesicles in Hepatocellular Carcinoma. Int J Mol Sci 2023; 24:12512. [PMID: 37569887 PMCID: PMC10419408 DOI: 10.3390/ijms241512512] [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: 07/12/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Incidence of hepatocellular carcinoma (HCC) is increasing globally. Radioembolization (RE)/selective internal radiotherapy (SIRT) is a promising treatment for inoperable HCC. RE triggers an immune response, involving extracellular vesicles (EVs) which are crucial for cell communication and tumor development. This study explores EV immune profiles and origins in patients with inoperable HCC before and after SIRT/RE. Blood samples from 50 HCC-patients treated with SIRT/RE were collected before and after therapy to determine cytokines and isolate EVs using size exclusion chromatography. The dynamic range and EV quality required for detecting variations in surface markers were assessed. Thirty-seven EV surface markers were analyzed using flow cytometry and correlated with clinical parameters. Several immunological markers (CD4, CD2, CD40, CD45, CD49e, CD69, CD209-EVs) were present in the circulation of HCC patients. These markers positively correlated with therapy response and survival. Conversely, B cell CD20, endothelial cell CD146, platelet CD49e, and CD41b EV markers negatively correlated with 60-day survival. Elevated levels of IL-6 and IL-8 before therapy correlated negatively with patient survival, coinciding with a positive correlation with CD20-positive EVs. Plasma EVs from HCC patients exhibit immunological, cancer, and coagulation markers, including potential biomarkers (CD4, CD20, CD49e, CD146). These may enhance our understanding of cancer biology and facilitate SIRT therapy monitoring.
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Affiliation(s)
- Severin Gylstorff
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39120 Magdeburg, Germany
- Translational and Experimental Trauma Research, Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Ulm, 89081 Ulm, Germany
| | - Vanessa Wilke
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Daniel Kraft
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Maciej Pech
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Florian Haag
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39120 Magdeburg, Germany
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Borna Relja
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University, 39120 Magdeburg, Germany
- Translational and Experimental Trauma Research, Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Ulm, 89081 Ulm, Germany
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19
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Bucalau AM, Collette B, Tancredi I, Vouche M, Pezzullo M, Bouziotis J, Moreno-Reyes R, Trotta N, Levillain H, Van Laethem JL, Verset G. Clinical impact of 99mTc-MAA SPECT/CT-based personalized predictive dosimetry in selective internal radiotherapy: a real-life single-center experience in unresectable HCC patients. Eur J Hybrid Imaging 2023; 7:12. [PMID: 37414964 PMCID: PMC10326228 DOI: 10.1186/s41824-023-00171-8] [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: 04/09/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Recent data demonstrated that personalized dosimetry-based selective internal radiotherapy (SIRT) is associated with better outcome for unresectable hepatocellular carcinoma (HCC). AIM We aim to evaluate the contribution of personalized predictive dosimetry (performed with Simplicity90® software) in our population of HCC patients by comparing them to our historical cohort whose activity was determined by standard dosimetry. METHODS This is a retrospective, single-center study conducted between February 2016 and December 2020 that included patients with HCC who received SIRT after simulation based on either standard dosimetry (group A) or, as of December 2017, on personalized dosimetry (group B). Primary endpoints were best overall response (BOR) and objective response rate (ORR) evaluated by mRECIST at 3 months. Safety and toxicity profiles were evaluated at 1- and 3-months post-treatment. For group A we compared the activity to be administered determined a posteriori using Simplicit90Y® and the activity actually administered determined by the standard approach. RESULTS Between February 2016 and December 2020, 66 patients received 69 simulations leading to 40 treatments. The median follow-up time was equal for both groups, 21 months (range 3-55) in group A and 21 months (range 4-39) in group B. The per patient analysis revealed a significant benefit of personalized predictive dosimetry in terms of better overall response at 3 months (80% vs. 33.3%, p = 0.007) and at 6 months (77.8% vs. 22.2%, p = 0.06). This trend was found in the analysis by nodule with a response rate according to mRECIST of 87.5% for personalized dosimetry versus 68.4% for standard dosimetry at 3 months, p = 0.24. Only one grade 3 biological toxicity (hyperbilirubinemia) was noted in group A. The comparison between the administered activity and the recommended activity recalculated a posteriori using Simplicit90Y® showed that the vast majority of patients who progressed (83.33%) received less activity than that recommended by the personalized approach or an inadequate distribution of the administered activity. CONCLUSIONS Our study aligns to recent literature and confirms that the use of personalized dosimetry allows a better selection of HCC patients who can benefit from SIRT, and consequently, improves the effectiveness of this treatment.
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Affiliation(s)
- Ana-Maria Bucalau
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Benoît Collette
- Department of Nuclear Medicine, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Illario Tancredi
- Department of Radiology, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michael Vouche
- Department of Radiology, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Martina Pezzullo
- Department of Radiology, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jason Bouziotis
- Department of Biomedical Research, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Rodrigo Moreno-Reyes
- Department of Nuclear Medicine, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicola Trotta
- Department of Nuclear Medicine, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hugo Levillain
- Department of Nuclear Medicine, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean Luc Van Laethem
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gontran Verset
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Erasme/Bordet Institute-Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
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20
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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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21
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Cox DRA, Chung W, Grace J, Wong D, Kutaiba N, Ranatunga D, Khor R, Perini MV, Fink M, Jones R, Goodwin M, Dobrovic A, Testro A, Muralidharan V. Evaluating treatment response following locoregional therapy for hepatocellular carcinoma: A review of the available serological and radiological tools for assessment. JGH OPEN 2023; 7:249-260. [PMID: 37125252 PMCID: PMC10134770 DOI: 10.1002/jgh3.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 04/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is an aggressive primary malignancy of the liver and is the third most common cause of cancer-related global mortality. There has been a steady increase in treatment options for HCC in recent years, including innovations in both curative and non-curative therapies. These advances have brought new challenges and necessary improvements in strategies of disease monitoring, to allow early detection of HCC recurrence. Current serological and radiological strategies for post-treatment monitoring and prognostication and their limitations will be discussed and evaluated in this review.
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Affiliation(s)
- Daniel R A Cox
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - William Chung
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Josephine Grace
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Darren Wong
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Numan Kutaiba
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Dinesh Ranatunga
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Richard Khor
- Department of Radiation Oncology Austin Health Melbourne Victoria Australia
- School of Molecular Sciences, La Trobe University Melbourne Victoria Australia
- Department of Medical Imaging and Radiation Sciences Monash University Melbourne Victoria Australia
| | - Marcos V Perini
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - Michael Fink
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - Robert Jones
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Mark Goodwin
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Alex Dobrovic
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
| | - Adam Testro
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
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22
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Blum S, Silvestrini E, Weinstein J, Greben C. Posttreatment Exposure Rates for 90Y-Microsphere Patients: A Comparison of Products. J Nucl Med Technol 2023; 51:60-62. [PMID: 36041878 DOI: 10.2967/jnmt.122.264335] [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: 05/06/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
There has been a significant increase in the use of 90Y-microspheres in treating liver malignancies. This increase could be seen over the last 30 y, and Food and Drug Administration approval of 2 products-Sirtex SIR-Spheres and Boston Scientific TheraSphere-has helped in the proliferation of these treatments. As the increase in use of both products rose at our institution, there was a need to determine whether there should be special considerations for patients who receive one product compared with patients who receive the other product. This determination was made by measuring exposure rates for several regions of the patient before and after implantation. An independent-samples t test analysis (ɑ = 0.05) was performed for 50 patients (25 TheraSphere and 25 SIR-Spheres) to determine whether the products behaved similarly to the extent that exposure to others was minimized and that as-low-as-reasonably-achievable principles were kept. The results showed that the products exhibited no significant differences in exposure rates, suggesting that no special considerations are needed for the procedure for one product compared with the other.
