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Kesim S, Balaban Genc ZC, Soydemir E, Baltacioglu F, Kissa TN, Ozdemir B, Ozguven S, Filizoglu N, Niftaliyeva K, Engur CO, Kostek O, Akdeniz E, Turoglu HT, Erdil TY, Cimsit C, Ones T. Evaluating therapeutic efficacy of extended shelf-life 90 Y glass microspheres in transarterial radioembolization for colorectal cancer: a quantitative FDG PET/CT analysis. Nucl Med Commun 2024; 45:268-277. [PMID: 38214074 DOI: 10.1097/mnm.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVES There is a lack of sufficient evidence regarding the use of extended shelf-life (ExSL) Yttrium-90 ( 90 Y) glass radiomicrospheres in metastatic colorectal cancer (mCRC) patients. We aimed to investigate the efficacy of ExSL 90 Y glass radiomicrospheres with a personalized treatment approach by analyzing 18 F-FDG PET/CT quantitative parameters [metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] separately before and after the treatment. METHODS A total of 93 radioembolization sessions involving 77 patients were included. Simplicit 90 Y software was utilized to perform multicompartmental voxel-based dosimetry. Adverse events were recorded using the CTCAE v5.0 criteria. The survival data were recorded in detail. RESULTS The overall disease control rate was 84.9%, with a median overall survival (OS) of 12.7 months and median progression-free survival (PFS) of 8.3 months. A statistically significant increase in treatment response rate was observed when there was an increase in absorbed tumor dose for pre-treatment unit MTV ( P = 0.005) and TLG ( P = 0.004) values. We didn't observe any additional side effects/vital risks that could be considered clinically significant. CONCLUSION Our study has provided evidence on the therapeutic effectiveness and safety in terms of dose-toxicity profile of ExSL 90 Y glass microspheres in a large cohort of mCRC patients. With a personalized treatment approach, the increase in radiation dose absorbed by the tumor has shown a significant contribution to treatment response rate, as indicated by quantitative measurements obtained through 18 F-FDG PET/CT.
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Affiliation(s)
- Selin Kesim
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
| | | | - Efe Soydemir
- Department of Radiology, Pendik Research and Training Hospital, Marmara University,
| | - Feyyaz Baltacioglu
- Department of Radiology, Pendik Research and Training Hospital, Marmara University,
| | - Tugba Nergiz Kissa
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
| | - Berdan Ozdemir
- Department of Radiology, Pendik Research and Training Hospital, Marmara University,
| | - Salih Ozguven
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
| | - Nuh Filizoglu
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
| | - Khanim Niftaliyeva
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
| | - Ceren Ozge Engur
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
| | - Osman Kostek
- Department of Internal Medicine, Division of Medical Oncology, Pendik Research and Training Hospital, Marmara University and
| | - Esra Akdeniz
- Department of Medical Education, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Halil Turgut Turoglu
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
| | - Tanju Yusuf Erdil
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
| | - Cagatay Cimsit
- Department of Radiology, Pendik Research and Training Hospital, Marmara University,
| | - Tunc Ones
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University,
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Habibollahi P, Mahvash A, Kokabi N, Nezami N. Unlocking Precision in Radioembolization: Navigating the Future of Holmium-166 Radioembolization Mapping and Lung Shunt Study by Implementing Scout Dosimetry. Cardiovasc Intervent Radiol 2024; 47:451-452. [PMID: 38491164 DOI: 10.1007/s00270-024-03697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nima Kokabi
- Department of Radiology, Division of Interventional Radiology, School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Nariman Nezami
- Department of Radiology, Interventional Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, CCC Bldg., Room CG225, Washington, DC, USA.
- Georgetown University School of Medicine, Washington, DC, USA.
- Lombardi Comprehensive Cancer Center, Washington, DC, USA.
- The Fischell Department of Bioengineering, University of Maryland College Park, College Park, MD, USA.
