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Wu S, Fan K, Yang Q, Chen Z, Hou Y, Zou Y, Cai W, Kang L. Smart nanoparticles and microbeads for interventional embolization therapy of liver cancer: state of the art. J Nanobiotechnology 2023; 21:42. [PMID: 36747202 PMCID: PMC9901004 DOI: 10.1186/s12951-023-01804-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
The process of transcatheter arterial chemoembolization is characterized by the ability to accurately deliver chemotherapy drugs with minimal systemic side effects and has become the standard treatment for unresectable intermediate hepatocellular carcinoma (HCC). However, this treatment option still has much room for improvement, one of which may be the introduction of nanomaterials, which exhibit unique functions and can be applied to in vivo tumor imaging and therapy. Several biodegradable and multifunctional nanomaterials and nanobeads have recently been developed and applied in the locoregional treatment of hepatocellular cancer. This review explores recent developments and findings in relation to micro-nano medicines in transarterial therapy for HCC, emerging strategies to improve the efficacy of delivering nano-based medicines, and expounding prospects for clinical applications of nanomaterials.
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Affiliation(s)
- Sitong Wu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, 100034, China
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Kevin Fan
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, 53705, USA
| | - Qi Yang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, 100034, China
| | - Zhao Chen
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, 100034, China
| | - Yi Hou
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, 100029, China.
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, 100034, China.
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, WI, 53705, USA.
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, 100034, China.
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d'Abadie P, Walrand S, Goffette P, Amini N, Maanen AV, Lhommel R, Jamar F. Antireflux catheter improves tumor targeting in liver radioembolization with resin microspheres. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:768-773. [PMID: 34792032 DOI: 10.5152/dir.2021.20785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to determine whether antireflux (ARC) catheter may result in better tumor targeting in liver radioembolization using 90Y-resin microspheres. METHODS Patients treated with resin microspheres for hepatocellular carcinoma (HCC) and secondary liver malignancies were retrospectively analyzed. All patients underwent a 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography (SPECT) following the planning arteriography with a conventional end-hole catheter. For 90Y-microspheres injection, two groups were defined depending on the type of catheter used: an ARC group (n=38) and a control group treated with a conventional end-hole catheter (n=23). 90Y positron emission tomography computed tomography (PET/CT) was performed after the therapeutic arteriography. The choice of the catheter was not randomized, but left to the choice of the interventional radiologist. 99mTc-MAA SPECT and 90Y PET/CT were co-registered with the baseline imaging to determine a tumor to normal liver ratio (T/NL[MAA or 90Y]) and tumor dose (TD[MAA or 90Y]) for the planning and therapy. RESULTS Overall, 38 patients (115 lesions) and 23 patients (75 lesions) were analyzed in the ARC and control groups, respectively. In the ARC group, T/NL90Y and TD90Y were significantly higher than T/NLMAA and TDMAA. Median (IQR) T/NL90Y was 2.16 (2.15) versus 1.74 (1.43) for T/NLMAA (p < 0.001). Median (IQR) TD90Y was 90.96 Gy (98.31 Gy) versus 73.72 Gy (63.82 Gy) for TDMAA (p < 0.001). In this group, the differences were highly significant for neuroendocrine metastases (NEM) and HCC and less significant for colorectal metastases (CRM). In the control group, no significant differences were demonstrated. CONCLUSION The use of an ARC significantly improves tumor deposition in liver radioembolization with resin microspheres.
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Affiliation(s)
- Philippe d'Abadie
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Stephan Walrand
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Pierre Goffette
- Department of Interventional Radiology, Saint Luc University Hospital and King Albert II cancer Institute, Brussels, Belgium
| | - Nadia Amini
- Department of Interventional Radiology, Saint Luc University Hospital and King Albert II cancer Institute, Brussels, Belgium
| | - Aline van Maanen
- From the Department of Nuclear Medicine Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Renaud Lhommel
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
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Tan HY, Yeong CH, Wong YH, McKenzie M, Kasbollah A, Md Shah MN, Perkins AC. Neutron-activated theranostic radionuclides for nuclear medicine. Nucl Med Biol 2020; 90-91:55-68. [PMID: 33039974 DOI: 10.1016/j.nucmedbio.2020.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022]
Abstract
Theranostics in nuclear medicine refers to personalized patient management that involves targeted therapy and diagnostic imaging using a single or combination of radionuclide (s). The radionuclides emit both alpha (α) or beta (β-) particles and gamma (γ) rays which possess therapeutic and diagnostic capabilities, respectively. However, the production of these radionuclides often faces difficulties due to high cost, complexity of preparation methods and that the products are often sourced far from the healthcare facilities, hence losing activity due to radioactive decay during transportation. Subject to the availability of a nuclear reactor within an accessible distance from healthcare facilities, neutron activation is the most practical and cost-effective route to produce radionuclides suitable for theranostic purposes. Holmium-166 (166Ho), Lutetium-177 (177Lu), Rhenium-186 (186Re), Rhenium-188 (188Re) and Samarium-153 (153Sm) are some of the most promising neutron-activated radionuclides that are currently in clinical practice and undergoing clinical research for theranostic applications. The aim of this paper is to review the physical characteristics, current clinical applications and future prospects of these neutron activated radionuclides in theranostics. The production, physical properties, validated clinical applications and clinical studies for each neutron-activated radionuclide suitable for theranostic use in nuclear medicine are reviewed in this paper.