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Affiliation(s)
| | - Eugenio Silvestrini
- Radiation Safety, Department of Radiology, Northwell Health, Manhasset, New York; .,Department of Physics and Astronomy, Hofstra University, Hempstead, New York; and
| | - Jonathan Weinstein
- Donald and Barbara Zucker School of Medicine, Northwell Health, Hofstra University, Hempstead, New York
| | - Craig Greben
- Donald and Barbara Zucker School of Medicine, Northwell Health, Hofstra University, Hempstead, New York
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23
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Larsen LI, López GP, Selwyn R, Carroll NJ. Microfluidic Fabrication of Silica Microspheres Infused with Positron Emission Tomography Imaging Agents. ACS APPLIED BIO MATERIALS 2023; 6:712-721. [PMID: 36633291 DOI: 10.1021/acsabm.2c00940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Selective internal radiation therapy (SIRT) is a treatment which delivers radioactive therapeutic microspheres via the hepatic artery to destroy tumorigenic tissue of the liver. However, the dose required varies significantly from patient to patient due to nuances in individual biology. Therefore, a positron emission tomography (PET) imaging surrogate, or radiotracer, is used to predict in vivo behavior of therapeutic Y-90 spheres. The ideal surrogate should closely resemble Y-90 microspheres in morphology for highest predictive accuracy. This work presents the fabrication of positron-emitting silica microspheres infused with PET radiotracers copper, fluorine, and gallium. A quick one-pot synthesis is used to create precursor sol, followed by droplet formation with flow-focusing microfluidics, and finally thermal treatment to yield 10-50 μm microspheres with narrow size distribution. Loading of the infused element is controllable in the sol synthesis, while the final sphere size is tunable based on microfluidic flow rates and device channel width. The system is then employed to make radioactive Ga-68 microspheres, which are tested for radioactivity and stability. The fabrication method can be completed within a few hours, depending on the desired microsphere quantity. A microfluidic system is applied to fabricate silica particles loaded with diverse elemental infusions, including radioactive Ga-68.
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Affiliation(s)
- Lewis I Larsen
- Department of Chemical and Biological Engineering, University of New Mexico, Albuquerque, New Mexico87131, United States.,Center for Micro-Engineered Materials, University of New Mexico, Albuquerque, New Mexico87131, United States
| | - Gabriel P López
- Department of Chemical and Biological Engineering, University of New Mexico, Albuquerque, New Mexico87131, United States.,Center for Micro-Engineered Materials, University of New Mexico, Albuquerque, New Mexico87131, United States
| | - Reed Selwyn
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico87131, United States
| | - Nick J Carroll
- Department of Chemical and Biological Engineering, University of New Mexico, Albuquerque, New Mexico87131, United States.,Center for Micro-Engineered Materials, University of New Mexico, Albuquerque, New Mexico87131, United States
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24
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Phantom-based evaluation of yttrium-90 datasets using biograph vision quadra. Eur J Nucl Med Mol Imaging 2023; 50:1168-1182. [PMID: 36504278 PMCID: PMC9931793 DOI: 10.1007/s00259-022-06074-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The image quality characteristics of two NEMA phantoms with yttrium-90 (90Y) were evaluated on a long axial field-of-view (AFOV) PET/CT. The purpose was to identify the optimized reconstruction setup for the imaging of patients with hepatocellular carcinoma after 90Y radioembolization. METHODS Two NEMA phantoms were used, where one had a 1:10 sphere to background activity concentration ratio and the second had cold background. Reconstruction parameters used are as follows: iterations 2 to 8, Gaussian filter 2- to 6-mm full-width-at-half-maximum, reconstruction matrices 440 × 440 and 220 × 220, high sensitivity (HS), and ultra-high sensitivity (UHS) modes. 50-, 40-, 30-, 20-, 10-, and 5-min acquisitions were reconstructed. The measurements included recovery coefficients (RC), signal-to-noise ratio (SNR), background variability, and lung error which measures the residual error in the corrections. Patient data were reconstructed with 20-, 10-, 5-, and 1-min time frames and evaluated in terms of SNR. RESULTS The RC for the hot phantom was 0.36, 0.45, 0.53, 0.63, 0.68, and 0.84 for the spheres with diameters of 10, 13, 17, 22, 28, and 37 mm, respectively, for UHS 2 iterations, a 220 × 220 matrix, and 50-min acquisition. The RC values did not differ with acquisition times down to 20 min. The SNR was the highest for 2 iterations, measured 11.7, 16.6, 17.6, 19.4, 21.9, and 27.7 while the background variability was the lowest (27.59, 27.08, 27.36, 26.44, 30.11, and 33.51%). The lung error was 18%. For the patient dataset, the SNR was 19%, 20%, 24%, and 31% higher for 2 iterations compared to 4 iterations for 20-, 10-, 5-, and 1-min time frames, respectively. CONCLUSIONS This study evaluates the NEMA image quality of a long AFOV PET/CT scanner with 90Y. It provides high RC for the smallest sphere compared to other standard AFOV scanners at shorter scan times. The maximum patient SNR was for 2 iterations, 20 min, while 5 min delivers images with acceptable SNR.
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25
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Salem R, Padia SA, Lam M, Chiesa C, Haste P, Sangro B, Toskich B, Fowers K, Herman JM, Kappadath SC, Leung T, Sze DY, Kim E, Garin E. Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging 2023; 50:328-343. [PMID: 36114872 PMCID: PMC9816298 DOI: 10.1007/s00259-022-05956-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE In light of recently published clinical reports and trials, the TheraSphere Global Dosimetry Steering Committee (DSC) reconvened to review new data and to update previously published clinical and dosimetric recommendations for the treatment of hepatocellular carcinoma (HCC). METHODS The TheraSphere Global DSC is comprised of health care providers across multiple disciplines involved in the treatment of HCC with yttrium-90 (Y-90) glass microsphere-based transarterial radioembolization (TARE). Literature published between January 2019 and September 2021 was reviewed, discussed, and adjudicated by the Delphi method. Recommendations included in this updated document incorporate both the results of the literature review and the expert opinion and experience of members of the committee. RESULTS Committee discussion and consensus led to the expansion of recommendations to apply to five common clinical scenarios in patients with HCC to support more individualized efficacious treatment with Y-90 glass microspheres. Existing clinical scenarios were updated to reflect recent developments in dosimetry approaches and broader treatment paradigms evolving for patients presenting with HCC. CONCLUSION Updated consensus recommendations are provided to guide clinical and dosimetric approaches for the use of Y-90 glass microsphere TARE in HCC, accounting for disease presentation, tumor biology, and treatment intent.
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Affiliation(s)
- Riad Salem
- Department of Radiology, Northwestern Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, USA.