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Grégory J, Ronot M, Laurent V, Chabrot P, de Baere T, Chevallier P, Vilgrain V, Aubé C. French Interventional Radiology Centers' Uptake of Transradial Approach and Outpatient Hepatocellular Carcinoma Intra-Arterial Treatments. Cardiovasc Intervent Radiol 2024; 47:432-440. [PMID: 37930400 DOI: 10.1007/s00270-023-03578-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This study aims to investigate the uptake of transradial approach (TRA) and outpatient setting for transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in the treatment of hepatocellular carcinoma (HCC) among French interventional radiology centers. MATERIALS AND METHODS This cross-sectional study was based on a 34-question survey assessing center activity, radial access, and outpatient care. The survey was developed by a working group, tested by two external experts, and distributed to active members of two French radiological societies via a web-based self-reporting questionnaire in March 2022. The survey remained open for eight weeks, with two reminder emails sent to non-responders. Only one answer per center was considered. RESULTS Of the 44 responding centers, 39% (17/44) performed TRA for TACE and/or TARE, with post-procedure patient comfort as main motivation. Among the 27 centers not performing TRA, 33% (9/27) reported a lack of technical experience, but all 27 intended to adopt TRA within two years. Only six centers performed TACE or TARE in an outpatient setting. Reasons limiting its implementation included TACE for HCC not being a suitable intervention (61%, 27/44) and organizational barriers (41%, 18/44). Among centers not performing outpatient TACE or TARE, 34% (13/38) said "No," 34% (13/38) said "Maybe," and 32% (12/38) said "Yes" when asked about adopting it within two years. CONCLUSION French interventional radiologists have low TRA uptake for HCC treatment, but TRA adoption potential exists. Respondents were uncertain about performing TACE or TARE in an outpatient setting within a 2-year horizon.
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Affiliation(s)
- Jules Grégory
- Université Paris Cité, Paris, France.
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France.
- Inserm INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004, Paris, France.
| | - Maxime Ronot
- Université Paris Cité, Paris, France
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France
- Centre de Recherche sur L'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500, Vandoeuvre-Lès-Nancy, France
| | - Pascal Chabrot
- Department of Radiology, University Hospital Center, Hospital Gabriel Montpied, 58, Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave RoussyUniversité Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Patrick Chevallier
- Department of Diagnosis and Interventional Imaging, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200, Nice, France
| | - Valérie Vilgrain
- Université Paris Cité, Paris, France
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France
- Centre de Recherche sur L'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Christophe Aubé
- Département de Radiologie, centre hospitalier universitaire d'Angers, 4 rue Larrey, 49 933, Angers, France
- Laboratoire HIFIH, UPRES 3859, Université d'Angers, 49 045, Angers, France
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Yu S, Yu M, Keane B, Mauro DM, Helft PR, Harris WP, Sanoff HK, Johnson MS, O’Neil B, McRee AJ, Somasundaram A. A Pilot Study of Pembrolizumab in Combination With Y90 Radioembolization in Subjects With Poor Prognosis Hepatocellular Carcinoma. Oncologist 2024; 29:270-e413. [PMID: 38325328 PMCID: PMC10911903 DOI: 10.1093/oncolo/oyad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Combination checkpoint inhibition therapy with yttrium-90 (Y90) radioembolization represents an emerging area of interest in the treatment of advanced hepatocellular carcinoma (HCC). HCRN GI15-225 is an open-label, single-arm multicenter, pilot study (NCT03099564). METHODS Eligible patients had poor prognosis, localized HCC defined as having portal vein thrombus, multifocal disease, and/or diffuse disease that were not eligible for liver transplant or surgical resection. Patients received pembrolizumab 200 mg intravenously every 3 weeks in conjunction with glass yttrium-90 (Y90) radioembolization TheraSphere. Primary endpoint was 6-month progression-free survival (PFS6) per RECIST 1.1. Secondary endpoints included time to progression (TTP), objective response rate (ORR), overall survival (OS), and safety/tolerability. RESULTS Between October 23, 2017 and November 24, 2020, 29 patients were enrolled: 2 were excluded per protocol. Fifteen of the remaining 27 patients were free of progression at 6 months (55.6%; 95% CI, 35.3-74.5) with median PFS 9.95 months (95% CI, 4.14-15.24) and OS 27.30 months (95% CI, 10.15-39.52). One patient was not evaluable for response due to death; among the remaining 26 patients, ORR was 30.8% (95% CI, 14.3-51.8) and DCR was 84.6% (95% CI, 65.1-95.6). CONCLUSION In patients with localized, poor prognosis HCC, pembrolizumab in addition to glass Y90 radioembolization demonstrated promising efficacy and safety consistent with prior observations (ClinicalTrials.gov Identifier: NCT03099564; IRB Approved: 16-3255 approved July 12, 2016).