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Affiliation(s)
- Hun Yee Tan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia
| | - Yin How Wong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia
| | - Molly McKenzie
- School of Life Sciences, University of Dundee, DD1 4HN, United Kingdom
| | - Azahari Kasbollah
- Medical Technology Division, Malaysian Nuclear Agency, Bangi, 43000 Kajang, Selangor, Malaysia
| | - Mohamad Nazri Md Shah
- Department of Biomedical Imaging, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia
| | - Alan Christopher Perkins
- Radiological Sciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
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van Roekel C, van den Hoven AF, Bastiaannet R, Bruijnen RCG, Braat AJAT, de Keizer B, Lam MGEH, Smits MLJ. Use of an anti-reflux catheter to improve tumor targeting for holmium-166 radioembolization-a prospective, within-patient randomized study. Eur J Nucl Med Mol Imaging 2020; 48:1658-1668. [PMID: 33128132 PMCID: PMC8113291 DOI: 10.1007/s00259-020-05079-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The objective of this study was to investigate whether the use of an anti-reflux catheter improves tumor targeting for colorectal cancer patients with unresectable, chemorefractory liver metastases (mCRC) treated with holmium-166 (166Ho)-radioembolization. MATERIALS AND METHODS In this perspective, within-patient randomized study, left and right hepatic perfusion territories were randomized between infusion with a Surefire® anti-reflux catheter or a standard microcatheter. The primary outcome was the difference in tumor to non-tumor (T/N) activity distribution. Secondary outcomes included the difference in infusion efficiency, absorbed doses, predictive value of 166Ho-scout, dose-response relation, and survival. RESULTS Twenty-one patients were treated in this study (the intended number of patients was 25). The median T/N activity concentration ratio with the use of the anti-reflux catheter was 3.2 (range 0.9-8.7) versus 3.6 (range 0.8-13.3) with a standard microcatheter. There was no difference in infusion efficiency (0.04% vs. 0.03% residual activity for the standard microcatheter and anti-reflux catheter, respectively) (95%CI - 0.05-0.03). No influence of the anti-reflux catheter on the dose-response rate was found. Median overall survival was 7.8 months (95%CI 6-13). CONCLUSION Using a Surefire® anti-reflux catheter did not result in a higher T/N activity concentration ratio in mCRC patients treated with 166Ho-radioembolization, nor did it result in improved secondary outcomes measures. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02208804.
