1
|
Ramdhani K, Lam MGEH, Braat AJAT, Smits MLJ, El-Haddad G. Hepatic Radioembolization: A Multistep Theragnostic Procedure. PET Clin 2024; 19:431-446. [PMID: 38816137 DOI: 10.1016/j.cpet.2024.03.010] [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: 06/01/2024]
Abstract
This article provides a thorough overview of the practice and multistep approach of hepatic radioembolization. The current literature on hepatic radioembolization in primary or metastatic liver tumors as well as future perspectives are discussed.
Collapse
Affiliation(s)
- K Ramdhani
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Ghassan El-Haddad
- Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, FL, USA
| |
Collapse
|
2
|
Yeakel J, Seyedin SN, Harada G, Hagopian G, Mahmood S, Bennett R, Harris JP, Abbott EM, Lindner S, Dayyani F, Sehgal V, Kuo JV, Abi-Jaoudeh N. The Impact of Local Control on Overall Survival after Y-90 Selective Internal Radiotherapy of Liver Metastases in Oligometastatic Cancer: A Retrospective Analysis. Cancers (Basel) 2024; 16:2401. [PMID: 39001464 PMCID: PMC11240767 DOI: 10.3390/cancers16132401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Y-90 Selective Internal Radiotherapy (SIRT) is an ablative therapy used for inoperable liver metastasis. The purpose of this investigation was to examine the impact of local control after SIRT on overall survival (OS) in oligometastatic patients. A retrospective, single-institution study identified oligometastatic patients with ≤5 non-intracranial metastases receiving unilateral or bilateral lobar Y-90 SIRT from 2009 to 2021. The primary endpoint was OS defined from Y-90 SIRT completion to the date of death or last follow-up. Local failure was classified as a progressive disease at the target lesion(s) by RECIST v1.1 criteria starting at 3 months after SIRT. With a median follow-up of 15.7 months, 33 patients were identified who had a total of 79 oligometastatic lesions treated with SIRT, with the majority histology of colorectal adenocarcinoma (n = 22). In total, 94% of patients completed the Y-90 lobectomy. Of the 79 individual lesions treated, 22 (27.8%) failed. Thirteen patients received salvage liver-directed therapy following intrahepatic failure; ten received repeat SIRT. Median OS (mOS) was 20.1 months, and 12-month OS was 68.2%. Intralesional failure was associated with worse 1 y OS (52.3% vs. 86.2%, p = 0.004). These results suggest that intralesional failure following Y-90 may be associated with inferior OS, emphasizing the importance of disease control in low-metastatic-burden patients.
Collapse
Affiliation(s)
- John Yeakel
- Department of Radiation Oncology, University of California Irvine, Orange, CA 92868, USA
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55902, USA
| | - Steven N Seyedin
- Department of Radiation Oncology, University of California Irvine, Orange, CA 92868, USA
| | - Garrett Harada
- Department of Radiation Oncology, University of California Irvine, Orange, CA 92868, USA
| | - Garo Hagopian
- Department of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Sharmeen Mahmood
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Rebecca Bennett
- Division of Vascular and Interventional Radiology, Department of Radiological Sciences, University of California Irvine, Orange, CA 92868, USA
| | - Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine, Orange, CA 92868, USA
| | | | | | - Farshid Dayyani
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Varun Sehgal
- Department of Radiation Oncology, University of California Irvine, Orange, CA 92868, USA
| | - Jeffrey V Kuo
- Department of Radiation Oncology, University of California Irvine, Orange, CA 92868, USA
| | - Nadine Abi-Jaoudeh
- Division of Vascular and Interventional Radiology, Department of Radiological Sciences, University of California Irvine, Orange, CA 92868, USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Bastiaannet R, Lin M, Frey EC, de Jong HW. Intraprocedural C-arm dual-phase cone-beam enhancement patterns correlate with tumor absorbed dose after radioembolization. Med Phys 2024; 51:3045-3052. [PMID: 38064591 PMCID: PMC10994751 DOI: 10.1002/mp.16882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Recent studies have shown a clear relationship between absorbed dose and tumor response to treatment after hepatic radioembolization. These findings help to create more personalized treatment planning and dosimetry. However, crucial to this goal is the ability to predict the dose distribution prior to treatment. The microsphere distribution is ultimately determined by (i) the hepatic vasculature and the resulting blood flow dynamics and (ii) the catheter position. PURPOSE To show that pretreatment, intra-procedural imaging of blood flow patterns, as quantified by catheter-directed intra-arterial contrast enhancement, correlate with posttreatment microsphere accumulation and, consequently, absorbed dose. MATERIALS AND METHODS Patients who participated in a clinical trial (NCT01177007) and for whom both a pretreatment dual-phase contrast-enhanced cone-beam CT (CBCT) and a posttreatment 90Y PET/CT scan were available were included in this retrospective study. Tumors and perfused volumes were manually delineated on the CBCT by an experienced radiologist. The mean, sum, and standard deviation of the voxels in each volume were recorded. The delineations were transferred to the PET-based absorbed dose maps by coregistration of the corresponding CTs. Linear multiple regression was used to correlate pretreatment CBCT enhancement to posttreatment 90Y PET/CT-based absorbed dose in each region. Leave-one-out cross-validation and Bland-Altman analyses were performed on the predicted versus measured absorbed doses. RESULTS Nine patients, with a total of 23 tumors were included. All presented with hepatocellular carcinoma (HCC). Visually, all patients had a clear correspondence between CBCT enhancement and absorbed dose. The correlation between CBCT enhancement and posttherapy absorbed tumor dose based was strong (R2 = 0.91), and moderate for the non-tumor liver tissue (R2 = 0.61). Limits of agreement were approximately ±55 Gray for tumor tissue. CONCLUSION There is a linear relationship between pretreatment blood dynamics in HCC tumors and posttreatment absorbed dose, which, if shown to be generalizable, allows for pretreatment tumor absorbed dose prediction.
Collapse
Affiliation(s)
- Remco Bastiaannet
- The Russell H Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Eric C. Frey
- The Russell H Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Hugo W.A.M. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
6
|
Budzyńska A, Kubik A, Kacperski K, Pastusiak P, Kuć M, Piasecki P, Konior M, Gryziński M, Dziuk M, Iller E. PET/CT and SPECT/CT imaging of 90Y hepatic radioembolization at therapeutic and diagnostic activity levels: Anthropomorphic phantom study. PLoS One 2024; 19:e0271711. [PMID: 38421965 PMCID: PMC10903856 DOI: 10.1371/journal.pone.0271711] [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: 07/05/2022] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Prior to 90Y radioembolization procedure, a pretherapy simulation using 99mTc-MAA is performed. Alternatively, a small dosage of 90Y microspheres could be used. We aimed to assess the accuracy of lung shunt fraction (LSF) estimation in both high activity 90Y posttreatment and pretreatment scans with isotope activity of ~100 MBq, using different imaging techniques. Additionally, we assessed the feasibility of visualising hot and cold hepatic tumours in PET/CT and Bremsstrahlung SPECT/CT images. MATERIALS AND METHODS Anthropomorphic phantom including liver (with two spherical tumours) and lung inserts was filled with 90Y chloride to simulate an LSF of 9.8%. The total initial activity in the liver was 1451 MBq, including 19.4 MBq in the hot sphere. Nine measurement sessions including PET/CT, SPECT/CT, and planar images were acquired at activities in the whole phantom ranging from 1618 MBq down to 43 MBq. The visibility of the tumours was appraised based on independent observers' scores. Quantitatively, contrast-to-noise ratio (CNR) was calculated for both spheres in all images. RESULTS LSF estimation. For high activity in the phantom, PET reconstructions slightly underestimated the LSF; absolute difference was <1.5pp (percent point). For activity <100 MBq, the LSF was overestimated. Both SPECT and planar scintigraphy overestimated the LSF for all activities. Lesion visibility. For SPECT/CT, the cold tumour proved too small to be discernible (CNR <0.5) regardless of the 90Y activity in the liver, while hot sphere was visible for activity >200 MBq (CNR>4). For PET/CT, the cold tumour was only visible with the highest 90Y activity (CNR>4), whereas the hot one was seen for activity >100 MBq (CNR>5). CONCLUSIONS PET/CT may accurately estimate the LSF in a 90Y posttreatment procedure. However, at low activities of about 100 MBq it seems to provide unreliable estimations. PET imaging provided better visualisation of both hot and cold tumours.
Collapse
Affiliation(s)
- Anna Budzyńska
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- Affidea Mazovian PET-CT Medical Centre, Warsaw, Poland
| | - Agata Kubik
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Krzysztof Kacperski
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- National Centre for Nuclear Research, Particle Acceleration Physics and Technology Division (TJ1), Otwock—Świerk, Poland
| | - Patrycja Pastusiak
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Michał Kuć
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division (H2), Otwock—Świerk, Poland
| | - Piotr Piasecki
- Department of Interventional Radiology, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Marcin Konior
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock - Świerk, Poland
| | - Michał Gryziński
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division (H2), Otwock—Świerk, Poland
| | - Mirosław Dziuk
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- Affidea Mazovian PET-CT Medical Centre, Warsaw, Poland
| | - Edward Iller
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock - Świerk, Poland
| |
Collapse
|
7
|
Wagemans MEHM, Kunnen B, Stella M, van Rooij R, Smits M, Bruijnen R, Lam MGEH, de Jong HWAM, Braat AJAT. Comparison of 3 Different Therapeutic Particles in Radioembolization of Locally Advanced Intrahepatic Cholangiocarcinoma. J Nucl Med 2024; 65:272-278. [PMID: 38176716 DOI: 10.2967/jnumed.123.265597] [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: 05/16/2023] [Revised: 11/07/2023] [Indexed: 01/06/2024] Open
Abstract
Our objective was to compare 3 different therapeutic particles used for radioembolization in locally advanced intrahepatic cholangiocarcinoma. Methods: 90Y-glass, 90Y-resin, and 166Ho-labeled poly(l-lactic acid) microsphere prescribed activity was calculated as per manufacturer recommendations. Posttreatment quantitative 90Y PET/CT and quantitative 166Ho SPECT/CT were used to determine tumor-absorbed dose, whole-normal-liver-absorbed dose, treated-normal-liver-absorbed dose, tumor-to-nontumor ratio, lung-absorbed dose, and lung shunt fraction. Response was assessed using RECIST 1.1 and the [18F]FDG PET-based change in total lesion glycolysis. Hepatotoxicity was assessed using the radioembolization-induced liver disease classification. Results: Six 90Y-glass, 8 90Y-resin, and 7 166Ho microsphere patients were included for analysis. The mean administered activity was 2.6 GBq for 90Y-glass, 1.5 GBq for 90Y-resin, and 7.0 GBq for 166Ho microspheres. Tumor-absorbed dose and treated-normal-liver-absorbed dose were significantly higher for 90Y-glass than for 90Y-resin and 166Ho microspheres (mean tumor-absorbed dose, 197 Gy for 90Y-glass vs. 73 Gy for 90Y-resin and 50 Gy for 166Ho; mean treated-normal-liver-absorbed dose, 79 Gy for 90Y-glass vs. 37 Gy for 90Y-resin and 31 Gy for 166Ho). The whole-normal-liver-absorbed dose and tumor-to-nontumor ratio did not significantly differ between the particles. All patients had a lung-absorbed dose under 30 Gy and a lung shunt fraction under 20%. The 3 groups showed similar toxicity and response according to RECIST 1.1 and [18F]FDG PET-based total lesion glycolysis changes. Conclusion: The therapeutic particles used for radioembolization differed from each other and showed significant differences in absorbed dose, whereas toxicity and response were similar for all groups. This finding emphasizes the need for separate dose constraints and dose targets for each particle.