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Affiliation(s)
- Shawn Yu
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Menggang Yu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Barry Keane
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David M Mauro
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul R Helft
- Department of Medicine, Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - William P Harris
- Department of Medicine, University of Washington/FHCC, Seattle, WA, USA
| | - Hanna K Sanoff
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew S Johnson
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA
| | - Bert O’Neil
- Community Health Network, Indianapolis, IN, USA
| | | | - Ashwin Somasundaram
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Beattie BJ, Kirov AS, Kesner AL. Technical Note: Impact of impurities on Yttrium-90 glass microsphere activity quantitation. Med Phys 2024; 51:2306-2310. [PMID: 37956259 DOI: 10.1002/mp.16828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Glass 90 Y microspheres are produced with known radionuclide impurities. These impurities are not independently monitored. Clinical instruments, including ionization chamber dose calibrators and positron emmission tomography (PET) cameras, can be much more sensitive in detecting signals from these impurities than to signals from 90 Y itself. PURPOSE The "typical" levels of 90 Y impurities have been studied to assess their impact on dosimetry during internal implantation, and for the management of waste. However, unaccounted-for decay spectra of impurities can also have an impact on dose calibrator and PET readings. Thus, even what might be considered negligibly small impurity fractions, can in principle cause substantial overestimates of the amount of 90 Y activity present in a sample. To our knowledge, quantitative effects of radionuclide impurities in glass microspheres on activity measurements have not been documented in the field. As activity quantitation for dosimetry and its correlations with outcome becomes more prevalent, the effects of impurities on measurements may remain unaccounted for in dosimetry studies. METHODS In this letter, we review theoretical and physical considerations that will result in asymmetric errors in quantitation from 90 Y impurities and estimate their typical and potential impact on clinical utilization. Among the common impurities 88 Y is of particular concern for its impact on 90 Y dose measurements because of its decay characteristics, along with other isotopes 91 Y and 46 Sc which can also impact measurements. RESULTS The typical level of 88 Y impurities reported by the manufacturer should only cause small errors in dose calibrator and PET measurements made within the 12-day label-specified use-by period, up to 2.0% and 1.6%, respectively. However, the product specification max allowable impurity levels, specified by the manufacturer, leave open the potential for much greater bias from within the 12-day use-by period, potentially as high as 13.2% for dose calibrator measurements and 10.6% for PET from the 88 Y impurities. CONCLUSIONS While typical levels of impurities appear to have acceptable impact on patient absorbed dose, it should be noted that they can have adverse effects on 90 Y radioactivity measurements. Furthermore, there is currently minimal independent verification and/or monitoring of impurity levels within the field.
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Affiliation(s)
- Bradley J Beattie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Assen S Kirov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Adam L Kesner
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
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deBettencourt MF, Liu Y, Cotler SJ, Molvar CA, Abdelrahman T, Thomas TO. SBRT vs. Y90: HCC Treatment Outcomes and Costs. Am J Clin Oncol 2024; 47:99-104. [PMID: 37981697 DOI: 10.1097/coc.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Stereotactic Body Radiotherapy (SBRT) and Yttrium-90 (Y90) are among the ablative therapies used as treatment options for localized hepatocellular carcinoma (HCC). To date, direct comparisons of the 2 modalities' outcomes and costs are lacking. This study aimed to analyze demographic, treatment, and cost information for patients with HCC treated with SBRT and Y90. METHODS Patients with HCC treated with SBRT or Y90 radioembolization between January 2018 and January 2020 at one institution were retrospectively reviewed. Demographic and treatment data were compared utilizing χ 2 tests. Kaplan-Meier curves and log-rank tests were applied to compare overall survival and progression-free survival in different treatment groups. Cox proportional hazard models were applied to analyze the unadjusted and adjusted survival differences. Ten SBRT and 10 Y90 patients were randomly selected for Medicare cost analysis. RESULTS Sixty-three patients received Y90, and 21 received SBRT. On univariable and multivariable analysis, there was no significant difference in overall survival or progression-free survival between the Y90 and SBRT cohorts. SBRT patients had higher American Joint Committee on Cancer staging ( P =0.039), greater tumor size (4.07 vs. 2.96 cm, P =0.013), and greater rates of prior liver-directed therapy (71.4% SBRT vs. 12.7% Y90, P <0.001). The average cost for SBRT was $15,148, and Y90 was $41,360. CONCLUSIONS SBRT and Y90 are effective therapies in the treatment of HCC, specifically having similar overall survival and progression-free survival. Y90 was found to have a significantly higher cost than SBRT. This study demonstrates the need for prospective studies to assess these modalities in treating HCC.