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Affiliation(s)
- Caren van Roekel
- University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Andor F van den Hoven
- University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Remco Bastiaannet
- University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rutger C G Bruijnen
- University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Arthur J A T Braat
- University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Bart de Keizer
- University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marnix G E H Lam
- University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten L J Smits
- University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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van Roekel C, Bastiaannet R, Smits MLJ, Bruijnen RC, Braat AJAT, de Jong HWAM, Elias SG, Lam MGEH. Dose-Effect Relationships of 166Ho Radioembolization in Colorectal Cancer. J Nucl Med 2020; 62:272-279. [PMID: 32591491 DOI: 10.2967/jnumed.120.243832] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023] Open
Abstract
Radioembolization is a treatment option for colorectal cancer (CRC) patients with inoperable, chemorefractory hepatic metastases. Personalized treatment requires established dose thresholds. Hence, the aim of this study was to explore the relationship between dose and effect (i.e., response and toxicity) in CRC patients treated with 166Ho radioembolization. Methods: CRC patients treated in the HEPAR II and SIM studies were analyzed. Absorbed doses were estimated using the activity distribution on posttreatment 166Ho SPECT/CT. Metabolic response was assessed using the change in total-lesion glycolysis on 18F-FDG PET/CT between baseline and 3-mo follow-up. Toxicity between treatment and 3 mo was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5, and its relationship with parenchyma-absorbed dose was assessed using linear models. The relationship between tumor-absorbed dose and patient- and tumor-level response was analyzed using linear mixed models. Using a threshold of 100% sensitivity for response, the threshold for a minimal mean tumor-absorbed dose was determined and its impact on survival was assessed. Results: Forty patients were included. The median parenchyma-absorbed dose was 37 Gy (range, 12-55 Gy). New CTCAE grade 3 or higher clinical and laboratory toxicity was present in 8 and 7 patients, respectively. For any clinical toxicity (highest grade per patient), the mean difference in parenchymal dose (Gy) per step increase in CTCAE grade category was 5.75 (95% CI, 1.18-10.32). On a patient level, metabolic response was as follows: complete response, n = 1; partial response, n = 11; stable disease, n = 17; and progressive disease, n = 8. The mean tumor-absorbed dose was 84% higher in patients with complete or partial response than in patients with progressive disease (95% CI, 20%-180%). Survival for patients with a mean tumor-absorbed dose of more than 90 Gy was significantly better than for patients with a mean tumor-absorbed dose of less than 90 Gy (hazard ratio, 0.16; 95% CI, 0.06-0.511). Conclusion: A significant dose-response relationship in CRC patients treated with 166Ho radioembolization was established, and a positive association between toxicity and parenchymal dose was found. For future patients, it is advocated to use a 166Ho scout dose to select patients and yo personalize the administered activity, targeting a mean tumor-absorbed dose of more than 90 Gy and a parenchymal dose of less than 55 Gy.
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Affiliation(s)
- Caren van Roekel
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Remco Bastiaannet
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten L J Smits
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rutger C Bruijnen
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arthur J A T Braat
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marnix G E H Lam
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Abstract
The current review documents the major hallmarks in the history and development of radioembolization, the origins of which date back to the late 1940s. Radioembolization was initially abandoned because of the increased incidence of adverse effects and lack of commercial interest; however, it regained avid interest in clinical trials and has achieved established clinical utility in the last 15 years. This review focuses on the main stations of the evolution of radioembolization, namely, initial animal and human experimental studies, production of Y-microspheres, development of current therapeutic agents (resin and glass spheres and labeled Lipiodol), prediction and prevention of inadvertent, extrahepatic shunt side effects, initial prospective studies, and large randomized trials till final approval from the relevant official bodies. The historical knowledge of the initial concepts of the method and the limitations encountered may pave the way toward further evolution and possible new applications.
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Klaassen NJM, Arntz MJ, Gil Arranja A, Roosen J, Nijsen JFW. The various therapeutic applications of the medical isotope holmium-166: a narrative review. EJNMMI Radiopharm Chem 2019; 4:19. [PMID: 31659560 PMCID: PMC6682843 DOI: 10.1186/s41181-019-0066-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/05/2019] [Indexed: 12/17/2022] Open
Abstract
Over the years, a broad spectrum of applications of the radionuclide holmium-166 as a medical isotope has been established. The isotope holmium-166 is attractive as it emits high-energy beta radiation which can be used for a therapeutic effect and gamma radiation which can be used for nuclear imaging purposes. Furthermore, holmium-165 can be visualized by MRI because of its paramagnetic properties and by CT because of its high density. Since holmium-165 has a natural abundance of 100%, the only by-product is metastable holmium-166 and no costly chemical purification steps are necessary for production of nuclear reactor derived holmium-166. Several compounds labelled with holmium-166 are now used in patients, such Ho166-labelled microspheres for liver malignancies, Ho166-labelled chitosan for hepatocellular carcinoma (HCC) and [166Ho]Ho DOTMP for bone metastases. The outcomes in patients are very promising, making this isotope more and more interesting for applications in interventional oncology. Both drugs as well as medical devices labelled with radioactive holmium are used for internal radiotherapy. One of the treatment possibilities is direct intratumoural treatment, in which the radioactive compound is injected with a needle directly into the tumour. Numerous other applications have been developed, like patches for treatment of skin cancer and holmium labelled antibodies and peptides. The second major application that is currently clinically applied is selective internal radiation therapy (SIRT, also called radioembolization), a novel treatment option for liver malignancies. This review discusses medical drugs and medical devices based on the therapeutic radionuclide holmium-166.