Collapse
Affiliation(s)
- Martijn E H M Wagemans
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
| | - Britt Kunnen
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
- Image Sciences Institute, UMC Utrecht and University Utrecht, Utrecht, The Netherlands
| | - Martina Stella
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
| | - Rob van Rooij
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
| | - Maarten Smits
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
| | - Rutger Bruijnen
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; and
| |
Collapse
|
8
|
Doyle PW, Workman CS, Grice JV, McGonigle TW, Huang S, Borgmann AJ, Baker JC, Duncan DP, Taylor JE, Brown DB. Predictive Dosimetry and Outcomes of Hepatocellular Carcinoma Treated by Yttrium-90 Resin Microsphere Radioembolization: A Retrospective Analysis Using Technetium-99m Macroaggregated Albumin Single Photon Emission CT/CT and Planning Software. J Vasc Interv Radiol 2024:S1051-0443(24)00026-5. [PMID: 38246416 DOI: 10.1016/j.jvir.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 11/11/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To characterize estimated mean absorbed tumor dose (ADT), objective response (OR), and estimated target dose of hepatocellular carcinoma (HCC) after resin microsphere yttrium-90 (90Y) radioembolization using partition dosimetry. MATERIALS AND METHODS In this retrospective, single-center study, multicompartment dosimetry of index tumors receiving 90Y radioembolization between October 2015 and June 2022 was performed using a commercial software package and pretreatment technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT)/computed tomography (CT). In total, 101 patients with HCC underwent 102 treatments of 127 index tumors. Patients underwent imaging every 2-3 months after treatment to determine best response per modified Response Evaluation Criteria in Solid Tumors (mRECIST). Best response was defined as the greatest response category per mRECIST and categorized as OR or nonresponse (NR). A Cox proportional hazards model evaluated the probability of tumor OR and progression-free survival using ADT. RESULTS The median follow-up period was 148 days (interquartile range [IQR], 92-273 days). The median ADT of OR was 141.9 Gy (IQR, 89.4-215.8 Gy) compared with the median ADT of NR treatments of 70.8 Gy (IQR, 42.0-135.3 Gy; P < .001). Only ADT was predictive of response (hazard ratio = 2.79 [95% confidence interval {CI}: 1.44-5.40]; P = .003). At 6 months, an ADT of 157 Gy predicted 90.0% (95% CI: 41.3%-98.3%) probability of OR. At 1 year, an ADT of 157 Gy predicted 91.6% (95% CI: 78.3%-100%) probability of progression-free survival. Partition modeling and delivered activity were predictive of progression (P = .021 and P = .003, respectively). CONCLUSIONS For HCC treated with resin microspheres, tumors receiving higher ADT exhibited higher rates of OR. An ADT of 157 Gy predicted 90.0% OR at 6 months.
Collapse
Affiliation(s)
- Patrick W Doyle
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C Spencer Workman
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared V Grice
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Trey W McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony J Borgmann
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer C Baker
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Duncan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason E Taylor
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
9
|
Brunson CP, McGregor HJ, Hennemeyer CT, Patel MV, Woodhead GJ, Young SJ. Measurement of the Tumor-to-Normal Ratio for Radioembolization of Hepatocellular Carcinoma: A Prospective Study Comparing 2-Dimensional Perfusion Angiography, Technetium-99m Macroaggregated Albumin, and Yttrium-90 SPECT/CT. J Vasc Interv Radiol 2024; 35:94-101. [PMID: 37783268 DOI: 10.1016/j.jvir.2023.09.023] [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: 03/28/2023] [Revised: 08/11/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE To calculate the preradioembolic tumor-to-normal (T:N) ratio in hepatocellular carcinoma (HCC) using 2-dimensional (2D) perfusion angiography and compare it with that calculated using technetium-99m macroaggregated albumin (99mTc MAA) single-photon emission computed tomography (SPECT)/computed tomography (CT). MATERIALS AND METHODS This prospective single-arm study enrolled 15 participants with HCC who underwent 2D perfusion angiography immediately before the enrollment and with the microcatheter located at the same location as 99mTc MAA injection, after which SPECT/CT was performed. Quantitative digital subtraction angiography was used to calculate the area under the curve for the tumor and normal hepatic parenchyma and subsequently calculate the T:N ratio. The T:N ratio was calculated from the 99mTc MAA SPECT/CT and post-yttrium-90 bremsstrahlung SPECT/CT using dosimetry software. RESULTS The mean participant age was 64.1 years ± 9.8, and the study included 14 (93%) men and 1 (7%) woman. The mean tumor size was 4.1 cm (SD ± 2.4), and all participants received segmental treatments with glass microspheres. The mean T:N ratio calculated by 99mTc MAA SPECT/CT was 2.28 (SD ± 0.89) vs 2.25 (SD ± 0.99) calculated by 2D perfusion angiography (P = .45). For the 13 participants who underwent selective internal radiation therapy (transarterial radioembolization), there was no significant difference between the T:N ratios calculated by 2D perfusion angiography and post-90Y SPECT/CT (2.25 [SD ± 1.05] vs 1.91 [SD ± 0.39]; P = .12). CONCLUSIONS The T:N ratio calculated by 2D perfusion angiography correlated well with that calculated by 99mTc MAA SPECT/CT.
Collapse
Affiliation(s)
- Christopher P Brunson
- Department of Radiology & Biomedical Imaging, University of California-San Francisco, San Francisco, California.
| | - Hugh J McGregor
- Department of Vascular and Interventional Radiology, University of Washington, Seattle, Washington
| | | | - Mikin V Patel
- Department of Vascular and Interventional Radiology, University of Chicago, Chicago, Illinois
| | | | - Shamar J Young
- Division of Interventional Radiology, University of Arizona, Tucson, Arizona
| |
Collapse
|
10
|
Campbell GS, Reed DK, Desai A, T Lirette S. Liver Tumor Enhancement at Hybrid Angio-CT and Comparison With Tumor and Hepatic Parenchymal Distribution of Yttrium-90 Microspheres by Positron Emission Tomography. Cureus 2023; 15:e49861. [PMID: 38169929 PMCID: PMC10759247 DOI: 10.7759/cureus.49861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
This single-center retrospective study evaluated patients who underwent treatment of a primary or secondary hepatic malignancy with injection of glass or resin yttrium-90 (90Y) microspheres with a corresponding hybrid angiography-computed tomography (angio-CT) and 90Y positron emission tomography (PET). Volumetric contours were defined by three independent observers and were used to calculate relative tumoral enhancement at angio-CT. This parameter was compared with the tumor-to-normal (T/N) activity ratio predicted by technetium-99m macro-aggregated albumin (99mTc-MAA) single photon emission computed tomography (SPECT) and microsphere activity distribution by 90Y PET. A similar correlation was observed for the enhancement ratio at angio-CT with observed microsphere distribution at 90Y PET (r=0.34) to that predicted by 99mTc-MAA SPECT (r=0.32). The enhancement ratio on angio-CT performed as well as 99mTc-MAA in the prediction of 90Y PET activity distribution. The technique could not be readily applied to tumors with large areas of hypoattenuation (necrosis) on angio-CT. With refinement and further study, this technique could be used as a quantitative adjunct to standard-of-care 99mTc-MAA SPECT for dosimetry calculations and prediction of microsphere distribution to maximize tumor response and minimize hepatotoxicity.
Collapse
Affiliation(s)
- Garth S Campbell
- Interventional Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Dustin K Reed
- Interventional Radiology, Mississippi Baptist Medical Center, Jackson, USA
| | - Ajinkya Desai
- Interventional Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Seth T Lirette
- Data Science, University of Mississippi Medical Center, Jackson, USA
| |
Collapse
|
11
|
Anbari Y, Veerman FE, Keane G, Braat AJ, Smits ML, Bruijnen RC, Tan W, Li Y, Duan F, Lam MG. Current status of yttrium-90 microspheres radioembolization in primary and metastatic liver cancer. J Interv Med 2023; 6:153-159. [PMID: 38312126 PMCID: PMC10831371 DOI: 10.1016/j.jimed.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 02/06/2024] Open
Abstract
Liver malignancy, including primary liver cancer and metastatic liver cancer, has become one of the most common causes of cancer-related death worldwide due to the high malignant degree and limited systematic treatment strategy. Radioembolization with yttrium-90 (90Y)-loaded microspheres is a relatively novel technology that has made significant progress in the local treatment of liver malignancy. The different steps in the extensive work-up of radioembolization for patients with an indication for treatment with 90Y microspheres, from patient selection to follow up, both technically and clinically, are discussed in this paper. It describes the application and development of 90Y microspheres in the treatment of liver cancer.
Collapse
Affiliation(s)
- Yasaman Anbari
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Grace Keane
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | - Wenle Tan
- Interventional Radiology Department, Chinese PLA General Hospital, Beijing, China
| | - Ye Li
- Interventional Radiology Department, Chinese PLA General Hospital, Beijing, China
| | - Feng Duan
- Interventional Radiology Department, Chinese PLA General Hospital, Beijing, China
| | | |
Collapse
|
12
|
Doyle PW, Workman CS, Grice JV, McGonigle TW, Huang S, Borgmann AJ, Baker JC, Taylor JE, Brown DB. Partition Dosimetry and Outcomes of Metastatic Neuroendocrine Tumors after Yttrium-90 Resin Microsphere Radioembolization. J Vasc Interv Radiol 2023:S1051-0443(23)00758-3. [PMID: 37871833 DOI: 10.1016/j.jvir.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE To characterize estimated mean tumor-absorbed dose (ADT) and objective response of metastatic neuroendocrine tumor (NET) after resin microsphere yttrium-90 (90Y) hepatic radioembolization using partition dosimetry. MATERIALS AND METHODS In this retrospective, single-center study, multicompartment dosimetry of index tumors receiving 90Y radioembolization between 2013 and 2022 involved the use of Sureplan (MIM Software, Cleveland, Ohio) and technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT) combined with computed tomography. Thirty-six patients with NET underwent treatment of 56 index tumors. Patients underwent imaging every 3-6 months after treatment to determine best response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) criteria. Responses were categorized as objective response (OR) or nonresponse (NR). Wilcoxon rank sum test evaluated differences in continuous variables, and Pearson χ2 test evaluated differences in categorical variables. RESULTS Median follow-up was 582 days (IQR, 187-1,227 days). Per RECIST 1.1, 27 patients (75%) experienced OR and 9 patients experienced (25%) NR. Of the 36 patients, 33 (92%) showed hypervascular, mRECIST-evaluable tumors. Among them, 28 patients (85%) showed mRECIST OR and 5 patients (15%) showed NR. The mRECIST OR group received a higher ADT than the NR group (median, 107 Gy; IQR, 95.1-154 Gy vs median, 70.4 Gy; IQR, 62.9-87.6 Gy; P = .048). All tumors receiving at least 120 Gy showed mRECIST OR. CONCLUSIONS In hypervascular metastatic NET treated by 90Y resin microsphere radioembolization, higher tumor dose was associated with better tumor response per mRECIST. Doses of ≥120 Gy led to OR.