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Affiliation(s)
| | - Yirong Liu
- Department of Radiation Oncology Northwestern Medical Group Northwestern Memorial Hospital Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital, Chicago, IL
| | | | | | | | - Tarita O Thomas
- Department of Radiation Oncology Northwestern Medical Group Northwestern Memorial Hospital Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital, Chicago, IL
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Mercolli L, Zeimpekis K, Prenosil GA, Sari H, Rathke HG, Rominger A, Shi K. Phantom study for 90Y liver radioembolization dosimetry with a long axial field-of-view PET/CT. Phys Med 2024; 118:103296. [PMID: 38281409 DOI: 10.1016/j.ejmp.2024.103296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/20/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024] Open
Abstract
PURPOSE The physical properties of yttrium-90 (90Y) allow for imaging with positron emission tomography/computed tomography (PET/CT). The increased sensitivity of long axial field-of-view (LAFOV) PET/CT scanners possibly allows to overcome the small branching ratio for positron production from 90Y decays and to improve for the post-treatment dosimetry of 90Y of selective internal radiation therapy. METHODS For the challenging case of an image quality body phantom, we compare a full Monte Carlo (MC) dose calculation with the results from the two commercial software packages Simplicit90Y and Hermes. The voxel dosimetry module of Hermes relies on the 90Y images taken with a LAFOV PET/CT, while the MC and Simplicit90Y dose calculations are image independent. RESULTS The resulting doses from the MC calculation and Simplicit90Y agree well within the error margins. The image-based dose calculation with Hermes, however, consistently underestimates the dose. This is due to the mismatch of the activity distribution in the PET images and the size of the volume of interest. We found that only for the smallest phantom sphere there is a statistically significant dependence of the Hermes dose on the image reconstruction parameters and scan time. CONCLUSION Our study shows that Simplicit90Y's local deposition model can provide a reliable dose estimate. On the other hand, the image based dose calculation suffers from the suboptimal reconstruction of the 90Y distribution in small structures.
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Affiliation(s)
- Lorenzo Mercolli
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland.
| | - Konstantinos Zeimpekis
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - George A Prenosil
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Hasan Sari
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Hendrik G Rathke
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Kunagyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
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Pashazadeh A, Baghani HR, Robatjazi M, Kadavil P. The effect of geometrical parameters of skin brachytherapy patch source on depth dose distribution using Monte Carlo simulation. Appl Radiat Isot 2024; 204:111117. [PMID: 38007882 DOI: 10.1016/j.apradiso.2023.111117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
Brachytherapy of superficial skin tumors using beta-emitting sources is a method that has been investigated by some researchers in both simulation and experimental studies with promising results. In the current study, the effect of geometrical parameters of some relevant radionuclides including Y-90, Re-188, P-32, and Ho-166 on the depth dose distribution in skin tissue has been investigated through Monte Carlo simulation. MCNPX Monte Carlo code was employed to model the above-mentioned patch sources in cylindrical format and then the effect of patch geometrical parameters including the source-to-skin distance (SSD), patch thickness, and patch diameter on depth dose distribution was assessed through modeling and calculation of the dose inside a cubic phantom mimicking the skin tissue. The obtained results demonstrated that increasing the SSD, patch thickness, and patch diameter (with the same activity) will reduce the depth dose distribution. Changing the SSD has a more significant effect on the dose gradient within the depth than other geometrical parameters. It was also observed that the effect of patch diameter on the skin-delivered dose gets less sensible as the patch size goes beyond the range of beta radiation inside tissue. Finally, it can be concluded that the patch source geometrical parameters can affect the depth dose distribution inside the skin tissue. This fact may be of concern regarding the delivery of a high radiation dose in a single treatment session. Therefore, variations of patch source geometrical parameters should be considered during the skin dose calculation plan.