| | - Siddharth A Padia
- Department of Radiology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Marnix Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlo Chiesa
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paul Haste
- Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Beau Toskich
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Kirk Fowers
- Boston Scientific Corporation, Marlborough, MA, USA
| | - Joseph M Herman
- Department of Radiation Medicine, Northwell Health, New Hyde Park, NY, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Leung
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Daniel Y Sze
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Edward Kim
- Department of Interventional Radiology, Mount Sinai, New York City, NY, USA
| | - Etienne Garin
- INSERM, INRA, Centre de Lutte Contre Le Cancer Eugène Marquis, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, 35000, Rennes, France
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26
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Milano A, Capotosti A, Zagaria L, Perotti G, Rizzo A, Longo V, De Leoni D, Moretti R, Breschi L, Meffe G, Placidi L, Cusumano D, Cerrito L, Annunziata S, Iezzi R, Indovina L. Dose-response Analysis in Hepatic Tumors Treated with 90Y-TARE According to a Personalized Dosimetric Workflow: Preliminary Results. Curr Radiopharm 2023; 16:326-336. [PMID: 37291781 DOI: 10.2174/1874471016666230608100921] [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: 11/04/2022] [Revised: 04/12/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transarterial Radioembolization (TARE) is a widespread radiation therapy for unresectable hepatic lesions, but a clear understanding of the dose-response link is still missing. The aim of this preliminary study is to investigate the role of both dosimetric and clinical parameters as classifiers or predictors of response and survival for TARE in hepatic tumors and to present possible response cut-off. METHODS 20 patients treated with glass or resin microspheres according to a personalized workflow were included. Dosimetric parameters were extracted from personalized absorbed dose maps obtained from the convolution of 90Y PET images with 90Y voxel S-values. RESULTS D95 ≥ 104 Gy and tumor mean absorbed dose MADt ≥ 229 Gy were found to be optimal cut-off values for complete response, while D30 ≥ 180 Gy and MADt ≥ 117 Gy were selected as cut-off values for at least partial response and predicted better survival. Clinical parameters Alanine Transaminase (ALT) and Model for End-Stage Liver Disease (MELD) didn't show sufficient classification capability for response or survival. CONCUSION These preliminary results highlight the importance of an accurate dosimetric evaluation and suggest a cautious approach when considering clinical indicators. Dosimetric cut-off values could be a support tool in both planning and post-treatment phases. Larger multi-centric randomized trials, with standardized methods regarding patient selection, response criteria, Regions of Interest definition, dosimetric approach and activity planning are needed to confirm these promising results.
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Affiliation(s)
- Alessia Milano
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy
| | - Amedeo Capotosti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Luca Zagaria
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Germano Perotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Alessio Rizzo
- Department of Nuclear Medicine, Candiolo Cancer Institute, FPO - IRCCS, Turin, Italy
| | - Valentina Longo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Davide De Leoni
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy
| | - Roberto Moretti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Laura Breschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Guenda Meffe
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
- UOS Fisica Medica, Mater Olbia Hospital, Strada Statale 125 Orientale Sarda - 07026 Olbia SS, Italy
| | - Lucia Cerrito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Salvatore Annunziata
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Roberto Iezzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Luca Indovina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
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Morsink NC, Nijsen JFW, Grinwis GCM, Hesselink JW, Kirpensteijn J, van Nimwegen SA. Intratumoral injection of holmium-166 microspheres as neoadjuvant therapy of soft tissue sarcomas in dogs. Front Vet Sci 2022; 9:1015248. [PMID: 36387397 PMCID: PMC9664058 DOI: 10.3389/fvets.2022.1015248] [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: 08/09/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Minimally invasive microbrachytherapy is in development to treat solid tumors by intratumoral injection of (radioactive) holmium-166 (166Ho) microspheres (MS). A high local dose can be administered with minimal damage to surrounding tissue because of the short soft tissue penetration depth of 166Ho beta radiation. We aimed to prospectively evaluate the safety and efficacy of 166Ho microbrachytherapy in client-owned canine patients with soft tissue sarcomas (STS). METHODS We included seven dogs with STS not suitable for local excision due to tumor size and/or location. 166HoMS were suspended in a carrier fluid and multiple needle-injections were performed in predetermined tumor segments to maximize tumor coverage. Tumor response was evaluated using 3D caliper and CT measurements. Follow-up further included monitoring for potential side effects and registration of subsequent treatments and survival, until at least two years after treatment. RESULTS Delivered radioactive doses ranged from 70 to 969 Gy resulting in a mean tumor volume reduction of 49.0 ± 21.3% after 33 ± 25 days. Treatment-related side effects consisted of local necrosis (n = 1) and ulceration of the skin covering the tumor (n = 1), which resolved with basic wound care, and surgical excision of residual tumor, respectively. Residual tumor was surgically resected in six patients after 22-93 days. After a mean follow-up of 1,005 days, four patients were alive, two patients were euthanized because of unrelated causes, and one patient was euthanized because of disease progression after the owner(s) declined subsequent surgical treatment. CONCLUSION 166Ho microbrachytherapy was a safe and effective neoadjuvant treatment option for canine patients with STS.
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Affiliation(s)
- Nino Chiron Morsink
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands,*Correspondence: Nino Chiron Morsink
| | - Johannes Frank Wilhelmus Nijsen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Jan Willem Hesselink
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jolle Kirpensteijn
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
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Goyal P, Salem R, Mouli SK. Role of interventional oncology in hepatocellular carcinoma: Future best practice beyond current guidelines. Br J Radiol 2022; 95:20220379. [PMID: 35867889 PMCID: PMC9815732 DOI: 10.1259/bjr.20220379] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. Liver transplant remains the goal of curative treatment, but limited supply of organs decreases accessibility and prolongs waiting time to transplantation. Therefore, interventional oncology therapies have been used to treat the majority of HCC patients, including those awaiting transplant. The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used staging system in management of HCC that helps allocate treatments. Since its inception in 1999, it was updated for the fifth time in November 2021 and for the first time shaped by expert opinions outside the core BCLC group. The most recent version includes additional options for early-stage disease, substratifies intermediate disease into three groups, and lists alternates to Sorafenib that can double the expected survival of advanced-stage disease. The group also proposed a new BCLC staging schema for disease progression, and endorsed treatment stage migration (TSM) directly into the main staging and treatment algorithm. This article reviews the recent developments underlying the current BCLC guidelines and highlights ongoing research, particularly involving radioembolization, that will shape future best practice.
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Affiliation(s)
- Piyush Goyal
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Samdeep K. Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
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Gupta P, Kalra N, Chaluvashetty SB, Gamangatti S, Mukund A, Abdul R, Shyam VS, Baijal SS, Mohan C. Indian College of Radiology and Imaging Guidelines on Interventions in Hepatocellular Carcinoma. Indian J Radiol Imaging 2022; 32:540-554. [DOI: 10.1055/s-0042-1754361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractHepatocellular carcinoma (HCC) is one of the most common malignancies and a significant cause of cancer-related death. Treatment of HCC depends on the stage of the tumor. As many patients with HCC are not deemed fit for surgical resection or liver transplantation, locoregional therapies play an essential role in the management. Image-guided locoregional treatments include percutaneous ablative therapies and endovascular therapies. The choice of an individual or a combination of therapies is guided by the tumor and patient characteristics. As the outcomes of image-guided locoregional treatments depend on the ability to achieve necrosis of the entire tumor along with a safety margin around it, it is mandatory to follow standard guidelines. In this manuscript, we discuss in detail the various aspects of image-guided locoregional therapies to guide interventional radiologists involved in the care of patients with HCC.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B. Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Amar Mukund
- Department of Interventional Radiology, ILBS, New Delhi, India
| | - Razik Abdul
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - VS Shyam
- Department of Interventional Radiology, ILBS, New Delhi, India
| | | | - Chander Mohan
- Department of Interventional Radiology, BLK Superspeciality Hospital, New Delhi, India
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Sharma NK, Kappadath SC, Chuong M, Folkert M, Gibbs P, Jabbour SK, Jeyarajah DR, Kennedy A, Liu D, Meyer JE, Mikell J, Patel RS, Yang G, Mourtada F. The American Brachytherapy Society consensus statement for permanent implant brachytherapy using Yttrium-90 microsphere radioembolization for liver tumors. Brachytherapy 2022; 21:569-591. [PMID: 35599080 PMCID: PMC10868645 DOI: 10.1016/j.brachy.2022.04.004] [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: 12/20/2021] [Revised: 03/25/2022] [Accepted: 04/14/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To develop a multidisciplinary consensus for high quality multidisciplinary implementation of brachytherapy using Yttrium-90 (90Y) microspheres transarterial radioembolization (90Y TARE) for primary and metastatic cancers in the liver. METHODS AND MATERIALS Members of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for 90Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience. RESULTS The ABS strongly recommends the use of 90Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisciplinary team. A quality management program must be implemented at the start of 90Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient-specific dosimetry optimized for treatment intent is recommended when conducting 90Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treatment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with 90Y TARE should be carefully considered. CONCLUSIONS ABS consensus for implementing a safe 90Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommendations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are critical for a unified outcome analysis of future effectiveness studies.