Collapse
Affiliation(s)
- Patrick W Doyle
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C Spencer Workman
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared V Grice
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Trey W McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony J Borgmann
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer C Baker
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason E Taylor
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
13
|
Andel D, Lam MGEH, de Bruijne J, Smits MLJ, Braat AJAT, Moelker A, Vegt E, Ruiter SJS, Noordzij W, Grazi G, Vallati GE, Bennink RJ, van Delden OM, Kranenburg OW, Ijzermans JNM, Nijkamp MW, Erdmann JI, Sciuto R, Hagendoorn J, Borel Rinkes IHM. Dose finding study for unilobar radioembolization using holmium-166 microspheres to improve resectability in patients with HCC: the RALLY protocol. BMC Cancer 2023; 23:771. [PMID: 37596578 PMCID: PMC10436405 DOI: 10.1186/s12885-023-11280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND High dose unilobar radioembolization (also termed 'radiation lobectomy')-the transarterial unilobar infusion of radioactive microspheres as a means of controlling tumour growth while concomitantly inducing future liver remnant hypertrophy-has recently gained interest as induction strategy for surgical resection. Prospective studies on the safety and efficacy of the unilobar radioembolization-surgery treatment algorithm are lacking. The RALLY study aims to assess the safety and toxicity profile of holmium-166 unilobar radioembolization in patients with hepatocellular carcinoma ineligible for surgery due to insufficiency of the future liver remnant. METHODS The RALLY study is a multicenter, interventional, non-randomized, open-label, non-comparative safety study. Patients with hepatocellular carcinoma who are considered ineligible for surgery due to insufficiency of the future liver remnant (< 2.7%/min/m2 on hepatobiliary iminodiacetic acid scan will be included. A classical 3 + 3 dose escalation model will be used, enrolling three to six patients in each cohort. The primary objective is to determine the maximum tolerated treated non-tumourous liver-absorbed dose (cohorts of 50, 60, 70 and 80 Gy). Secondary objectives are to evaluate dose-response relationships, to establish the safety and feasibility of surgical resection following unilobar radioembolization, to assess quality of life, and to generate a biobank. DISCUSSION This will be the first clinical study to assess the unilobar radioembolization-surgery treatment algorithm and may serve as a stepping stone towards its implementation in routine clinical practice. TRIAL REGISTRATION Netherlands Trial Register NL8902 , registered on 2020-09-15.
Collapse
Affiliation(s)
- Daan Andel
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Joep de Bruijne
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simeon J S Ruiter
- Department of HPB & Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Gianluca Grazi
- Hepatopancreatobiliary Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giulio E Vallati
- Interventional Radiology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Roel J Bennink
- Department of Radiology and Nuclear Medicine, Cancer Center, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Cancer Center, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Onno W Kranenburg
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten W Nijkamp
- Department of HPB & Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris I Erdmann
- Department of Surgery, Cancer Center, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rosa Sciuto
- Nuclear Medicine, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Jeroen Hagendoorn
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Cancer Center, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
| |
Collapse
|
14
|
Tabotta F, Gnesin S, Dunet V, Ponti A, Digklia A, Boughdad S, Schaefer N, Prior JO, Villard N, Tsoumakidou G, Denys A, Duran R. 99mTc-macroaggregated albumin SPECT/CT predictive dosimetry and dose-response relationship in uveal melanoma liver metastases treated with first-line selective internal radiation therapy. Sci Rep 2023; 13:13118. [PMID: 37573346 PMCID: PMC10423257 DOI: 10.1038/s41598-023-39994-7] [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: 10/24/2022] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
First-line selective internal radiation therapy (SIRT) showed promising outcomes in patients with uveal melanoma liver metastases (UMLM). Patient survival depends on liver's disease control. SIRT planning is essential and little is known about dosimetry. We investigated whether 99mTc-MAA-SPECT/CT dosimetry could predict absorbed doses (AD) evaluated on 90Y-PET/CT and assess the dose-response relationship in UMLM patients treated with first-line SIRT. This IRB-approved, single-center, retrospective analysis (prospectively collected cohort) included 12 patients (median age 63y, range 43-82). Patients underwent MRI/CT, 18F-FDG-PET/CT before and 3-6 months post-SIRT, and 90Y-PET/CT immediately post-SIRT. Thirty-two target lesions were included. AD estimates in tumor and non-tumor liver were obtained from 99mTc-MAA-SPECT/CT and post-SIRT 90Y-PET/CT, and assessed with Lin's concordance correlation coefficients (ρc and Cb), Pearson's coefficient correlation (ρ), and Bland-Altman analyses (mean difference ± standard deviation; 95% limits-of-agreement (LOA)). Influence of tumor characteristics and microsphere type on AD was analyzed. Tumor response was assessed according to size-based, enhancement-based and metabolic response criteria. Mean target lesion AD was 349 Gy (range 46-1586 Gy). Concordance between 99mTc-MAA-SPECT/CT and 90Y-PET/CT tumor dosimetry improved upon dose correction for the recovery coefficient (RC) (ρ = 0.725, ρc = 0.703, Cb = 0.969) with good agreement (mean difference: - 4.93 ± 218.3 Gy, 95%LOA: - 432.8-422.9). Without RC correction, concordance was better for resin microspheres (ρ = 0.85, ρc = 0.998, Cb = 0.849) and agreement was very good between predictive 99mTc-MAA-SPECT/CT and 90Y-PET/CT dosimetry (mean difference: - 4.05 ± 55.9 Gy; 95%LOA: - 113.7-105.6). After RC correction, 99mTc-MAA-SPECT/CT dosimetry overestimated AD (- 70.9 ± 158.9 Gy; 95%LOA: - 382.3-240.6). For glass microspheres, concordance markedly improved with RC correction (ρ = 0.790, ρc = 0.713, Cb = 0.903 vs without correction: ρ = 0.395, ρc = 0.244, Cb = 0.617) and 99mTc-MAA-SPECT/CT dosimetry underestimated AD (148.9 ± 267.5 Gy; 95%LOA: - 375.4-673.2). For non-tumor liver, concordance was good between 99mTc-MAA-SPECT/CT and 90Y-PET/CT dosimetry (ρ = 0.942, ρc = 0.852, Cb = 0.904). 99mTc-MAA-SPECT/CT slightly overestimated liver AD for resin (3.4 ± 3.4 Gy) and glass (11.5 ± 13.9 Gy) microspheres. Tumor AD was not correlated with baseline or post-SIRT lesion characteristics and no dose-response threshold could be identified. 99mTc-MAA-SPECT/CT dosimetry provides good estimates of AD to tumor and non-tumor liver in UMLM patients treated with first-line SIRT.
Collapse
Affiliation(s)
- Flavian Tabotta
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Ponti
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Villard
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
15
|
Doppler M, Reincke M, Bettinger D, Vogt K, Weiss J, Schultheiss M, Uller W, Verloh N, Goetz C. Predictive Value of [ 99mTc]-MAA-Based Dosimetry in Hepatocellular Carcinoma Patients Treated with [ 90Y]-TARE: A Single-Center Experience. Diagnostics (Basel) 2023; 13:2432. [PMID: 37510175 PMCID: PMC10378141 DOI: 10.3390/diagnostics13142432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Transarterial radioembolization is a well-established method for the treatment of hepatocellular carcinoma. The tolerability and incidence of hepatic decompensation are related to the doses delivered to the tumor and healthy liver. This retrospective study was performed at our center to evaluate whether tumor- and healthy-liver-absorbed dose levels in TARE are predictive of tumor response according to the mRECIST 1.1 criteria and overall survival. One hundred and six patients with hepatocellular carcinoma were treated with [90Y]-loaded resin microspheres and completed the follow-up. The dose delivered to each compartment was calculated using a compartmental model. The model was based on [99mTc]-labelled albumin aggregate images obtained before the start of therapy. Tumor response was assessed after three months of treatment. Kaplan-Meier analysis was used to assess survival. The mean age of our population was 66 ± 13 years with a majority being BCLC B tumors. Forty-two patients presented with portal vein thrombosis. The response rate was 57% in the overall population and 59% in patients with thrombosis. Target-to-background (TBR) values measured on initial [99mTc]MAA-SPECT-imaging and tumor model dosimetric values were associated with tumor response (p < 0.001 and p = 0.009, respectively). A dosimetric threshold of 136.5 Gy was predictive of tumor response with a sensitivity of 84.2% and specificity of 89.4%. Overall survival was 24.1 months [IQR 13.1-36.4] for patients who responded to treatment compared to 10.4 months [IQR 6.3-15.9] for the remaining patients (p = 0.022). In this cohort, the initial [99mTc]MAA imaging is predictive of response and survival. The dosimetry prior to the application of TARE can be used for treatment planning and our results also suggest that the therapy is well-tolerated. In particular, hepatic decompensation can be predicted even in the presence of PVT.
Collapse
Affiliation(s)
- Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Marlene Reincke
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Katharina Vogt
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Christian Goetz
- Department of Nuclear Medicine, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Patel MV, McNiel D, Brunson C, Kuo PH, Hennemeyer CT, Woodhead G, McGregor H. Prior ablation and progression of disease correlate with higher tumor-to-normal liver 99mTc-MAA uptake ratio in hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:752-757. [PMID: 36344658 DOI: 10.1007/s00261-022-03718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Factors affecting tumor-to-normal tissue ratio (T:N) have implications for patient selection, dosimetry, and outcomes when considering radioembolization for HCC. This study sought to evaluate patient, disease specific, and technical parameters that predict T:N as measured on planning pre-90Y radioembolization 99mTc-MAA scintigraphy for hepatocellular carcinoma (HCC). METHODS 99mTc-MAA hepatic angiography procedures with SPECT/CT over a 4-year period were reviewed. Data recorded included patient demographics, details of underlying liver disease, tumor size, history of prior treatments for HCC and technical parameters from angiography. Anatomic-based segmentation was performed in 93 cases for measurement of tumor and perfused liver volumes and SPECT counts. T:N were calculated and correlated with collected variables. RESULTS Mean calculated T:N was 2.52. History of prior ablation was significantly correlated with higher T:N (mean 3.39 vs 2.24, p = 0.003). Cases in which mapping was being performed for treatment of disease progression was significantly correlated with higher T:N (mean 3.35 vs 2.14, p = 0.001). Larger tumor size trended toward lower T:N (p = 0.052). CONCLUSION Patients with history of ablation and those undergoing treatment for disease progression have higher T:N and, therefore, could be considered for radioembolization preferentially over alternative treatments.