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Affiliation(s)
- Nienke J M Klaassen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Mark J Arntz
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Alexandra Gil Arranja
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.,Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Science for Life, Faculty of Science, Utrecht University, 3508, TB, Utrecht, The Netherlands.,Department of Radiation Science and Technology, Delft University of Technology, Mekelweg 15, 2629, JB, Delft, The Netherlands
| | - Joey Roosen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - J Frank W Nijsen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
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Alsultan AA, Smits MLJ, Barentsz MW, Braat AJAT, Lam MGEH. The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00335-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Bakker RC, de Roos R, Ververs FFT, Lam MGEH, van der Lee MK, Zonnenberg BA, Krijger GC. Blood and urine analyses after radioembolization of liver malignancies with [ 166Ho]Ho-acetylacetonate-poly(l-lactic acid) microspheres. Nucl Med Biol 2019; 71:11-18. [PMID: 31108463 DOI: 10.1016/j.nucmedbio.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/17/2019] [Accepted: 03/23/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND [166Ho]Ho-acetylacetonate-poly(L-lactic acid) microspheres were used in radioembolization of liver malignancies by intra-arterial administration. The primary aim of this study was to assess the stability and biodistribution of these microspheres. MATERIALS AND METHODS Peripheral blood and urine samples were obtained from two clinical studies. Patient and in vitro experiment samples were analyzed using inductively coupled plasma mass spectrometry (ICP-MS), gamma-ray spectroscopy, light microscopy, Coulter particle counting, and high performance liquid chromatography (HPLC). RESULTS The median percentage holmium compared to the total amount injected into the hepatic artery was 0.19% (range 0.08-2.8%) and 0.32% (range 0.03-1.8%) in the 1 h blood plasma and 24 h urine, respectively. Both the blood plasma and urine were correlated with the neutron irradiation exposure required for [166Ho]Ho-AcAc-PLLA microsphere production (ρ = 0.616, p = 0.002). After a temporary interruption of the phase 2 clinical study, the resuspension medium was replaced to precipitate [166Ho]Ho3+ pre-administration using phosphate. The in vitro near-maximum neutron irradiation experiments showed significant [166Ho]Ho-AcAc-PLLA microsphere damage. CONCLUSION The amount of holmium in the peripheral blood and urine samples after [166Ho]Ho-AcAc-PLLA microsphere intrahepatic infusion was low. A further decrease was observed after reformulation of the resuspension solution but minimization of production damage is necessary.
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Affiliation(s)
- Robbert C Bakker
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands
| | - Remmert de Roos
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands
| | - F F Tessa Ververs
- Department of Pharmacy, University Medical Center Utrecht, the Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands
| | | | - Bernard A Zonnenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands
| | - Gerard C Krijger
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands.
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Reinders MTM, Smits MLJ, van Roekel C, Braat AJAT. Holmium-166 Microsphere Radioembolization of Hepatic Malignancies. Semin Nucl Med 2019; 49:237-243. [PMID: 30954190 DOI: 10.1053/j.semnuclmed.2019.01.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Holmium microspheres have recently become available in the European market as the third type of microspheres for radioembolization of unresectable liver malignancies. Holmium microspheres come with a dedicated administration system, and since these microspheres contain holmium-166 (166Ho) instead of yttrium-90, unique dosing and imaging possibilities have become available as well. In addition, a scout dose of 166Ho microspheres (Conformité Européenne mark is now granted and not pending anymore) can be used instead of 99mTc-macroaggragated albumin during the preparatory angiography procedure. So far, two prospective phase I and phase II clinical studies have been performed on 166Ho radioembolization in a population of liver metastases from mixed origins. These studies showed that a mean whole-liver dose of 60 Gy is safe and induces tumor response. Ongoing trials investigate the effect of 166Ho radioembolization in patients with neuroendocrine tumor metastases, hepatocellular carcinoma, and colorectal cancer metastases. Data derived from these studies will be used to refine the dosing schedule of 60 Gy to the whole liver and determine the optimal level of activity for each patient. This paper discusses several basics and provides an overview of relevant dosing aspects, technical aspects of performing holmium radioembolization, as well as a summary of completed and ongoing clinical studies and the upcoming developments regarding these microspheres.