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Affiliation(s)
- Navesh K Sharma
- Department of Radiation Oncology, Penn State Hershey School of Medicine, Hershey, PA
| | - S Cheenu Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX
| | - Michael Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL
| | - Michael Folkert
- Northwell Health Cancer Institute, Radiation Medicine at the Center for Advanced Medicine, New Hyde Park, NY
| | - Peter Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | | | | | - David Liu
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | - Rahul S Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gary Yang
- Loma Linda University, Loma Linda, CA
| | - Firas Mourtada
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE; Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA.
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Ahmadzadehfar H, Ilhan H, Lam MGEH, Sraieb M, Stegger L. Radioembolization, Principles and indications. Nuklearmedizin 2022; 61:262-272. [PMID: 35354218 DOI: 10.1055/a-1759-4238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Radioembolization is the selective application of radionuclide-loaded microspheres into liver arteries for the therapy of liver tumours and metastases. In this review, we focused on therapy planning and dosimetry, as well as the main indications of 90Y-glass and resin microspheres and 166Ho-microspheres.
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Affiliation(s)
| | - Harun Ilhan
- Department of Nuclear Medicine, Klinikum der Universität München, Munich, Germany.,Die Radiologie, Practice for Radiology, Nuclear Medicine, and Radiation Oncology, Munich, Germany
| | - Marnix G E H Lam
- Radiology and Nuclear Medicine, University of Utrecht Faculty of Medicine, Utrecht, Netherlands
| | - Miriam Sraieb
- Nuclear Medicine, University Hospital Essen, Germany
| | - Lars Stegger
- Nuclear Medicine, University Hospital Münster, Germany
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Raphael MJ, Karanicolas PJ. Regional Therapy for Colorectal Cancer Liver Metastases: Which Modality and When? J Clin Oncol 2022; 40:2806-2817. [PMID: 35649228 DOI: 10.1200/jco.21.02505] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For patients with unresectable colorectal liver metastases (uCRLM), regional therapies leverage the unique, dual blood supply to the liver; the hepatic artery is the main blood supply for liver tumors, whereas the portal vein supplies most normal hepatic parenchyma. Infusion of cancer therapies via the hepatic artery allows selective delivery to the tumors with relative sparing of normal liver tissue and little extrahepatic exposure, thus limiting systemic side effects. There is a paucity of randomized controlled trial evidence to inform the optimal integration of regional therapies into the management of CRLM. Hepatic arterial infusion pump (HAIP) chemotherapy has a potential survival benefit when used in the adjuvant setting after resection of CRLM. HAIP chemotherapy can be safely given with contemporary systemic therapies and is associated with a high objective response and rate of conversion to resectability in patients with uCRLM. Drug-eluting beads coated with irinotecan transarterial chemoembolization is associated with high objective response rates within the liver and has a well-established safety profile in patients with uCRLM. Transarterial radioembolization achieves high rates of response within the liver but is not associated with improvements in overall survival or quality of life in the first- or second-line setting for uCRLM. The best treatment approach is the one that most aligns with a given patients' values, preferences, and philosophy of care. In the first-line setting, HAIP could be offered to motivated patients who hope to achieve conversion to resectability. After progression on chemotherapy, HAIP, transarterial chemoembolization, and transarterial radioembolization are valuable treatment options to consider for patients with liver-limited or liver-predominant CRLM who seek to optimize response rates and regional control.
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Affiliation(s)
- Michael J Raphael
- Division of Medical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul J Karanicolas
- Division of Surgical Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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Guerrero M, Yao W, Lin M, Becker S, Molitoris J, Vedam S, Yi B. Validation of a commercial software dose calculation for Y-90 microspheres. Brachytherapy 2022; 21:561-566. [DOI: 10.1016/j.brachy.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/26/2022]
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Graves SA, Martin M, Tiwari A, Merrick MJ, Sunderland JJ. SIR-Spheres activity measurements reveal systematic miscalibration. J Nucl Med 2022; 63:1131-1135. [PMID: 34992155 DOI: 10.2967/jnumed.121.262650] [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: 05/26/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Accurate dosimetry-guided radiopharmaceutical therapy fundamentally relies on knowledge of the quantity of radioactivity administered to patients. The purpose of this work was to perform an independent and NIST-traceable activity measurement of 90Y SIR-Spheres®. Methods: Gamma spectroscopic measurements of the 90Y internal pair production decay mode were made using a high-purity germanium detector. Un-modified patient SIR-Spheres® vials were placed within a high-density polyethylene source holder positioned at a distance of 210 cm from the detector, with acquisition durations of 3 - 6 hours. Measured annihilation radiation detection rates were corrected for radioactive decay during acquisition, dead time, source attenuation, and source geometry effects. Detection efficiency was determined by two independent and NIST-traceable methods. Resulting 90Y activity measurements were compared against the manufacturer activity calibration. Results: Measured SIR-Sphere® vials (n = 5) were found to contain more activity than specified by the manufacturer calibration - on average the ratio of measured activity to calibrated was 1.233 ± 0.030. Activity measurements made using two distinct efficiency calibration methods were found to agree within 1%. Uncertainty in individual measurements was dominated by counting statistical uncertainty (~2.5%), uncertainty in the internal pair production branching ratio of 90Y (1.5%), and efficiency calibration (1.2% - 1.9%). Conclusion: The primary SIR-Spheres® activity calibration appears to be a significant underestimate of true activity. This mis-calibration has likely been consistent for as long as the SIR-Sphere® product has been available. This finding should be independently verified, and steps should be taken by the manufacturer to establish an accurate and traceable activity standard.
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Bertolet A, Wehrenberg-Klee E, Bobić M, Grassberger C, Perl J, Paganetti H, Schuemann J. Pre- and post-treatment image-based dosimetry in 90Y-microsphere radioembolization using the TOPAS Monte Carlo toolkit. Phys Med Biol 2021; 66:10.1088/1361-6560/ac43fd. [PMID: 34915451 PMCID: PMC8729171 DOI: 10.1088/1361-6560/ac43fd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/16/2021] [Indexed: 12/31/2022]
Abstract
Objective. To evaluate the pre-treatment and post-treatment imaging-based dosimetry of patients treated with 90Y-microspheres, including accurate estimations of dose to tumor, healthy liver and lung. To do so, the Monte Carlo (MC) TOPAS platform is in this work extended towards its utilization in radionuclide therapy.Approach. Five patients treated at the Massachusetts General Hospital were selected for this study. All patients had data for both pre-treatment SPECT-CT imaging using 99mTc-MAA as a surrogate of the 90Y-microspheres treatment and SPECT-CT imaging immediately after the 90Y activity administration. Pre- and post-treatment doses were computed with TOPAS using the SPECT images to localize the source positions and the CT images to account for tissue inhomoegeneities. We compared our results with analytical calculations following the voxel-based MIRD scheme.Main results. TOPAS results largely agreed with the MIRD-based calculations in soft tissue regions: the average difference in mean dose to the liver was 0.14 Gy GBq-1(2.6%). However, dose distributions in the lung differed considerably: absolute differences in mean doses to the lung ranged from 1.2 to 6.3 Gy GBq-1and relative differences from 153% to 231%. We also found large differences in the intra-hepatic dose distributions between pre- and post-treatment imaging, but only limited differences in the pulmonary dose.Significance. Doses to lung were found to be higher using TOPAS with respect to analytical calculations which may significantly underestimate dose to the lung, suggesting the use of MC methods for 90Y dosimetry. According to our results, pre-treatment imaging may still be representative of dose to lung in these treatments.