Collapse
Affiliation(s)
- Mikin V Patel
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, MC 2026, Chicago, IL, 60637, USA.
| | - David McNiel
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Christopher Brunson
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Phillip H Kuo
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Charles T Hennemeyer
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Gregory Woodhead
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Hugh McGregor
- Department of Radiology, University of Washington Medicine, Seattle, WA, USA
| |
Collapse
|
19
|
Taswell CS, Studenski M, Pennix T, Stover B, Georgiou M, Venkat S, Jones P, Zikria J, Thornton L, Yechieli R, Mohan P, Portelance L, Spieler B. For Hepatocellular Carcinoma Treated with Yttrium-90 Microspheres, Dose Volumetrics on Post-Treatment Bremsstrahlung SPECT/CT Predict Clinical Outcomes. Cancers (Basel) 2023; 15:cancers15030645. [PMID: 36765603 PMCID: PMC9913422 DOI: 10.3390/cancers15030645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
In transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) with Yttrium-90 (Y-90) microspheres, recent studies correlate dosimetry from bremsstrahlung single photon emission tomography (SPECT/CT) with treatment outcomes; however, these studies focus on measures of central tendency rather than volumetric coverage metrics commonly used in radiation oncology. We hypothesized that three-dimensional (3D) isodose coverage of gross tumor volume (GTV) is the driving factor in HCC treatment response to TARE and is best assessed using advanced dosimetry techniques applied to nuclear imaging of actual Y-90 biodistribution. We reviewed 51 lobar TARE Y-90 treatments of 43 HCC patients. Dose prescriptions were 120 Gy for TheraSpheres and 85 Gy for SIR-Spheres. All patients underwent post-TARE Y-90 bremsstrahlung SPECT/CT imaging. Commercial software was used to contour gross tumor volume (GTV) and liver on post-TARE SPECT/CT. Y-90 dose distributions were calculated using the Local Deposition Model based on post-TARE SPECT/CT activity maps. Median gross tumor volume (GTV) dose; GTV receiving less than 100 Gy, 70 Gy and 50 Gy; minimum dose covering the hottest 70%, 95%, and 98% of the GTV (D70, D95, D98); mean dose to nontumorous liver, and disease burden (GTV/liver volume) were obtained. Clinical outcomes were collected for all patients by chart and imaging review. HCC treatment response was assessed according to the modified response criteria in solid tumors (mRECIST) guidelines. Kaplan-Meier (KM) survival estimates and multivariate regression analyses (MVA) were performed using STATA. Median survival was 22.5 months for patients achieving objective response (OR) in targeted lesions (complete response (CR) or partial response (PR) per mRECIST) vs. 7.6 months for non-responders (NR, stable disease or disease progression per mRECIST). On MVA, the volume of underdosed tumor (GTV receiving less than 100 Gy) was the only significant dosimetric predictor for CR (p = 0.0004) and overall survival (OS, p = 0.003). All targets with less than CR (n = 39) had more than 20 cc of underdosed tumor. D70 (p = 0.038) correlated with OR, with mean D70 of 95 Gy for responders and 60 Gy for non-responders (p = 0.042). On MVA, mean dose to nontumorous liver trended toward significant association with grade 3+ toxicity (p = 0.09) and correlated with delivered activity (p < 0.001) and burden of disease (p = 0.05). Dosimetric models supplied area under the curve estimates of > 0.80 predicting CR, OR, and ≥grade 3 acute toxicity. Dosimetric parameters derived from the retrospective analysis of post-TARE Y-90 bremsstrahlung SPECT/CT after lobar treatment of HCC suggest that volumetric coverage of GTV, not a high mean or median dose, is the driving factor in treatment response and that this is best assessed through the analysis of actual Y-90 biodistribution.
Collapse
Affiliation(s)
- Crystal Seldon Taswell
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Matthew Studenski
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Thomas Pennix
- Miller School of Medicine, University of Miami, 1600 NW 10th Ave, Miami, FL 33136, USA
| | - Bryan Stover
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Mike Georgiou
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Shree Venkat
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Patricia Jones
- Department of Medicine, Division of Digestive Health and Liver Diseases, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Joseph Zikria
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Lindsay Thornton
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Raphael Yechieli
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Prasoon Mohan
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Lorraine Portelance
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Benjamin Spieler
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
- Correspondence:
| |
Collapse
|
20
|
Accuracy and reproducibility of a cone beam CT-based virtual parenchymal perfusion algorithm in the prediction of SPECT/CT anatomical and volumetric results during the planification of radioembolization for HCC. Eur Radiol 2023; 33:3510-3520. [PMID: 36651956 DOI: 10.1007/s00330-023-09390-w] [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: 06/10/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate anatomical and volumetric predictability of a cone beam computed tomography (CBCT)-based virtual parenchymal perfusion (VPP) software for the single-photon-emission computed tomography (SPECT)/CT imaging results during the work-up for transarterial radioembolization (TARE) procedure in patients with hepatocellular carcinoma (HCC). METHODS VPP was evaluated retrospectively on CBCT data of patients treated by TARE for HCC. 99mTc macroaggregated albumin particles (99mTc-MAA) uptake territories on work-up SPECT/CT was used as ground truth for the evaluation. Semi-quantitative evaluation consisted of the ranking of visual consistency of the parenchymal enhancement and portal vein tumoral involvement on VPP and 99mTc-MAA SPECT/CT, using a three-rank scale and two-rank scale, respectively. Inter-reader agreement was evaluated using a kappa coefficient. Quantitative evaluation included absolute volume error calculation and Pearson correlation between volumes enhanced territories on VPP and 99mTc-MAA SPECT/CT. RESULTS Fifty-two CBCTs were performed in 33 included patients. Semi-quantitative evaluation showed a good concordance between actual 99mTc-MAA uptake and the virtual enhanced territories in 73% and 75% of cases; a mild concordance in 12% and 10% and a poor concordance in 15%, for the two readers. Kappa coefficient was 0.86. Portal vein involvement evaluation showed a good concordance in 58.3% and 66.7% for the two readers, respectively, with a kappa coefficient of 0.82. Quantitative evaluation showed a volume error of 0.46 ± 0.78 mL [0.01-3.55], and Pearson R2 factor at 0.75 with a p value < 0.01. CONCLUSION CBCT-based VPP software is accurate and reliable to predict 99mTc-MAA SPECT/CT anatomical and volumetric results in HCC patients during TARE. KEY POINTS • Virtual parenchymal perfusion (VPP) software is accurate and reliable in the prediction of 99mTc-MAA SPECT volumetric and targeting results in HCC patients during transarterial radioembolization (TARE). • VPP software may be used per-operatively to optimize the microcatheter position for 90Y infusion allowing precise tumor targeting while preserving non-tumoral parenchyma. • Post-operatively, VPP software may allow an accurate estimation of the perfused volume by each arterial branch and, thus, a precise 90Y dosimetry for TARE procedures.
Collapse
|
21
|
Iezzi R, Gangi A, Posa A, Pua U, Liang P, Santos E, Kurup AN, Tanzilli A, Tenore L, De Leoni D, Filippiadis D, Giuliante F, Valentini V, Gasbarrini A, Goldberg SN, Meijerink M, Manfredi R, Kelekis A, Colosimo C, Madoff DC. Emerging Indications for Interventional Oncology: Expert Discussion on New Locoregional Treatments. Cancers (Basel) 2023; 15:cancers15010308. [PMID: 36612304 PMCID: PMC9818393 DOI: 10.3390/cancers15010308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Interventional oncology (IO) employs image-guided techniques to perform minimally invasive procedures, providing lower-risk alternatives to many traditional medical and surgical therapies for cancer patients. Since its advent, due to rapidly evolving research development, its role has expanded to encompass the diagnosis and treatment of diseases across multiple body systems. In detail, interventional oncology is expanding its role across a wide spectrum of disease sites, offering a potential cure, control, or palliative care for many types of cancer patients. Due to its widespread use, a comprehensive review of the new indications for locoregional procedures is mandatory. This article summarizes the expert discussion and report from the "MIOLive Meet SIO" (Society of Interventional Oncology) session during the last MIOLive 2022 (Mediterranean Interventional Oncology Live) congress held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions. The aim of this paper is to provide an updated review of the new techniques and devices available for innovative indications not only to residents and fellows but also to colleagues approaching locoregional treatments.
Collapse
Affiliation(s)
- Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
- Correspondence: (R.I.); (A.P.)
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Correspondence: (R.I.); (A.P.)
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Ping Liang
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ernesto Santos
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Anil N. Kurup
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - Alessandro Tanzilli
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Lorenzo Tenore
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Davide De Leoni
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece
| | - Felice Giuliante
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
- Internal Medicine and Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Shraga N. Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 12000, Israel
| | - Martijn Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Riccardo Manfredi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alexis Kelekis
- 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
| | - David C. Madoff
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, 330 Cedar St., TE-2, New Haven, CT 06510, USA
| |
Collapse
|
22
|
Kokabi N, Webster LA, Elsayed M, Switchenko JM, Chen B, Brandon D, Galt J, Sethi I, Cristescu M, Kappadath SC, Schuster DM. Accuracy and Safety of Scout Dose Resin Yttrium-90 Microspheres for Radioembolization Therapy Treatment Planning: A Prospective Single-Arm Clinical Trial. J Vasc Interv Radiol 2022; 33:1578-1587.e5. [PMID: 36075560 PMCID: PMC9834905 DOI: 10.1016/j.jvir.2022.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/09/2022] [Accepted: 08/26/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To compare the accuracy and safety of 0.56 GBq resin yttrium-90 (90Y) (scout90Y) microspheres with those of technetium-99m macroaggregated albumin (MAA) in predicting the therapeutic 90Y (Rx90Y) dose for patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS This prospective single-arm clinical trial (Clinicaltrials.gov: NCT04172714) recruited patients with HCC. Patients underwent same-day mapping with MAA and scout90Y. Rx90Y activity was administered 3 days after mapping. Using paired t test and Pearson correlation, the tumor-to-normal ratio (TNR), lung shunt fraction (LSF), predicted mean tumor dose (TD), and nontumoral liver dose (NTLD) by MAA and scout90Y were compared with those by Rx90Y. Bland-Altman plots compared the level of agreement between the TNR and LSF of scout90Y and MAA with that of Rx90Y. The safety of scout90Y was evaluated by examining the discrepancy in extrahepatic activity between MAA and scout90Y. RESULTS Thirty patients were treated using 19 segmental and 14 nonsegmental (ie, 2 contiguous segments or nonsegmental) therapies. MAA had weak LSF, moderate TNR, and moderate TD linear correlation with Rx90Y. Scout90Y had a moderate LSF, strong TNR, strong TD, and very strong NTLD in correlation with those of Rx90Y. Furthermore, the TNR and LSF of scout90Y had a stronger agreement with those of Rx90Y than with those of MAA. In the nonsegmental subgroup, MAA had no significant correlation with the TD and NTLD of Rx90Y, whereas scout90Y had a very strong correlation with both of these factors. In the segmental subgroup, both MAA and scout90Y had a strong linear correlation with the TD and NTLD of Rx90Y. CONCLUSIONS Compared with MAA, scout90Y is a more accurate surrogate for Rx90Y biodistribution for nonsegmental therapies.
Collapse
Affiliation(s)
- Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Linzi A Webster
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mohammad Elsayed
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bernard Chen
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - James Galt
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mircea Cristescu
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - S Cheenu Kappadath
- Division of Diagnostic Imaging, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David M Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
23
|
Shukla J, Goyal A, Chhabra A, Rathore Y, Bansal K, Pandey S, Parmar M, Singhal S, Kalra N, Duseja A, Mittal BR. Cold kit for Rhenium-188 microspheres based selective intra-arterial therapy (SIRT): Preparation, characterization and feasibility study. Appl Radiat Isot 2022; 190:110423. [PMID: 36183659 DOI: 10.1016/j.apradiso.2022.110423] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 12/24/2022]
Abstract
Selective-intra-arterial radionuclide therapy (SIRT) using radiolabeled microspheres are being widely employed for the delivery of therapeutic radioisotope to liver cancers by exploiting the dual blood supply to liver. It delivers the therapeutic radiations to tumor and spares the healthy liver. Several radiolabeled microspheres formulations, labelled with 90Y, are commercially available. However, high-cost leads to unaffordability for several patients. 188Re-based therapy seems affordable due to commercial availability of 188W/188Re generator that have long shelf-life of more than 6 months. To provide affordable solution, the microsphere cold kit with quick and facile methodology for 188Re radiolabeling has been developed. The microsphere cold kit has been characterized for their physicochemical properties. The Quality Control (QC) tests were also performed for clinical application. The feasibility studies were performed to study distribution and retention of 188Re microspheres in tumor. The results demonstrated that the developed cold kit enables facile and quick radiolabeling with 188Re. 188Re microspheres showed good retention in tumor and found suitable for SIRT.