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Bouvry C, Palard X, Edeline J, Ardisson V, Loyer P, Garin E, Lepareur N. Transarterial Radioembolization (TARE) Agents beyond 90Y-Microspheres. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1435302. [PMID: 30687734 PMCID: PMC6330886 DOI: 10.1155/2018/1435302] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/19/2018] [Indexed: 12/14/2022]
Abstract
Liver malignancies, either primary tumours (mainly hepatocellular carcinoma and cholangiocarcinoma) or secondary hepatic metastases, are a major cause of death, with an increasing incidence. Among them, hepatocellular carcinoma (HCC) presents with a dark prognosis because of underlying liver diseases and an often late diagnosis. A curative surgical treatment can therefore only be proposed in 20 to 30% of the patients. However, new treatment options for intermediate to advanced stages, such as internal radionuclide therapy, seem particularly attractive. Transarterial radioembolization (TARE), which consists in the use of intra-arterial injection of a radiolabelled embolising agent, has led to very promising results. TARE with 90Y-loaded microspheres is now becoming an established procedure to treat liver tumours, with two commercially available products (namely, SIR-Sphere® and TheraSphere®). However, this technology remains expensive and is thus not available everywhere. The aim of this review is to describe TARE alternative technologies currently developed and investigated in clinical trials, with special emphasis on HCC.
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Affiliation(s)
- C. Bouvry
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, CNRS, ISCR (Institut des Sciences Chimiques de Rennes), UMR 6226, 35000 Rennes, France
| | - X. Palard
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, Inserm, LTSI (Laboratoire Traitement du Signal et de l'Image), UMR_S 1099, 35000 Rennes, France
| | - J. Edeline
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35000 Rennes, France
| | - V. Ardisson
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
| | - P. Loyer
- Univ Rennes, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35000 Rennes, France
| | - E. Garin
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35000 Rennes, France
| | - N. Lepareur
- Comprehensive Cancer Centre Eugène Marquis, 35042 Rennes, France
- Univ Rennes, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35000 Rennes, France
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Braat AJAT, Prince JF, van Rooij R, Bruijnen RCG, van den Bosch MAAJ, Lam MGEH. Safety analysis of holmium-166 microsphere scout dose imaging during radioembolisation work-up: A cohort study. Eur Radiol 2017; 28:920-928. [PMID: 28786008 PMCID: PMC5811583 DOI: 10.1007/s00330-017-4998-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/21/2017] [Accepted: 07/18/2017] [Indexed: 12/18/2022]
Abstract
Objective Radioembolisation is generally preceded by a scout dose of technetium-99m-macroaggregated albumin to estimate extrahepatic shunting of activity. Holmium-166 microspheres can be used as a scout dose (±250 MBq) and as a therapeutic dose. The general toxicity of a holmium-166 scout dose (166Ho-SD) and safety concerns of an accidental extrahepatic deposition of 166Ho-SD were investigated. Methods All patients who received a 166Ho-SD in our institute were reviewed for general toxicity and extrahepatic depositions. The absorbed dose in extrahepatic tissue was calculated on SPECT/CT and correlated to clinical toxicities. Results In total, 82 patients were included. No relevant clinical toxicity occurred. Six patients had an extrahepatic deposition of 166Ho-SD (median administered activity 270 MBq). The extrahepatic depositions (median activity 3.7 MBq) were located in the duodenum (3x), gastric fundus, falciform ligament and the lesser curvature of the stomach, and were deposited in a median volume of 15.3 ml, which resulted in an estimated median absorbed dose of 3.6 Gy (range 0.3–13.8 Gy). No adverse events related to the extrahepatic deposition of the 166Ho-SD occurred after a median follow-up of 4 months (range 1–12 months). Conclusion These results support the safety of 250 MBq 166Ho-SD in a clinical setting. Key Points • A holmium-166 scout dose is safe in a clinical setting. • Holmium-166 scout dose is a safe alternative for99mTc-MAA for radioembolisation work-up. • Holmium-166 scout dose potentially has several benefits over99mTc-MAA for radioembolisation work-up.
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Affiliation(s)
- Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Huispostnummer E01.132, 3584 CX, Utrecht, The Netherlands.
| | - Jip F Prince
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Huispostnummer E01.132, 3584 CX, Utrecht, The Netherlands
| | - Rob van Rooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Huispostnummer E01.132, 3584 CX, Utrecht, The Netherlands
| | - Rutger C G Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Huispostnummer E01.132, 3584 CX, Utrecht, The Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Huispostnummer E01.132, 3584 CX, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Huispostnummer E01.132, 3584 CX, Utrecht, The Netherlands
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