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Affiliation(s)
- Alejandro Bertolet
- Department of Radiation Oncology, Massachusetts General Hospital
and Harvard Medical School, Boston, MA, USA
| | - Eric Wehrenberg-Klee
- Department of Radiology, Division of Interventional Radiology,
Massachusetts General Hospital, Boston, MA, USA
| | - Mislav Bobić
- Department of Radiation Oncology, Massachusetts General Hospital
and Harvard Medical School, Boston, MA, USA & Department of Physics, ETH
Zürich, Zürich, Switzerland
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital
and Harvard Medical School, Boston, MA
| | - Joseph Perl
- SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital
and Harvard Medical School, Boston, MA, USA
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital
and Harvard Medical School, Boston, MA, USA
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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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Yoo MY, Paeng JC, Kim HC, Lee MS, Lee JS, Lee DS, Kang KW, Cheon GJ. Efficacy of voxel-based dosimetry map for predicting response to trans-arterial radioembolization therapy for hepatocellular carcinoma: a pilot study. Nucl Med Commun 2021; 42:1396-1403. [PMID: 34392298 DOI: 10.1097/mnm.0000000000001471] [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: 02/04/2023]
Abstract
OBJECTIVE Typical clinical dosimetry models for trans-arterial radioembolization (TARE) assume uniform dose distribution in each tissue compartment. We performed simple voxel-based dosimetry using post-treatment 90Y PET following TARE with 90Y-resin microspheres and investigated its prognostic value in a pilot cohort. METHOD Ten patients with 14 hepatocellular carcinoma lesions who underwent TARE with 90Y-resin microspheres were retrospectively included. The partition model-based expected target tumor dose (TDp) was calculated using a pretreatment 99mTc-macroaggregated albumin scan. From post-treatment 90Y-microsphere PET and voxel-wise S-value kernels, voxel-based dose maps were produced and the absorbed dose of each lesion (TDv) was calculated. Heterogeneity of intratumoral absorbed doses was assessed using the SD and coefficient of variation of voxel doses. The response of each lesion was determined based on contrast-enhanced MRI or CT, or both. Lesion responses were classified as local control success or failure. Prognostic values of dosimetry parameters and clinicopathological factors were evaluated in terms of progression-free survival (PFS) of each lesion. RESULTS TDv was significantly different between local control success and failure groups, whereas tumor size, TDp and intratumoral dose heterogeneity were not. Univariate survival analysis identified serum aspartate transaminase level ≥40 IU/L, tumor size ≥66 mm and TDv <81 Gy as significant prognostic factors for PFS. However, only TDv was an independent predictive factor in the multivariate analysis (P = 0.022). There was a significant correlation between TDv and PFS (P = 0.009; r = 0.669). CONCLUSIONS In TARE, voxel-based dose index TDv can be estimated on post-treatment 90Y PET using a simple method. TDv was a more effective prognostic factor for TARE than TDp and clinicopathologic factors in this pilot study. Further studies are warranted on the role of voxel-based dose and dose distribution in TARE.
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Affiliation(s)
- Min Young Yoo
- Departments of Nuclear Medicine, Chungbuk National University Hospital, Cheongju
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital
| | - Min Sun Lee
- Department of Nuclear Medicine, Seoul National University Hospital
- Interdisciplinary Program in Radiation Applied Life Science, Seoul National University, Seoul
- Nuclear Emergency and Environmental Protection Division, Korea Atomic Energy Research Institute, Daejeon
| | - Jae Sung Lee
- Department of Nuclear Medicine, Seoul National University Hospital
- Interdisciplinary Program in Radiation Applied Life Science, Seoul National University, Seoul
- Department of Biomedical Sciences, Seoul National University College of Medicine
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Chiesa C, Sjogreen-Gleisner K, Walrand S, Strigari L, Flux G, Gear J, Stokke C, Gabina PM, Bernhardt P, Konijnenberg M. EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres. EJNMMI Phys 2021; 8:77. [PMID: 34767102 PMCID: PMC8589932 DOI: 10.1186/s40658-021-00394-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/21/2021] [Indexed: 11/27/2022] Open
Abstract
The aim of this standard operational procedure is to standardize the methodology employed for the evaluation of pre- and post-treatment absorbed dose calculations in 90Y microsphere liver radioembolization. Basic assumptions include the permanent trapping of microspheres, the local energy deposition method for voxel dosimetry, and the patient-relative calibration method for activity quantification.The identity of 99mTc albumin macro-aggregates (MAA) and 90Y microsphere biodistribution is also assumed. The large observed discrepancies in some patients between 99mTc-MAA predictions and actual 90Y microsphere distributions for lesions is discussed. Absorbed dose predictions to whole non-tumoural liver are considered more reliable and the basic predictors of toxicity. Treatment planning based on mean absorbed dose delivered to the whole non-tumoural liver is advised, except in super-selective treatments.Given the potential mismatch between MAA simulation and actual therapy, absorbed doses should be calculated both pre- and post-therapy. Distinct evaluation between target tumours and non-tumoural tissue, including lungs in cases of lung shunt, are vital for proper optimization of therapy. Dosimetry should be performed first according to a mean absorbed dose approach, with an optional, but important, voxel level evaluation. Fully corrected 99mTc-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and 90Y TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected 99mTc-MAA SPECT may be used. This offers better planning quality than non dosimetric methods such as Body Surface Area (BSA) or mono-compartmental dosimetry. Quantitative 90Y bremsstrahlung SPECT can be used if dedicated correction methods are available.The proposed methodology is feasible with standard camera software and a spreadsheet. Available commercial or free software can help facilitate the process and improve calculation time.
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Affiliation(s)
- Carlo Chiesa
- Nuclear Medicine Unit, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Stephan Walrand
- Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain, Brussels, Belgium
| | - Lidia Strigari
- Medical Physics Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Pablo Minguez Gabina
- Department of Medical Physics and Radiation Protection, Gurutzeta/Cruces University Hospital, Barakaldo, Spain
| | - Peter Bernhardt
- Department of Radiation Physics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mark Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Kim SP, Juneau D, Cohalan C, Enger SA. Standardizing SPECT/CT dosimetry following radioembolization with yttrium-90 microspheres. EJNMMI Phys 2021; 8:71. [PMID: 34716850 PMCID: PMC8557238 DOI: 10.1186/s40658-021-00413-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background Multiple post-treatment dosimetry methods are currently under investigation for Yttrium-90 (\documentclass[12pt]{minimal}
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\begin{document}$$^{90}\hbox {Y}$$\end{document}90Y) radioembolization. Within each methodology, a variety of dosimetric inputs exists that affect the final dose estimates. Understanding their effects is essential to facilitating proper dose analysis and crucial in the eventual standardization of radioembolization dosimetry. The purpose of this study is to investigate the dose differences due to different self-calibrations and mass density assignments in the non-compartmental and local deposition methods. A practical mean correction method was introduced that permits dosimetry in images where the quality is compromised by patient motion and partial volume effects. Methods Twenty-one patients underwent \documentclass[12pt]{minimal}
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\begin{document}$$^{90}\hbox {Y}$$\end{document}90Y radioembolization and were imaged with SPECT/CT. Five different self-calibrations (FOV, Body, OAR, Liverlung, and Liver) were implemented and dosimetrically compared. The non-compartmental and local deposition method were used to perform dosimetry based on either nominal- or CT calibration-based mass densities. A mean correction method was derived assuming homogeneous densities. Cumulative dose volume histograms, linear regressions, boxplots, and Bland Altman plots were utilized for analysis. Results Up to 270% weighted dose difference was found between self-calibrations with mean dose differences up to 50 Gy in the liver and 23 Gy in the lungs. Between the local deposition and non-compartmental methods, the liver and lung had dose differences within 0.71 Gy and 20 Gy, respectively. The local deposition method’s nominal and CT calibration-based mass density implementations dosimetric metrics were within 1.4% in the liver and 24% in the lungs. The mean lung doses calculated with the CT method were shown to be inflated. The mean correction method demonstrated that the corrected mean doses were greater by up to \documentclass[12pt]{minimal}
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\begin{document}$$\sim 5$$\end{document}∼5 Gy in the liver and lower by up to \documentclass[12pt]{minimal}
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\begin{document}$$\sim 12$$\end{document}∼12 Gy in the lungs. Conclusions The OAR calibration may be utilized as a potentially more accurate and precise self-calibration. The non-compartmental method was found more comparable to the local deposition method in organs that were more homogeneous in mass densities. Due to the potential for inflated lung mean doses, the non-compartmental and local deposition method implemented with nominal mass densities is recommended for more consistent dosimetric results. If patient motion and partial volume effects are present in the liver, our practical correction method will calculate more representative doses in images suboptimal for dosimetry.