Collapse
Affiliation(s)
- Jaya Shukla
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ankita Goyal
- Department of Chemistry, Post Graduate Government College for Girls, Sector-42, Chandigarh, India
| | - Anupriya Chhabra
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogesh Rathore
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kavita Bansal
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Somit Pandey
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madan Parmar
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonal Singhal
- Department of Chemistry, Panjab University, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
24
|
Prediction of Lung Shunt Fraction for Yttrium-90 Treatment of Hepatic Tumors Using Dynamic Contrast Enhanced MRI with Quantitative Perfusion Processing. Tomography 2022; 8:2687-2697. [PMID: 36412683 PMCID: PMC9680251 DOI: 10.3390/tomography8060224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
There is no noninvasive method to estimate lung shunting fraction (LSF) in patients with liver tumors undergoing Yttrium-90 (Y90) therapy. We propose to predict LSF from noninvasive dynamic contrast enhanced (DCE) MRI using perfusion quantification. Two perfusion quantification methods were used to process DCE MRI in 25 liver tumor patients: Kety's tracer kinetic modeling with a delay-fitted global arterial input function (AIF) and quantitative transport mapping (QTM) based on the inversion of transport equation using spatial deconvolution without AIF. LSF was measured on SPECT following Tc-99m macroaggregated albumin (MAA) administration via hepatic arterial catheter. The patient cohort was partitioned into a low-risk group (LSF ≤&nbsp;10%) and a high-risk group (LSF >&nbsp;10%). Results: In this patient cohort, LSF was positively correlated with QTM velocity |u| (r = 0.61, F = 14.0363, p = 0.0021), and no significant correlation was observed with Kety's parameters, tumor volume, patient age and gender. Between the low LSF and high LSF groups, there was a significant difference for QTM |u| (0.0760 ± 0.0440 vs. 0.1822 ± 0.1225 mm/s, p = 0.0011), and Kety's Ktrans (0.0401 ± 0.0360 vs 0.1198 ± 0.3048, p = 0.0471) and Ve&nbsp;(0.0900 ± 0.0307 vs. 0.1495 ± 0.0485, p = 0.0114). The area under the curve (AUC) for distinguishing between low LSF and high LSF was 0.87 for |u|, 0.80 for Ve and 0.74 for Ktrans. Noninvasive prediction of LSF is feasible from DCE MRI with QTM velocity postprocessing.
Collapse
|
25
|
Trans-arterial Radioembolization Dosimetry in 2022. Cardiovasc Intervent Radiol 2022; 45:1608-1621. [PMID: 35982334 DOI: 10.1007/s00270-022-03215-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/26/2022] [Indexed: 11/02/2022]
Abstract
Trans-arterial radioembolization is currently performed using 90Y-loaded glass or resin microspheres and also using 166Ho-loaded microspheres. The goal of this review is to present dosimetry and radiobiology concepts, the different dosimetry approaches available (simulation-based dosimetry and post-treatment dosimetry), main confounding factors as main clinical dosimetry results provided during the last decade for both hepatocellular carcinoma (HCC) and metastases of colorectal carcinoma (mCRC). Based on the different number of microspheres or different isotope used, radiobiology of the three devices is different, meaning that tumouricidal doses and maximal tolerated doses are different. Tumouricidal doses described for HCCs were 100-120 grays (Gy) with 90Y resin microspheres and 205 Gy with 90Y glass microspheres. For mCRC, it is 39-60 with 90Y resin microspheres, 139 Gy with 90Y glass microspheres and 90 Gy with 166Ho microspheres. An impact of tumoural doses with overall survival has also been reported. Personalised dosimetry has been developed and is now recommended by several international expert groups. Level-one evidence of the major impact of personalised dosimetry on response and overall survival in HCC is now available, bringing a new standard approach for TARE in clinical practice as well as for trial design.
Collapse
|
26
|
Using an Assumed Lung Mass Inaccurately Estimates the Lung Absorbed Dose in Patients Undergoing Hepatic 90Yttrium Radioembolization Therapy. Cardiovasc Intervent Radiol 2022; 45:1793-1800. [PMID: 35925379 DOI: 10.1007/s00270-022-03197-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/03/2022] [Indexed: 11/02/2022]
Abstract
RATIONALE Currently, the estimated absorbed radiation dose to the lung in 90Y radioembolization therapy is calculated using an assumed 1 kg lung mass for all patients. The aim of this study was to evaluate whether using a patient-specific lung mass measurement for each patient rather than a generic, assumed 1 kg lung mass would change the estimated lung absorbed dose. METHODS A retrospective analysis was performed on 68 patients who had undergone 90Y radioembolization therapy at our institution. Individualized lung volumes were measured manually on CT scans for each patient, and these volumes were used to calculate personalized lung masses. The personalized lung masses were used to recalculate the estimated lung absorbed dose from the 90Y therapy, and this dose was compared to the estimated lung absorbed dose calculated using an assumed 1 kg lung mass. RESULTS Patient-specific lung masses were significantly different from the generic 1 kg when compared individually for each patient (p < 0.0001). Median individualized lung mass was 0.71 (IQR: 0.59, 1.02) kg overall and was significantly different from the generic 1 kg lung mass for female patients [0.59 (0.50, 0.68) kg, (p < 0.0001)] but not for male patients [0.99 (0.71, 1.14) kg, (p = 0.24)]. Median estimated lung absorbed dose was 4.48 (2.38, 11.71) Gy using a patient-specific lung mass and 3.45 (1.81, 6.68) Gy when assuming a 1 kg lung mass for all patients. The estimated lung absorbed dose was significantly different using a patient-specific versus generic 1 kg lung mass when comparing the doses individually for each patient (p < 0.0001). The difference in the estimated lung absorbed dose between the patient-specific and generic 1 kg lung mass method was significant for female patients as a subgroup but not for male patients. CONCLUSIONS The current method of assuming a 1 kg lung mass for all patients inaccurately estimates the lung absorbed dose in 90Y radioembolization therapy. Using patient-specific lung masses resulted in estimated lung absorbed doses that were significantly different from those calculated using an assumed 1 kg lung mass for all patients. A personalized dosimetry method that includes individualized lung masses is necessary and can warrant a 90Y dose reduction in some patients with lung masses smaller than 1 kg. LEVEL OF EVIDENCE Level 3, Retrospective Study.
Collapse
|
27
|
Stella M, van Rooij R, Lam MGEH, de Jong HWAM, Braat AJAT. Lung Dose Measured on Postradioembolization 90Y PET/CT and Incidence of Radiation Pneumonitis. J Nucl Med 2022; 63:1075-1080. [PMID: 34772794 PMCID: PMC9258566 DOI: 10.2967/jnumed.121.263143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/26/2021] [Indexed: 01/03/2023] Open
Abstract
Radiation pneumonitis is a rare but possibly fatal side effect of 90Y radioembolization. It may occur 1-6 mo after therapy, if a significant part of the 90Y microspheres shunts to the lungs. In current clinical practice, a predicted lung dose greater than 30 Gy is considered a criterion to exclude patients from treatment. However, contrasting findings regarding the occurrence of radiation pneumonitis and lung dose were previously reported in the literature. In this study, the relationship between the lung dose and the eventual occurrence of radiation pneumonitis after 90Y radioembolization was investigated. Methods: We retrospectively analyzed 317 90Y liver radioembolization procedures performed during an 8-y period (February 2012 to September 2020). We calculated the predicted lung mean dose (LMD) using 99mTc-MAA planar scintigraphy (LMDMAA) acquired during the planning phase and left LMD (LMDY-90) using the 90Y PET/CT acquired after the treatment. For the lung dose computation, we used the left lung as the representative lung volume, to compensate for scatter from the liver moving in the craniocaudal direction because of breathing and mainly affecting the right lung. Results: In total, 272 patients underwent 90Y procedures, of which 63% were performed with glass microspheres and 37% with resin microspheres. The median injected activity was 1,974 MBq (range, 242-9,538 MBq). The median LMDMAA was 3.5 Gy (range, 0.2-89.0 Gy). For 14 procedures, LMDMAA was more than 30 Gy. Median LMDY-90 was 1 Gy (range, 0.0-22.1 Gy). No patients had an LMDY-90 of more than 30 Gy. Of the 3 patients with an LMDY-90 of more than 12 Gy, 2 patients (one with an LMDY-90 of 22.1 Gy and an LMDMAA of 89 Gy; the other with an LMDY-90 of 17.7 Gy and an LMDMAA of 34.1 Gy) developed radiation pneumonitis and consequently died. The third patient, with an LMDY-90 of 18.4 Gy (LMDMAA, 29.1 Gy), died 2 mo after treatment, before the imaging evaluation, because of progressive disease. Conclusion: The occurrence of radiation pneumonitis as a consequence of a lung shunt after 90Y radioembolization is rare (<1%). No radiation pneumonitis developed in patients with a measured LMDY-90 lower than 12 Gy.
Collapse
Affiliation(s)
- Martina Stella
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rob van Rooij
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
28
|
Aramburu J, Antón R, Sangro B. How Could 90Y-Loaded Microsphere Distribution Be Optimized? Cardiovasc Intervent Radiol 2022; 45:970-971. [PMID: 35680673 DOI: 10.1007/s00270-022-03180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Jorge Aramburu
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain.
- Universidad de Navarra, Centro de Ingeniería Biomédica (CBIO), Campus Universitario, 31009, Pamplona, Spain.
| | - Raúl Antón
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
- Universidad de Navarra, Centro de Ingeniería Biomédica (CBIO), Campus Universitario, 31009, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
| | - Bruno Sangro
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Liver Unit, Clínica Universidad de Navarra and CIBEREHD, 31008, Pamplona, Spain
| |
Collapse
|
29
|
Bomberna T, Vermijs S, Lejoly M, Verslype C, Bonne L, Maleux G, Debbaut C. A Hybrid Particle-Flow CFD Modeling Approach in Truncated Hepatic Arterial Trees for Liver Radioembolization: A Patient-specific Case Study. Front Bioeng Biotechnol 2022; 10:914979. [PMID: 35711632 PMCID: PMC9197434 DOI: 10.3389/fbioe.2022.914979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/11/2022] [Indexed: 12/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. At its intermediate, unresectable stage, HCC is typically treated by local injection of embolizing microspheres in the hepatic arteries to selectively damage tumor tissue. Interestingly, computational fluid dynamics (CFD) has been applied increasingly to elucidate the impact of clinically variable parameters, such as injection location, on the downstream particle distribution. This study aims to reduce the computational cost of such CFD approaches by introducing a novel truncation algorithm to simplify hepatic arterial trees, and a hybrid particle-flow modeling approach which only models particles in the first few bifurcations. A patient-specific hepatic arterial geometry was pruned at three different levels, resulting in three trees: Geometry 1 (48 outlets), Geometry 2 (38 outlets), and Geometry 3 (17 outlets). In each geometry, 1 planar injection and 3 catheter injections (each with different tip locations) were performed. For the truncated geometries, it was assumed that, downstream of the truncated outlets, particles distributed themselves proportional to the blood flow. This allowed to compare the particle distribution in all 48 "outlets" for each geometry. For the planar injections, the median difference in outlet-specific particle distribution between Geometry 1 and 3 was 0.21%; while the median difference between outlet-specific flow and particle distribution in Geometry 1 was 0.40%. Comparing catheter injections, the maximum median difference in particle distribution between Geometry 1 and 3 was 0.24%, while the maximum median difference between particle and flow distribution was 0.62%. The results suggest that the hepatic arterial tree might be reliably truncated to estimate the particle distribution in the full-complexity tree. In the resulting hybrid particle-flow model, explicit particle modeling was only deemed necessary in the first few bifurcations of the arterial tree. Interestingly, using flow distribution as a surrogate for particle distribution in the entire tree was considerably less accurate than using the hybrid model, although the difference was much higher for catheter injections than for planar injections. Future work should focus on replicating and experimentally validating these results in more patient-specific geometries.