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Affiliation(s)
- Ali Pashazadeh
- Institute of Medical Technology, Otto von Guericke University, Magdeburg, Germany
| | | | - Mostafa Robatjazi
- Medical Physics and Radiological Sciences Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Tang CYL, Chua WM, Huang HL, Lam WWC, Loh LM, Tai D, Ong SYK, Yan SX, Loke KSH, Ng DCE, Tham WY. Safety and efficacy of peptide receptor radionuclide therapy in patients with advanced pheochromocytoma and paraganglioma: A single-institution experience and review of the literature. J Neuroendocrinol 2023; 35:e13349. [PMID: 37937484 DOI: 10.1111/jne.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Despite advances in diagnosis and management, patients with advanced pheochromocytomas and paragangliomas (PPGL) face limited treatment options. This study aims to evaluate the safety and efficacy of peptide receptor radionuclide therapy (PRRT) in patients with advanced PPGL, based on a single-institution experience and provide a comprehensive review of the literature. METHODS A retrospective analysis was conducted on patients with advanced pheochromocytoma and paraganglioma who received PRRT at a single institution from April 2012 to March 2022. Clinical characteristics, treatment response, adverse events, and survival outcomes were assessed. A systematic literature review was also performed. RESULTS A total of 15 patients with advanced PPGL were included, the majority of whom had both metastatic and functional disease. Most patients received four infusions of 177Lu-DOTATATE (73%). The median therapeutic 177Lu-DOTATATE radioactivity for each infusion was 7.4 GBq. Only one patient was treated with one infusion of 90Y-DOTATATE (4.2 GBq) in addition to three infusions of Lu-177 DOTATATE. Overall, PRRT suggests a promising efficacy with disease control rate of 63.6% by RECIST v1.1. The median overall survival (OS) was not reached and the median progression free survival (PFS) was 25.9 months. In terms of safety, PRRT was well tolerated. Review of the literature revealed consistent findings, supporting the efficacy and safety of PRRT in PPGL. CONCLUSION This study suggests that PRRT is a safe and effective therapeutic option for patients with PPGL. Our findings align with the existing literature, providing additional evidence to support the use of PRRT in this challenging patient population.
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Affiliation(s)
- Charlene Yu Lin Tang
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Wei Ming Chua
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
- Department of Neuroradiology, Singapore General Hospital, Singapore, Singapore
| | - Hian Liang Huang
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Winnie Wing-Chuen Lam
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Lih Ming Loh
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - David Tai
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Simon Yew Kuang Ong
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Sean Xuexian Yan
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kelvin S H Loke
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - David Chee-Eng Ng
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Wei Ying Tham
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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11
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Boshell D, Bester L. Radioembolisation of liver metastases. J Med Imaging Radiat Oncol 2023; 67:842-852. [PMID: 37343147 DOI: 10.1111/1754-9485.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
This review aims to present contemporary data for SIRT in the treatment of secondary hepatic malignancies including colorectal, neuroendocrine, breast and uveal melanoma.
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Affiliation(s)
- David Boshell
- Department of Radiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Lourens Bester
- Department of Radiology, University of Notre Dame, Sydney, New South Wales, Australia
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Durma AD, Saracyn M, Kołodziej M, Jóźwik-Plebanek K, Kamiński G. Remarkable regression of inoperable pancreatic grade 3 neuroendocrine neoplasm after radioligand therapy with [177Lu]Lu-DOTATATE and [90Y]Y‑DOTATATE. Pol Arch Intern Med 2023; 133:16576. [PMID: 37795839 DOI: 10.20452/pamw.16576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Adam D Durma
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine – National Research Institute, Warsaw, Poland.