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Affiliation(s)
- S Peter Kim
- Medical Physics Unit, McGill University, Montreal, Canada. .,Biological and Biomedical Engineering, McGill University, Montreal, Canada.
| | - Daniel Juneau
- Department of Medical Imaging, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Claire Cohalan
- Department of Physics and Biomedical Engineering, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Shirin A Enger
- Medical Physics Unit, McGill University, Montreal, Canada.,Biological and Biomedical Engineering, McGill University, Montreal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
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Commander CW, Mauro DM. Current Approach to Planning Angiography and MAA Administration. Semin Intervent Radiol 2021; 38:397-404. [PMID: 34629705 DOI: 10.1055/s-0041-1735616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transarterial radioembolization of primary and secondary hepatic malignancies utilizing yttrium-90 microspheres is a commonly performed treatment by interventional radiologists. Traditionally performed as a two-part procedure, a diagnostic angiography is performed 1 to 3 weeks prior to treatment with the injection of technetium-99m-macroaggregated albumin followed by planar scintigraphy in the nuclear medicine department. Careful attention must be paid to the details during the diagnostic angiography to ensure the delivery of a safe and optimal dose to the diseased liver and to minimize radiation-induced damage to both unaffected liver and adjacent structures. In this article, we will review the steps and considerations that must be made during the angiography planning and discuss current and future areas of research.
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Affiliation(s)
- Clayton W Commander
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David M Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Laidlaw GL, Johnson GE. Recognizing and Managing Adverse Events in Y-90 Radioembolization. Semin Intervent Radiol 2021; 38:453-459. [PMID: 34629713 DOI: 10.1055/s-0041-1735617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transarterial radioembolization using yttrium-90 (Y-90) microspheres is an important therapy in the management of unresectable primary liver tumors or hepatic metastases. While radioembolization is generally well-tolerated, it is not free from adverse events, and familiarity with the prevention and treatment of radioembolization-specific complications is an important component of patient care. This article aims to review radioembolization-specific toxicities stratified by hepatic, extrahepatic, and systemic effects, with a focus on preventing and mitigating radioembolization-induced morbidity.
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Affiliation(s)
- Grace L Laidlaw
- Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Guy E Johnson
- Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
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Garlipp B, Amthauer H, Kupitz D, Grosser OS, Jürgens J, Damm R, Powerski M, Fabritius M, Oecal O, Stuebs P, Benckert C, Seidensticker R, Ricke J, Pech M, Seidensticker M. The Impact of Unilateral 90Y-radioembolization on Functional Changes in the Contralateral Hepatic Lobe: The Prospective, Open-label RadioEmbolization, Volumetry, and Liver FuncTion Measurements (REVoluTion) Study. ANNALS OF SURGERY OPEN 2021; 2:e095. [PMID: 37635822 PMCID: PMC10455191 DOI: 10.1097/as9.0000000000000095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022] Open
Abstract
Objectives To investigate how metabolic function of the contralateral liver lobe is affected by unilateral radioembolization (RE), and to compare the changes in volume and metabolic function. Background Unilateral RE induces contralateral liver hypertrophy, but it is unknown if metabolic liver function improves in line with volume increases. Methods This prospective open-label, nonrandomized, therapy-optimizing study included all consecutive patients undergoing right-sided or sequential 90Y-RE for liver malignancies without underlying liver disease or biliary obstruction at a single center in Germany. Magnetic resonance imaging volumetry and hepatobiliary scintigraphy were performed immediately before RE and approximately 6 weeks after RE. Results Twenty-three patients were evaluated (11 metastatic colorectal cancer, 4 cholangiocellular carcinoma, 3 metastatic breast cancer, 1 each of metastatic neuroendocrine tumor, hepatocellular carcinoma, renal cell carcinoma, oesophageal cancer, pancreatic ductal adenocarcinoma). In the untreated contralateral left liver lobe, mean (SD) metabolic function significantly increased from 1.34 (0.76) %/min/m2 at baseline to 1.56 (0.75) %/min/m2 6 weeks after RE (P = 0.024). The mean (SD) functional volume (liver volume minus tumor volume) of the left liver lobe significantly increased from baseline (407.3 [170.3] mL) to follow-up (499.1 [209.8] mL; P < 0.01), with an equivalent magnitude to the metabolic function increase. There were no reports of grade ≥3 adverse events. Conclusion This study indicates that unilobar RE produces a significant increase in the metabolic function, and equivalent volume increase, of the contralateral lobe. RE may be a useful option to induce hypertrophy of the future liver remnant before surgical resection of primary or secondary liver malignancies.
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Affiliation(s)
- Benjamin Garlipp
- From the General Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Holger Amthauer
- Klinik für Nuklearmedizin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dennis Kupitz
- Klinik für Radiologie und Nuklearmedizin, Otto von Guericke University, Magdeburg, Germany
| | - Oliver S. Grosser
- Klinik für Radiologie und Nuklearmedizin, Otto von Guericke University, Magdeburg, Germany
| | - Julian Jürgens
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Robert Damm
- Klinik für Radiologie und Nuklearmedizin, Otto von Guericke University, Magdeburg, Germany
| | - Maciej Powerski
- Klinik für Radiologie und Nuklearmedizin, Otto von Guericke University, Magdeburg, Germany
| | - Matthias Fabritius
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Osman Oecal
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Patrick Stuebs
- Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, DRK Kliniken Berlin, Berlin, Germany
| | - Christoph Benckert
- Allgemein-und Viszeralchirurgie, Klinikum im Friedrichshain, Berlin, Germany
| | - Ricarda Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Jens Ricke
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Maciej Pech
- Klinik für Radiologie und Nuklearmedizin, Otto von Guericke University, Magdeburg, Germany
| | - Max Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
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Decoteau MA, Steuterman S, Kurian SM, Case J, Lewis PR, Fisher JS, Schaffer RL, Marsh CL. Mitigation of radiation exposure during surgical hepatectomy after yttrium-90 radioembolization. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:N1-N11. [PMID: 34107455 DOI: 10.1088/1361-6498/ac09c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/09/2021] [Indexed: 06/12/2023]
Abstract
Yttrium-90 (Y-90) radioembolization for the treatment of hepatocellular carcinoma can present safety challenges when transplanting recently treated Y-90 patients. To reduce surgeons' contact with radioactive tissue and remain within occupational dose limits, current guidelines recommend delaying transplants at least 14 days, if possible. We wanted to determine the level of radiation exposure to the transplant surgeon when explanting an irradiated liver before the recommended decay period. Anex-vivoradiation exposure analysis was conducted on the explanted liver of a patient who received Y-90 therapy 46 h prior to orthotopic liver transplant. To estimate exposure to the surgeon's hands, radiation dosimeter rings were placed inside three different surgical glove configurations and exposed to the explanted liver. Estimated radiation doses corrected for Y-90 decay were calculated. Radiation safety gloves performed best, with an average radiation exposure rate of 5.36 mSV h-1in the static hand position, an 83% reduction in exposure over controls with no glove (31.31 mSv h-1). Interestingly, non-radiation safety gloves also demonstrated reduced exposure rates, well below occupational regulation limits. Handling of Y-90 radiated organs within the immediate post-treatment period can be done safely and does not exceed federal occupational dose limits if appropriate gloves and necessary precautions are exercised.