Collapse
Affiliation(s)
- Tim Bomberna
- IBiTech-Biommeda, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Saar Vermijs
- IBiTech-Biommeda, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Maryse Lejoly
- Department of Radiology and Medical Imaging, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Chris Verslype
- Department of Clinical Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Charlotte Debbaut
- IBiTech-Biommeda, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Taebi A, Janibek N, Goldman R, Pillai R, Vu CT, Roncali E. The Impact of Injection Distance to Bifurcations on Yttrium-90 Distribution in Liver Cancer Radioembolization. J Vasc Interv Radiol 2022; 33:668-677.e1. [PMID: 35301128 PMCID: PMC9156550 DOI: 10.1016/j.jvir.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To model the effect of the injection location on the distribution of yttrium-90 (90Y) microspheres in the liver during radioembolization using computational simulation and to determine the potential effects of radial movements of the catheter tip. MATERIALS AND METHODS Numerical studies were conducted using images from a representative patient with hepatocellular carcinoma. The right hepatic artery (RHA) was segmented from contrast-enhanced cone-beam computed tomography scans. The blood flow was investigated in the trunk of the RHA using numerical simulations for 6 injection position scenarios at 2 sites located at a distance of approximately 5 and 20 mm upstream of the first bifurcation (RHA diameters of approximately 4.6 mm). The 90Y delivery to downstream vessels was calculated from the simulated hepatic artery hemodynamics. RESULTS Varying the injection location along the RHA and across the vessel cross-section resulted in different simulated microsphere distributions in the downstream vascular bed. When the catheter tip was 5 mm upstream of the bifurcation, 90Y distribution in the downstream branches varied by as much as 53% with a 1.5-mm radial movement of the tip. However, the catheter radial movement had a weaker effect on the microsphere distribution when the injection plane was farther from the first bifurcation (20 mm), with a maximum delivery variation of 9% to a downstream branch. CONCLUSIONS An injection location far from bifurcations is recommended to minimize the effect of radial movements of the catheter tip on the microsphere distribution.
Collapse
Affiliation(s)
- Amirtaha Taebi
- Department of Agricultural and Biological Engineering, Mississippi State University
| | - Nursultan Janibek
- Department of Mechanical and Aerospace Engineering, University of California Davis
| | - Roger Goldman
- Department of Radiology, University of California Davis
| | - Rex Pillai
- Department of Radiology, University of California Davis
| | | | - Emilie Roncali
- Department of Radiology, University of California Davis,Department of Biomedical Engineering, University of California Davis
| |
Collapse
|
32
|
Hosseini Shabanan S, Nezami N, Abdelsalam ME, Sheth RA, Odisio BC, Mahvash A, Habibollahi P. Selective Internal Radiation Therapy with Yttrium-90 for Intrahepatic Cholangiocarcinoma: A Systematic Review on Post-Treatment Dosimetry and Concomitant Chemotherapy. Curr Oncol 2022; 29:3825-3848. [PMID: 35735415 PMCID: PMC9222092 DOI: 10.3390/curroncol29060306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
Selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-loaded microspheres is increasingly used for the treatment of Intrahepatic Cholangiocarcinoma (ICC). Dosimetry verifications post-treatment are required for a valid assessment of any dose-response relationship. We performed a systematic review of the literature to determine how often clinics conducted post-treatment dosimetry verification to measure the actual radiation doses delivered to the tumor and to the normal liver in patients who underwent SIRT for ICC, and also to explore the corresponding dose-response relationship. We also investigated other factors that potentially affect treatment outcomes, including the type of microspheres used and concomitant chemotherapy. Out of the final 47 studies that entered our study, only four papers included post-treatment dosimetry studies after SIRT to quantitatively assess the radiation doses delivered. No study showed that one microsphere type provided a benefit over another, one study demonstrated better imaging-based response rates associated with the use of glass-based TheraSpheres, and two studies found similar toxicity profiles for different types of microspheres. Gemcitabine and cisplatin were the most common chemotherapeutic drugs for concomitant administration with SIRT. Future studies of SIRT for ICC should include dosimetry to optimize treatment planning and post-treatment radiation dosage measurements in order to reliably predict patient responses and liver toxicity.
Collapse
Affiliation(s)
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
| | - Mohamed E. Abdelsalam
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.E.A.); (R.A.S.); (B.C.O.); (A.M.)
| | - Rahul Anil Sheth
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.E.A.); (R.A.S.); (B.C.O.); (A.M.)
| | - Bruno C. Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.E.A.); (R.A.S.); (B.C.O.); (A.M.)
| | - Armeen Mahvash
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.E.A.); (R.A.S.); (B.C.O.); (A.M.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.E.A.); (R.A.S.); (B.C.O.); (A.M.)
| |
Collapse
|
33
|
Weber M, Lam M, Chiesa C, Konijnenberg M, Cremonesi M, Flamen P, Gnesin S, Bodei L, Kracmerova T, Luster M, Garin E, Herrmann K. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 2022; 49:1682-1699. [PMID: 35146577 PMCID: PMC8940802 DOI: 10.1007/s00259-021-05600-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
Primary liver tumours (i.e. hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC)) are among the most frequent cancers worldwide. However, only 10-20% of patients are amenable to curative treatment, such as resection or transplant. Liver metastases are most frequently caused by colorectal cancer, which accounts for the second most cancer-related deaths in Europe. In both primary and secondary tumours, radioembolization has been shown to be a safe and effective treatment option. The vast potential of personalized dosimetry has also been shown, resulting in markedly increased response rates and overall survival. In a rapidly evolving therapeutic landscape, the role of radioembolization will be subject to changes. Therefore, the decision for radioembolization should be taken by a multidisciplinary tumour board in accordance with the current clinical guidelines. The purpose of this procedure guideline is to assist the nuclear medicine physician in treating and managing patients undergoing radioembolization treatment. PREAMBLE: The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association that facilitates communication worldwide among individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. These guidelines are intended to assist practitioners in providing appropriate nuclear medicine care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals taking into account the unique circumstances of each case. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set out in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources or advances in knowledge or technology subsequent to publication of the guidelines. The practice of medicine involves not only the science but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognised that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
Collapse
Affiliation(s)
- M Weber
- Department of Nuclear medicine, University clinic Essen, Essen, Germany.
| | - M Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - C Chiesa
- Nuclear Medicine, Foundation IRCCS National Tumour Institute, Milan, Italy
| | - M Konijnenberg
- Nuclear Medicine Department, Erasmus MC, Rotterdam, The Netherlands
| | - M Cremonesi
- Radiation Research Unit, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - P Flamen
- Department of Nuclear Medicine, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000, Brussels, Belgium
| | - S Gnesin
- Institute of Radiation physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - L Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - T Kracmerova
- Department of Medical Physics, Motol University Hospital, Prague, Czech Republic
| | - M Luster
- Department of Nuclear medicine, University hospital Marburg, Marburg, Germany
| | - E Garin
- Department of Nuclear Medicine, Cancer, Institute Eugène Marquis, Rennes, France
| | - K Herrmann
- Department of Nuclear medicine, University clinic Essen, Essen, Germany
| |
Collapse
|
34
|
Chen H, Teng M, Zhang H, Liang X, Cheng H, Liu G. Advanced radionuclides in diagnosis and therapy for hepatocellular carcinoma. CHINESE CHEM LETT 2022. [DOI: 10.1016/j.cclet.2022.03.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
35
|
Miller C, Rousseau J, Ramogida CF, Celler A, Rahmim A, Uribe CF. Implications of physics, chemistry and biology for dosimetry calculations using theranostic pairs. Theranostics 2022; 12:232-259. [PMID: 34987643 PMCID: PMC8690938 DOI: 10.7150/thno.62851] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Theranostics is an emerging paradigm that combines imaging and therapy in order to personalize patient treatment. In nuclear medicine, this is achieved by using radiopharmaceuticals that target identical molecular targets for both imaging (using emitted gamma rays) and radiopharmaceutical therapy (using emitted beta, alpha or Auger-electron particles) for the treatment of various diseases, such as cancer. If the therapeutic radiopharmaceutical cannot be imaged quantitatively, a “theranostic pair” imaging surrogate can be used to predict the absorbed radiation doses from the therapeutic radiopharmaceutical. However, theranostic dosimetry assumes that the pharmacokinetics and biodistributions of both radiopharmaceuticals in the pair are identical or very similar, an assumption that still requires further validation for many theranostic pairs. In this review, we consider both same-element and different-element theranostic pairs and attempt to determine if factors exist which may cause inaccurate dose extrapolations in theranostic dosimetry, either intrinsic (e.g. chemical differences) or extrinsic (e.g. injecting different amounts of each radiopharmaceutical) to the radiopharmaceuticals. We discuss the basis behind theranostic dosimetry and present common theranostic pairs and their therapeutic applications in oncology. We investigate general factors that could create alterations in the behavior of the radiopharmaceuticals or the quantitative accuracy of imaging them. Finally, we attempt to determine if there is evidence showing some specific pairs as suitable for theranostic dosimetry. We show that there are a variety of intrinsic and extrinsic factors which can significantly alter the behavior among pairs of radiopharmaceuticals, even if they belong to the same chemical element. More research is needed to determine the impact of these factors on theranostic dosimetry estimates and on patient outcomes, and how to correctly account for them.
Collapse
|
36
|
Knešaurek K, Martinez RB, Ghesani M. Tumour-to-normal tissue (T/N) dosimetry ratios role in assessment of 90Y selective internal radiation therapy (SIRT). Br J Radiol 2022; 95:20210294. [PMID: 34762514 PMCID: PMC8722260 DOI: 10.1259/bjr.20210294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The purpose of our work is to assess the role of tumour-to-normal tissue (T/N) dosimetry ratios for predicting response in patients undergoing locoregional therapy to the liver with 90Y microspheres. METHODS A total of 39 patients (7 female:32 male, mean age 68.3 ± 7.6 years), underwent positron emission tomography (PET)/CT imaging after treatment with 90Y microspheres. For attenuation correction and localization of the 90Y microspheres, the low-dose, non-diagnostic CT images from PET/CT were used. The acquisition took 15 min and the reconstruction matrix size was 200 × 200 × 75 mm and voxel size of 4.07 × 4.07 × 3.00 mm. For dosimetry calculations, the local deposition method with known activity of 90Y was used. For each patient, regions of interest for tumour(s) and whole liver were manually created; the normal tissue region of interest was created automatically. mRECIST criteria on MRI done at 1 month post-treatment and subsequently every 3 months after 90Y treatment, were used to assess response. RESULTS For 39 patients, the mean liver, tumour and normal tissue doses (mean ± SD) were, 55.17 ± 26.04 Gy, 911.87 ± 866.54 Gy and 47.79 ± 20.47 Gy, respectively. Among these patients, 31 (79%) showed complete response (CR) and 8 (21%) showed progression of disease (PD). For patients with CR, the mean T/N dose ratio obtained was 24.91 (range 3.09-80.12) and for patients with PD, the mean T/N dose ratio was significantly lower, at 6.69 (range 0.36-14.75). CONCLUSION Our data show that patients with CR have a statistically higher T/N dose ratio than those with PD. Because, the number of PD cases was limited and partial volume effect was not considered, further investigation is warranted. ADVANCES IN KNOWLEDGE T/N dosimetry ratios can be used for assessing response in patients undergoing locoregional therapy to the liver with 90Y microspheres.
Collapse
Affiliation(s)
- Karin Knešaurek
- Diagnostic, Molecular & Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ricardo Bello Martinez
- Diagnostic, Molecular & Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Munir Ghesani
- Diagnostic, Molecular & Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
37
|
Nuclear Medicine Therapy in primary liver cancers. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Filippi L, Braat AJ. Theragnostics in primary and secondary liver tumors: the need for a personalized approach. 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... 2021; 65:353-370. [PMID: 34881847 DOI: 10.23736/s1824-4785.21.03407-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Primary and secondary hepatic tumors have a dramatic impact in oncology. Despite many advances in diagnosis and therapy, the management of hepatic malignancies is still challenging, ranging from various loco-regional approaches to system therapies. In this scenario, theragnostic approaches, based on the administration of a radiopharmaceuticals' pair, the first labeled with a radionuclide suitable for the diagnostic phase and the second one bound to radionuclide emitting particles for therapy, is gaining more and more importance. Selective internal radiation therapy (SIRT) with microspheres labeled with 90Y or 166Ho is widely used as a loco-regional treatment for primary and secondary hepatic tumors. While 166Ho presents both gamma and beta emission and can be therefore considered a real "theragnostic" agent, for 90Y-microspheres theragnostic approach is realized at the diagnostic phase through the utilization of macroaggregates of human albumin, labeled with 99mTc as "biosimilar" agent respect to microspheres. The aim of the present review was to cover theragnostic applications of 90Y/166Ho-labeled microspheres in clinical practice. Furthermore, we report the preliminary data concerning the potential role of some emerging theragnostic biomarkers for hepatocellular carcinoma, such as glypican-3 (GPC3) and prostate specific membrane antigen (PSMA).
Collapse
Affiliation(s)
- Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy -
| | - Arthur J Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
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: 61] [Impact Index Per Article: 20.3] [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.
Collapse
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.
| |
Collapse
|
43
|
Alsultan AA, van Roekel C, Barentsz MW, Smits MLJ, Kunnen B, Koopman M, Braat AJAT, Bruijnen RCG, de Keizer B, Lam MGEH. Dose-Response and Dose-Toxicity Relationships for Glass 90Y Radioembolization in Patients with Liver Metastases from Colorectal Cancer. J Nucl Med 2021; 62:1616-1623. [PMID: 33741643 PMCID: PMC8612342 DOI: 10.2967/jnumed.120.255745] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Radioembolization based on personalized treatment planning requires established dose-response and dose-toxicity relationships. The aim of this study was to investigate dose-response and dose-toxicity relationships in patients with colorectal liver metastases (CRLMs) treated with glass 90Y-microspheres. Methods: All CRLM patients treated with glass 90Y-microspheres in our institution were retrospectively analyzed. The tumor-absorbed dose was calculated for each measurable metastasis (i.e.,18F-FDG-positive and more than a 5-cm3 tumor volume) on posttreatment 90Y PET. Metabolic tumor response was determined on 18F-FDG PET/CT by measuring the total lesion glycolysis at baseline and at 3 mo after treatment. The relationship between tumor-absorbed dose and metabolic response was determined on a per-lesion and per-patient basis using a linear mixed-effects regression model. Clinical toxicity and laboratory toxicity were correlated with healthy liver-absorbed dose. Results: Thirty-one patients were included. The median tumor-absorbed dose of 85 measurable metastases was 133 Gy (range, 20-1001 Gy). Per response category, this was 196 Gy for complete response (CR), 177 Gy for partial response (PR), 72 Gy for stable disease, and 95 Gy for progressive disease (PD). A significant dose-response relationship was found on a tumor level, with a significantly higher tumor-absorbed dose in metastases with CR (+94%) and PR (+74%) than in metastases with PD (P < 0.001). A similar relationship was found on a patient level, with PR having a higher tumor-absorbed dose than did PD (+58%, P = 0.044). A tumor-absorbed dose of more than 139 Gy predicted a 3-mo metabolic response with the greatest accuracy (89% specificity and 77% sensitivity), whereas a tumor-absorbed dose of more than 189 Gy predicted response with 97% specificity and 45% sensitivity. The median healthy liver-absorbed dose was 63 Gy (range, 24-113 Gy). Toxicity was limited mostly to grades 1 and 2, with 1 case of radioembolization-induced liver disease in a patient who received the highest healthy liver-absorbed dose. A positive trend was seen for most laboratory parameters in our dose-toxicity analysis. Conclusion: A significant relationship was observed between dose and response in CRLM patients treated with glass 90Y radioembolization.
Collapse
Affiliation(s)
- Ahmed A Alsultan
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Caren van Roekel
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten W Barentsz
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten L J Smits
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Britt Kunnen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miriam Koopman
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rutger C G Bruijnen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bart de Keizer
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
44
|
Plachouris D, Tzolas I, Gatos I, Papadimitroulas P, Spyridonidis T, Apostolopoulos D, Papathanasiou N, Visvikis D, Plachouri KM, Hazle JD, Kagadis GC. A deep-learning-based prediction model for the biodistribution of 90 Y microspheres in liver radioembolization. Med Phys 2021; 48:7427-7438. [PMID: 34628667 DOI: 10.1002/mp.15270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radioembolization with 90 Y microspheres is a treatment approach for liver cancer. Currently, employed dosimetric calculations exhibit low accuracy, lacking consideration of individual patient, and tissue characteristics. PURPOSE The purpose of the present study was to employ deep learning (DL) algorithms to differentiate patterns of pretreatment distribution of 99m Tc-macroaggregated albumin on SPECT/CT and post-treatment distribution of 90 Y microspheres on PET/CT and to accurately predict how the 90 Y-microspheres will be distributed in the liver tissue by radioembolization therapy. METHODS Data for 19 patients with liver cancer (10 with hepatocellular carcinoma, 5 with intrahepatic cholangiocarcinoma, 4 with liver metastases) who underwent radioembolization with 90 Y microspheres were used for the DL training. We developed a 3D voxel-based variation of the Pix2Pix model, which is a special type of conditional GANs designed to perform image-to-image translation. SPECT and CT scans along with the clinical target volume for each patient were used as inputs, as were their corresponding post-treatment PET scans. The real and predicted absorbed PET doses for the tumor and the whole liver area were compared. Our model was evaluated using the leave-one-out method, and the dose calculations were measured using a tissue-specific dose voxel kernel. RESULTS The comparison of the real and predicted PET/CT scans showed an average absorbed dose difference of 5.42% ± 19.31% and 0.44% ± 1.64% for the tumor and the liver area, respectively. The average absorbed dose differences were 7.98 ± 31.39 Gy and 0.03 ± 0.25 Gy for the tumor and the non-tumor liver parenchyma, respectively. Our model had a general tendency to underpredict the dosimetric results; the largest differences were noticed in one case, where the model underestimated the dose to the tumor area by 56.75% or 72.82 Gy. CONCLUSIONS The proposed deep-learning-based pretreatment planning method for liver radioembolization accurately predicted 90 Y microsphere biodistribution. Its combination with a rapid and accurate 3D dosimetry method will render it clinically suitable and could improve patient-specific pretreatment planning.
Collapse
Affiliation(s)
- Dimitris Plachouris
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece
| | - Ioannis Tzolas
- School of Electrical and Computer Engineering, University of Patras, Rion, Greece
| | - Ilias Gatos
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece
| | - Panagiotis Papadimitroulas
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece.,R&D Department, Bioemission Technology Solutions, Athens, Greece
| | - Trifon Spyridonidis
- Department of Nuclear Medicine, School of Medicine, University of Patras, Rion, Greece
| | | | | | | | | | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - George C Kagadis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
45
|
Willowson KP, Eslick EM, Bailey DL. Individualised dosimetry and safety of SIRT for intrahepatic cholangiocarcinoma. EJNMMI Phys 2021; 8:65. [PMID: 34519900 PMCID: PMC8440713 DOI: 10.1186/s40658-021-00406-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to investigate the safety and efficacy of selective internal radiation therapy (SIRT) with 90Y resin microspheres for the treatment of Intrahepatic Cholangiocarcinoma (ICC). A total of 23 SIRT procedures from 18 ICC subjects were analysed to determine a lesion-based dose/response relationship with absorbed dose measures from 90Y PET and metabolic response as measured on [18F]FDG PET. Average absorbed dose (Davg), minimum dose to 70% of the volume (D70), volume receiving at least 50 Gy (V50), biological effective dose (BED) and equivalent uniform dose (EUD), were compared to changes in metabolic volume, maximum standardised uptake value (SUVmax) and total lesion glycolysis (TLG). Dose to normal liver was assessed with changes in liver uptake rate as measured with [99mTc]mebrofenin scintigraphy for a cohort of 20 subjects with primary liver malignancy (12 ICC, 8 hepatocellular carcinoma (HCC)). Results Thirty-four lesions were included in the analysis. A relationship was found between metabolic response and both Davg and EUD similar to that seen previously in metastatic colorectal cancer (mCRC), albeit trending towards a lower response plateau. Both dose and SUV coefficient of variation within the lesion (CoVdose and CoVSUV), baseline TLG and EUD were found to be mildly significant predictors of response. No strong correlation was seen between normal liver dose and change in [99mTc]mebrofenin liver uptake rate; low baseline uptake rate was not indicative of declining function following SIRT, and no subjects dropped into the ‘poor liver function’ category. Conclusions ICC lesions follow a similar dose–response trend as mCRC, however, despite high lesion doses a full metabolic response was rarely seen. The CoV of lesion dose may have a significant bearing on response, and EUD correlated more tightly with metabolic response compared to Davg. SIRT in primary liver malignancy appears safe in terms of not inducing a clinically significant decline in liver function, and poor baseline uptake rate is not predictive of a reduction in function post SIRT. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-021-00406-2.