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Affiliation(s)
- Mary A Decoteau
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, United States of America
| | - Steven Steuterman
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Department of Medical Physics and Radiation Safety, Scripps Clinic and Scripps Green Hospital, La Jolla, CA, United States of America
| | - Sunil M Kurian
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Scripps Clinic Bio-Repository and Bio-Informatics Core, Scripps Green Hospital, La Jolla, CA, United States of America
| | - Jamie Case
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Scripps Clinic Bio-Repository and Bio-Informatics Core, Scripps Green Hospital, La Jolla, CA, United States of America
| | - Paul R Lewis
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, United States of America
| | - Jonathan S Fisher
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
| | - Randolph L Schaffer
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
| | - Christopher L Marsh
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, 10666 N Torrey Pines Road, 200N, La Jolla, CA 92037, United States of America
- Scripps Clinic Bio-Repository and Bio-Informatics Core, Scripps Green Hospital, La Jolla, CA, United States of America
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Labour J, Boissard P, Baudier T, Khayi F, Kryza D, Durebex PV, Martino SPD, Mognetti T, Sarrut D, Badel JN. Yttrium-90 quantitative phantom study using digital photon counting PET. EJNMMI Phys 2021; 8:56. [PMID: 34318383 PMCID: PMC8316557 DOI: 10.1186/s40658-021-00402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND PET imaging of 90Y-microsphere distribution following radioembolisation is challenging due to the count-starved statistics from the low branching ratio of e+/e- pair production during 90Y decay. PET systems using silicon photo-multipliers have shown better 90Y image quality compared to conventional photo-multiplier tubes. The main goal of the present study was to evaluate reconstruction parameters for different phantom configurations and varying listmode acquisition lengths to improve quantitative accuracy in 90Y dosimetry, using digital photon counting PET/CT. METHODS Quantitative PET and dosimetry accuracy were evaluated using two uniform cylindrical phantoms specific for PET calibration validation. A third body phantom with a 9:1 hot sphere-to-background ratio was scanned at different activity concentrations of 90Y. Reconstructions were performed using OSEM algorithm with varying parameters. Time-of-flight and point-spread function modellings were included in all reconstructions. Absorbed dose calculations were carried out using voxel S-values convolution and were compared to reference Monte Carlo simulations. Dose-volume histograms and root-mean-square deviations were used to evaluate reconstruction parameter sets. Using listmode data, phantom and patient datasets were rebinned into various lengths of time to assess the influence of count statistics on the calculation of absorbed dose. Comparisons between the local energy deposition method and the absorbed dose calculations were performed. RESULTS Using a 2-mm full width at half maximum post-reconstruction Gaussian filter, the dosimetric accuracy was found to be similar to that found with no filter applied but also reduced noise. Larger filter sizes should not be used. An acquisition length of more than 10 min/bed reduces image noise but has no significant impact in the quantification of phantom or patient data for the digital photon counting PET. 3 iterations with 10 subsets were found suitable for large spheres whereas 1 iteration with 30 subsets could improve dosimetry for smaller spheres. CONCLUSION The best choice of the combination of iterations and subsets depends on the size of the spheres. However, one should be careful on this choice, depending on the imaging conditions and setup. This study can be useful in this choice for future studies for more accurate 90Y post-dosimetry using a digital photon counting PET/CT.
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Affiliation(s)
- Joey Labour
- CREATIS; CNRS UMR 5220; INSERM U 1044; Université de Lyon; INSA-Lyon; Université Lyon 1, Lyon, France
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | | | - Thomas Baudier
- CREATIS; CNRS UMR 5220; INSERM U 1044; Université de Lyon; INSA-Lyon; Université Lyon 1, Lyon, France
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | - Fouzi Khayi
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | - David Kryza
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
- Hospices Civils de Lyon; Université de Lyon; Université Claude Bernard Lyon 1; LAGEPP UMR 5007 CNRS, Lyon, France
| | | | | | | | - David Sarrut
- CREATIS; CNRS UMR 5220; INSERM U 1044; Université de Lyon; INSA-Lyon; Université Lyon 1, Lyon, France
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | - Jean-Noël Badel
- CREATIS; CNRS UMR 5220; INSERM U 1044; Université de Lyon; INSA-Lyon; Université Lyon 1, Lyon, France
- Centre de lutte contre le cancer Léon Bérard, Lyon, France
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Fahey FH, Lofton BK, White GA. Residency training for diagnostic imaging physicists should be expanded to include nuclear medicine physics. Med Phys 2021; 48:4123-4126. [PMID: 34250610 DOI: 10.1002/mp.15047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/11/2022] Open
Abstract
The American Board of Radiology offers certification in three specialties of medical physics: Therapeutic Medical Physics, Diagnostic Medical Physics, and Nuclear Medical Physics. Of these specialties, medical nuclear physics has the fewest active diplomates, only a few hundred. The diagnostic medical physics specialty certification incudes a variety of modalities (ultrasound, radiography, computed tomography, and magnetic resonance imaging) yet does not address nuclear medicine imaging or therapy. This separation dates to the beginning of the ABR certification process for medical physicists in 1947; originally there were three certificates available: X-ray and Radium Physics, Medical Nuclear Physics and, as combination of these two, Radiological Physics. Over the span of 75 years since the Medical Nuclear Physics certification was created, much has changed in the scope and proliferation of the nuclear medicine endeavor and the question arises as to the need for change in the preparation process for medical physicists in the field. I offer thanks to our contributors and note that they are writing in the classic style of a debate, the opinions that they argue may or may not reflect their personal views.
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Affiliation(s)
- Frederic H Fahey
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brad K Lofton
- Colorado Associates in Medical Physics, Colorado Springs, CO, USA
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Van BJ, Dewaraja YK, Sangogo ML, Mikell JK. Y-90 SIRT: evaluation of TCP variation across dosimetric models. EJNMMI Phys 2021; 8:45. [PMID: 34114115 PMCID: PMC8192668 DOI: 10.1186/s40658-021-00391-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Much progress has been made in implementing selective internal radiation therapy (SIRT) as a viable treatment option for hepatic malignancies. However, there is still much need for improved options for calculating the amount of activity to be administered. To make advances towards this goal, this study examines the relationship between predicted biological outcomes of liver tumors via tumor control probabilities (TCP) and parenchyma via normal tissue complication probabilities (NTCP) given variations in absorbed dose prescription methodologies. Methods Thirty-nine glass microsphere treatments in 35 patients with hepatocellular carcinoma or metastatic liver disease were analyzed using 99mTc-MAA SPECT/CT and 90Y PET/CT scans. Predicted biological outcomes corresponding to the single compartment (standard) model and multi-compartment (partition) dosimetry model were compared using our previously derived TCP dose-response curves over a range of 80–150 Gy prescribed absorbed dose to the perfused volume, recommended in the package insert for glass microspheres. Retrospective planning dosimetry was performed on the MAA SPECT/CT; changes from the planned infused activity due to selection of absorbed dose level and dosimetry model (standard or partition) were used to scale absorbed doses reported from 90Y PET/CT including liver parenchyma and lesions (N = 120) > 2 ml. A parameterized charting system was developed across all potential prescription options to enable a clear relationship between standard prescription vs. the partition model-based prescription. Using a previously proposed NTCP model, the change in prescribed dose from a standard model prescription of 120 Gy to the perfused volume to a 15% NTCP prescription to the normal liver was explored. Results Average TCP predictions for the partition model compared with the standard model varied from a 13% decrease to a 32% increase when the prescribed dose was varied across the range of 80–150 Gy. In the parametrized chart comparing absorbed dose prescription ranges across the standard model and partition models, a line of equivalent absorbed dose to a tumor was identified. TCP predictions on a per lesion basis varied between a 26% decrease and a 81% increase for the most commonly chosen prescription options when comparing the partition model with the standard model. NTCP model was only applicable to a subset of patients because of the small volume fraction of the liver that was targeted in most cases. Conclusion Our retrospective analysis of patient imaging data shows that the choice of prescribed dose and which model to prescribe potentially contribute to a wide variation in average tumor efficacy. Biological response data should be included as one factor when looking to improve patient care in the clinic. The use of parameterized charting, such as presented here, will help direct physicians when transitioning to newer prescription methods. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-021-00391-6.