Collapse
Affiliation(s)
- Kathy P Willowson
- Department of Nuclear Medicine, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. .,Institute of Medical Physics, The University of Sydney, Sydney, NSW, Australia.
| | - Enid M Eslick
- Department of Nuclear Medicine, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Dale L Bailey
- Department of Nuclear Medicine, Acute Services Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
46
|
Paunesku T, Gordon AC, White S, Harris K, Antipova O, Maxey E, Vogt S, Smith A, Daddario L, Procissi D, Larson A, Woloschak GE. Use of X-Ray Fluorescence Microscopy for Studies on Research Models of Hepatocellular Carcinoma. Front Public Health 2021; 9:711506. [PMID: 34490194 PMCID: PMC8417723 DOI: 10.3389/fpubh.2021.711506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: TheraSphere® microspheres containing yttrium 90Y are among many radioembolization agents used clinically to reduce liver tumor burden, and their effects on cancer volume reduction are well-established. At the same time, concerns about off target tissue injury often limit their use. Deeper investigation into tissue distribution and long-term impact of these microspheres could inform us about additional ways to use them in practice. Methods: Healthy rat liver and rabbit liver tumor samples from animals treated with TheraSpheres were sectioned and their elemental maps were generated by X-ray fluorescence microscopy (XFM) at the Advanced Photon Source (APS) synchrotron at Argonne National Laboratory (ANL). Results: Elemental imaging allowed us to identify the presence and distribution of TheraSpheres in animal tissues without the need for additional sample manipulation or staining. Ionizing radiation produced by 90Y radioactive contaminants present in these microspheres makes processing TheraSphere treated samples complex. Accumulation of microspheres in macrophages was observed. Conclusions: This is the first study that used XFM to evaluate the location of microspheres and radionuclides in animal liver and tumor samples introduced through radioembolization. XFM has shown promise in expanding our understanding of radioembolization and could be used for investigation of human patient samples in the future.
Collapse
Affiliation(s)
- Tatjana Paunesku
- Radiation Oncology Department, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Andrew C Gordon
- Radiology Department, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarah White
- Department of Radiology, Division of Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kathleen Harris
- Radiology Department, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Olga Antipova
- X-Ray Sciences Division, Advanced Photon Source, Argonne National Laboratory, Argonne, IL, United States
| | - Evan Maxey
- X-Ray Sciences Division, Advanced Photon Source, Argonne National Laboratory, Argonne, IL, United States
| | - Stefan Vogt
- X-Ray Sciences Division, Advanced Photon Source, Argonne National Laboratory, Argonne, IL, United States
| | - Anthony Smith
- Radiation Oncology Department, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Luiza Daddario
- Radiation Oncology Department, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniele Procissi
- Radiology Department, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Andrew Larson
- Radiology Department, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gayle E Woloschak
- Radiation Oncology Department, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
47
|
Craig AJ, Murray I, Denis-Bacelar AM, Rojas B, Gear JI, Hossen L, Maenhout A, Khan N, Flux GD. Comparison of 90Y SIRT predicted and delivered absorbed doses using a PSF conversion method. Phys Med 2021; 89:1-10. [PMID: 34339928 PMCID: PMC8501309 DOI: 10.1016/j.ejmp.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/23/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aims of this study were to develop and apply a method to correct for the differences in partial volume effects of pre-therapy Technetium-99 m (99mTc)-MAA SPECT and post-therapy Yttrium-90 (90Y) bremsstrahlung SPECT imaging in selective internal radiation therapy, and to use this method to improve quantitative comparison of predicted and delivered 90Y absorbed doses. METHODS The spatial resolution of 99mTc SPECT data was converted to that of 90Y SPECT data using a function calculated from 99mTc and 90Y point spread functions. This resolution conversion method (RCM) was first applied to 99mTc and 90Y SPECT phantom data to validate the method, and then to clinical data to assess the power of 99mTc SPECT imaging to predict the therapeutic absorbed dose. RESULTS The maximum difference between absorbed doses to phantom spheres was 178%. This was reduced to 27% after the RCM was applied. The clinical data demonstrated differences within 38% for mean absorbed doses delivered to the normal liver, which were reduced to 20% after application of the RCM. Analysis of clinical data showed that therapeutic absorbed doses delivered to tumours greater than 100 cm3 were predicted to within 52%, although there were differences of up to 210% for smaller tumours, even after the RCM was applied. CONCLUSIONS The RCM was successfully verified using phantom data. Analysis of the clinical data established that the 99mTc pre-therapy imaging was predictive of the 90Y absorbed dose to the normal liver to within 20%, but had poor predictability for tumours smaller than 100 cm3.
Collapse
Affiliation(s)
- Allison J. Craig
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom,Corresponding author.
| | - Iain Murray
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom
| | | | - Bruno Rojas
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom
| | - Jonathan I. Gear
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom
| | - Lucy Hossen
- Royal Brompton & Harefield NHSFT, London, United Kingdom
| | | | - Nasir Khan
- Chelsea & Westminster NHSFT, London, United Kingdom
| | - Glenn D. Flux
- Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom,The Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
48
|
Schatka I, Tschernig M, Rogasch JMM, Bluemel S, Graef J, Furth C, Sehouli J, Blohmer JU, Gebauer B, Fehrenbach U, Amthauer H. Selective Internal Radiation Therapy in Breast Cancer Liver Metastases: Outcome Assessment Applying a Prognostic Score. Cancers (Basel) 2021; 13:cancers13153777. [PMID: 34359677 PMCID: PMC8345060 DOI: 10.3390/cancers13153777] [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: 06/17/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 02/07/2023] Open
Abstract
Selective internal radiation therapy (SIRT) is a therapy option in patients with breast cancer liver metastasis (BCLM). This analysis aimed at identifying a prognostic score regarding overall survival (OS) after SIRT using routine pretherapeutic parameters. Retrospective analysis of 38 patients (age, 59 (39-84) years) with BCLM and 42 SIRT procedures. Cox regression for OS included clinical factors (age, ECOG and prior treatments), laboratory parameters, hepatic tumor load and dose reduction due to hepatopulmonary shunt. Elevated baseline ALT and/or AST was present if CTCAE grade ≥ 2 was fulfilled (>3 times the upper limit of normal). Median OS after SIRT was 6.4 months. In univariable Cox, ECOG ≥ 1 (hazard ratio (HR), 3.8), presence of elevated baseline ALT/AST (HR, 3.8), prior liver surgery (HR, 10.2), and dose reduction of 40% (HR, 8.1) predicted shorter OS (each p < 0.05). Multivariable Cox confirmed ECOG ≥ 1 (HR, 2.34; p = 0.012) and elevated baseline ALT/AST (HR, 4.16; p < 0.001). Combining both factors, median OS decreased from 19.2 months (0 risk factors; n = 14 procedures) to 5.9 months (1 factor; n = 20) or 2.2 months (2 factors; n = 8; p < 0.001). The proposed score may facilitate pretherapeutic identification of patients with unfavorable OS after SIRT. This may help to balance potential life prolongation with the hazards of invasive treatment and hospitalization.
Collapse
Affiliation(s)
- Imke Schatka
- Department of Nuclear Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (M.T.); (J.M.M.R.); (S.B.); (J.G.); (C.F.); (H.A.)
- Correspondence: ; Tel.: +49-(0)30-450-627-045
| | - Monique Tschernig
- Department of Nuclear Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (M.T.); (J.M.M.R.); (S.B.); (J.G.); (C.F.); (H.A.)
| | - Julian M. M. Rogasch
- Department of Nuclear Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (M.T.); (J.M.M.R.); (S.B.); (J.G.); (C.F.); (H.A.)
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Stephanie Bluemel
- Department of Nuclear Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (M.T.); (J.M.M.R.); (S.B.); (J.G.); (C.F.); (H.A.)
| | - Josefine Graef
- Department of Nuclear Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (M.T.); (J.M.M.R.); (S.B.); (J.G.); (C.F.); (H.A.)
| | - Christian Furth
- Department of Nuclear Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (M.T.); (J.M.M.R.); (S.B.); (J.G.); (C.F.); (H.A.)
| | - Jalid Sehouli
- Department of Gynecology and Breast Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (J.S.); (J.-U.B.)
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (J.S.); (J.-U.B.)
| | - Bernhard Gebauer
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (U.F.)
| | - Uli Fehrenbach
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (B.G.); (U.F.)
| | - Holger Amthauer
- Department of Nuclear Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13353 Berlin, Germany; (M.T.); (J.M.M.R.); (S.B.); (J.G.); (C.F.); (H.A.)
| |
Collapse
|
49
|
Lu Z, Chen G, Lin KH, Wu TH, Mok GSP. Evaluation of different CT maps for attenuation correction and segmentation in static 99m Tc-MAA SPECT/CT for 90 Y radioembolization treatment planning: A simulation study. Med Phys 2021; 48:3842-3851. [PMID: 34013551 DOI: 10.1002/mp.14991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Conventional 99m Tc-macroaggregated albumin (99m Tc-MAA) planar scintigraphy overestimates lung shunt fraction (LSF) compared to SPECT/CT. However, the respiratory motion artifact due to the temporal mismatch between static SPECT and helical CT (HCT) may compromise the SPECT quantitation accuracy by incorrect attenuation correction (AC) and volume-of-interest (VOI) segmentation. This study aims to evaluate AC and VOI segmentation effects systematically and to propose a CT map for LSF and tumor-to-normal liver ratio (TNR) estimation in static 99m Tc-MAA SPECT/CT. METHODS The 4D XCAT phantom was used to simulate a phantom population of 120 phantoms, modeling 10 different anatomical variations, nine TNRs (2-13.2), nine tumor sizes (2-6.7 cm diameter), eight tumor locations, three axial motion amplitudes of 1, 1.5, and 2 (cm), and four LSFs of 5%, 10%, 15%, and 20%. An analytical projector for low-energy high-resolution parallel-hole collimator was used to simulate 60 noisy projections over 360°, modeling attenuation and geometric collimator-detector response (GCDR). AC and VOI mismatch effects were investigated independently and together, using cine average CT (CACT), HCT at end-inspiration (HCT-IN), mid-respiration (HCT-MID), and end-expiration (HCT-EX) respectively as attenuation and segmentation maps. SPECT images without motion, AC, and VOI errors were also generated as reference. LSF and TNR errors were measured as compared to the ground truth. RESULTS HCT-MID has slightly better performance for AC effect compared with other CT maps in LSF and TNR estimation, while HCT-EX and HCT-MID perform better for VOI effect. For a respiratory motion amplitude of 1.5 cm and a LSF of 5%, the LSF errors are 19.56 ± 4.58%, -6.79 ± 1.74%, 77.29 ± 14.74%, and 111.25 ± 18.29% corresponding to HCT-MID, HCT-EX, HCT-IN, and CACT in static SPECT. The TNR errors are -12.38 ± 6.42%, -20.55 ± 11.25%, -20.89 ± 9.98%, and -22.89 ± 14.38% respectively. HCT-MID has the best performance for LSF estimation for LSF > 10% and TNR estimation, followed by HCT-EX, HCT-IN, and CACT. CONCLUSIONS The HCT-MID is recommended for AC and segmentation to alleviate respiratory artifacts and improve quantitation accuracy in 90 Y radioembolization treatment planning. HCT-EX would also be a recommended choice if HCT-MID is not available.
Collapse
Affiliation(s)
- Zhonglin Lu
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| | - Gefei Chen
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| | - Kuan-Heng Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Industrial PhD Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Greta S P Mok
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| |
Collapse
|
50
|
166Ho microsphere scout dose for more accurate radioembolization treatment planning. Eur J Nucl Med Mol Imaging 2021; 47:744-747. [PMID: 31875243 DOI: 10.1007/s00259-019-04617-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|