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Affiliation(s)
- Benjamin J Van
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Mamadou L Sangogo
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Justin K Mikell
- Department of Radiation Oncology, University of Michigan, Ann Arbor, 48109, MI, USA
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Thompson BC, Dezarn WA. Retrospective SPECT/CT dosimetry following transarterial radioembolization. J Appl Clin Med Phys 2021; 22:143-150. [PMID: 33710776 PMCID: PMC8035553 DOI: 10.1002/acm2.13213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/22/2021] [Accepted: 02/10/2021] [Indexed: 01/14/2023] Open
Abstract
Transarterial radioembolization (TARE) effectively treats unresectable primary and metastatic liver tumors through intra‐arterial injection of Yttrium‐90 (90Y) beta particle emitting microspheres which implant around the tumor. Current dosimetry models are highly simplistic and there is a large need for an image‐based dosimetry post‐TARE, which would improve treatment safety and efficacy. Current post‐TARE imaging is 90Y bremsstrahlung SPECT/CT and we study the use of these images for dosimetry. Retrospective image review of ten patients having a Philips HealthcareTM SPECT/CT following TARE SIR‐Spheres® implantation. Emission series with attenuation correction were resampled to 3 mm resolution and used to create image‐based dose distributions. Dose distributions and analysis were performed in MIM Software SurePlanTM utilizing SurePlanTM Local Deposition Method (LDM) and a dose convolution method (WFBH). We sought to implement a patient‐specific background subtraction prior to dose calculation to make these noisy bremsstrahlung SPECT images suitable for post‐TARE dosimetry. On average the percentage of mean background counts to maximum count in the image across all patients was 9.4 ± 4.9% (maximum = 7.6%, minimum = 2.3%). Absolute dose increased and profile line width decreased as background subtraction value increased. The average value of the LDM and WFBH dose methods was statistically the same. As background subtraction value increased, the DVH curves become unrealistic and distorted. Background subtraction on bremsstrahlung SPECT image has a large effect on post‐TARE dosimetry. The background contour defined provides a systematic estimate to the activity background that accounts for the scanner and patient conditions at the time of the image study and is easily implemented using commercially available software. Using the mean count in the background contour as a subtraction across the entire image gave the most realistic dose distributions. This methodology is independent of microsphere and software manufacturer allowing for use with any available products or tools.
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Affiliation(s)
- Briana C Thompson
- Department of Radiation Oncology, Wake Forest Baptist Hospital, Winston-Salem, NC, USA.,Wake Forest School of Medicine, Molecular Medicine and Translational Sciences, Winston Salem, NC, USA
| | - William A Dezarn
- Department of Radiation Oncology, Wake Forest Baptist Hospital, Winston-Salem, NC, USA.,Wake Forest School of Medicine, Molecular Medicine and Translational Sciences, Winston Salem, NC, USA
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Systematic review of lung shunt fraction quantification comparing SPECT/CT and planar scintigraphy for yttrium 90 radioembolization planning. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00417-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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High quality imaging and dosimetry for yttrium-90 ( 90Y) liver radioembolization using a SiPM-based PET/CT scanner. Eur J Nucl Med Mol Imaging 2021; 48:2426-2436. [PMID: 33443618 DOI: 10.1007/s00259-021-05188-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Transarterial radioembolization (TARE) with yttrium-90 (90Y) microspheres is a liver-directed treatment for primary and secondary hepatic malignancies. Personalized dosimetry aims for maximum treatment effect and reduced toxicity. We aimed to compare pre-treatment voxel-based dosimetry from 99mTc macroaggregated albumin (MAA) SPECT/CT with post-treatment 90Y PET/CT for absorbed dose values, and to evaluate image quality of 90Y SiPM-based PET/CT. METHODS Forty-two patients (28 men, 14 women, mean age: 67 ± 11 years) with advanced hepatic malignancies were prospectively enrolled. Twenty patients were treated with glass and 22 with resin microspheres. Radiation absorbed doses from planning 99mTc-MAA SPECT/CT and post-therapy 90Y PET/CT were assessed. 90Y PET/CT images were acquired for 20 min and reconstructed to produce 5-, 10-, 15-, and 20-min datasets, then evaluated using the 5-point Likert scale. RESULTS The mean administered activity was 3.44 ± 1.5 GBq for glass and 1.62 ± 0.7 GBq for resin microspheres. The mean tumor absorbed doses calculated from 99mTc-MAA SPECT/CT and 90Y PET/CT were 175.69 ± 113.76 Gy and 193.58 ± 111.09 Gy (P = 0.61), respectively for glass microspheres; they were 60.18 ± 42.20 Gy and 70.98 ± 49.65 Gy (P = 0.37), respectively for resin microspheres. The mean normal liver absorbed doses from 99mTc-MAA SPECT/CT and 90Y PET/CT were 32.70 ± 22.25 Gy and 30.62 ± 20.09 Gy (P = 0.77), respectively for glass microspheres; they were 18.33 ± 11.08 Gy and 24.32 ± 15.58 Gy (P = 0.17), respectively for resin microspheres. Image quality of 90Y PET/CT at 5-, 10-, 15-, and 20-min scan time showed a Likert score of 3.6 ± 0.54, 4.57 ± 0.58, 4.84 ± 0.37, and 4.9 ± 0.3, respectively. CONCLUSIONS 99mTc-MAA SPECT/CT demonstrated great accuracy for treatment planning dosimetry. SiPM-based PET/CT scanner showed good image quality at 10-min scan time, acquired in one bed position. A PET/CT scan time of 5 min showed acceptable image quality and suffices for dosimetry and treatment verification. This allows for inclusion of 90Y PET/CT in busy routine clinical workflows. Studies with larger patient cohorts are needed to confirm these findings.
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Kappadath SC, Lopez BP, Salem R, Lam MG. Lung shunt and lung dose calculation methods for radioembolization treatment planning. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:32-42. [PMID: 33393753 DOI: 10.23736/s1824-4785.20.03287-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Radioembolization, also known as selective internal radiation therapy (SIRT), is firmly established in the management of patients with unresectable liver cancers. Advances in normal and tumor liver dosimetry and new knowledge about tumor dose response relationships have helped promote the safe use of higher prescribed doses, consequently transitioning radioembolization from palliative to curative therapy. The lungs are considered a critical organ of risk for radioembolization treatment planning. Unfortunately, lung dosimetry has not achieved similar advances in dose calculation methodology as liver dosimetry. Current estimations of lung dose are dependent on a number of parameters associated with data acquisition and processing algorithms, leading to poor accuracy and precision. Therefore, the efficacy of curative radioembolization may be compromised in patients for whom the lung dose derived using currently available methods unnecessarily limits the desired administered activity to the liver. We present a systematic review of the various methods of determining the lung shunt fraction (LSF) and lung mean dose (LD). This review encompasses pretherapy estimations and post-therapy assessments of the LSF and LD using both 2D planar and 3D SPECT/CT based calculations. The advantages and limitations of each of these methods are deliberated with a focus on accuracy and practical considerations. We conclude the review by presenting a lexicon to precisely describe the methodology used for the estimation of LSF and LD; specifically, category, agent, modality, contour and algorithm, in order to aid in their interpretation and standardization in routine clinical practice.
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Affiliation(s)
- S Cheenu Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX, USA -
| | - Benjamin P Lopez
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Riad Salem
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Marnix G Lam
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, The Netherlands
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