| | - Marek Saracyn
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Maciej Kołodziej
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Katarzyna Jóźwik-Plebanek
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine – National Research Institute, Warsaw, Poland
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13
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Pham TP, Presles B, Popoff R, Alberini JL, Vrigneaud JM. Pre-treatment dosimetry in 90Y-SIRT: Is it possible to optimise SPECT reconstruction parameters and calculation methods for accurate dosimetry? Phys Med 2023; 115:103145. [PMID: 37852020 DOI: 10.1016/j.ejmp.2023.103145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 06/03/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE The aim of this study was (a) to optimise the99mTc-SPECT reconstruction parameters for the pre-treatment dosimetry of90Y-selective internal radiation therapy (SIRT) and (b) to compare the accuracy of clinical dosimetry methods with full Monte-Carlo dosimetry (fMCD) performed with Gate. METHODS To optimise the reconstruction parameters, two hundred reconstructions with different parameters were performed on a NEMA phantom, varying the number of iterations, subsets, and post-filtering. The accuracy of the dosimetric methods was then investigated using an anthropomorphic phantom. Absorbed dose maps were generated using (1) the Partition Model (PM), (2) the Dose Voxel Kernel (DVK) convolution, and (3) the Local Deposition Method (LDM) with known activity restricted to the whole phantom (WP) or to the liver and lungs (LL). The dose to the lungs was calculated using the "multiple DVK" and "multiple LDM" methods. RESULTS Optimal OSEM reconstruction parameters were found to depend on object size and dosimetric criterion chosen (Dmean or DVH-derived metric). The Dmean of all three dosimetric methods was close (≤ 10%) to the Dmean of fMCD simulations when considering large segmented volumes (whole liver, normal liver). In contrast, the Dmean to the small volume (∅=31) was systemically underestimated (12%-25%). For lungs, the "multiple DVK" and "multiple LDM" methods yielded a Dmean within 20% for the WP method and within 10% for the LL method. CONCLUSIONS All three methods showed a substantial degradation of the dose-volume histograms (DVHs) compared to fMCD simulations. The DVK and LDM methods performed almost equally well, with the "multiple DVK" method being more accurate in the lungs.
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Affiliation(s)
- Tien-Phong Pham
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France; Department of Nuclear Medicine, Georges-François Leclerc Cancer Centre, Dijon, France.
| | - Benoit Presles
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France
| | - Romain Popoff
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France; Department of Nuclear Medicine, Georges-François Leclerc Cancer Centre, Dijon, France
| | - Jean-Louis Alberini
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France; Department of Nuclear Medicine, Georges-François Leclerc Cancer Centre, Dijon, France
| | - Jean-Marc Vrigneaud
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France; Department of Nuclear Medicine, Georges-François Leclerc Cancer Centre, Dijon, France.
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14
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Bandalo V, Hoedlmoser H. Simulation of Hp(0,07) beta and photon response of a BeOSL finger ring dosemeter. Radiat Prot Dosimetry 2023; 199:1770-1773. [PMID: 37819320 DOI: 10.1093/rpd/ncad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 10/13/2023]
Abstract
Simulation of a dosemeter's energy and angular response lowers development cost and time. To support development of a new beta sensitive dosemeter we simulate both the dosemeter and the skin dose in a rod phantom as there are no fluence to dose conversion coefficients in the ICRU Report 47 for electrons. Published spectra for BSS2, N-Series and S-Cs and S-Co were used to define sources, with CAD models used to define the simulation geometry. Simulation tools were validated with experimental beta and photon responses available for the BeOSL photon ring. The developed toolchain was then used to simulate several iterations of a beta sensitive detector element inside a beta ring holder, with the goal to minimise the need for repeated prototype fabrication and characterisation. Simulation results for the final design were compared to measurements on 3D printed prototypes with all radiation qualities, except 90Sr/90Y 0°, falling within measurement uncertainty.
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15
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Malone CD, Sandow T. Durable Outcomes Missing for Radiation Segmentectomy with Resin Microspheres. J Vasc Interv Radiol 2023; 34:1844-1846. [PMID: 37315682 DOI: 10.1016/j.jvir.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Christopher D Malone
- Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd., St. Louis, MO 63110.
| | - Tyler Sandow
- Department of Radiology, Ochsner Health System, New Orleans, LA
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16
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Choi R, Lee M, Choi JW, Kim HC. Safety of Radioembolization via the Cystic Artery in Patients with Hepatocellular Carcinoma and Parasitized Arterial Supply. J Vasc Interv Radiol 2023; 34:1802-1808. [PMID: 37364731 DOI: 10.1016/j.jvir.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of radioembolization through the cystic artery supplying hepatocellular carcinoma (HCC) adjacent to the gallbladder. MATERIALS AND METHODS This retrospective, single-center study included 24 patients who underwent radioembolization via the cystic artery between March 2017 and October 2022. The median tumor size was 8.3 cm (range, 3.4-20.4 cm). Twenty-two (92%) patients had Child-Pugh Class A disease, and 2 (8%) patients had Class B cirrhosis. Technical issues, adverse events, and tumor response were analyzed. RESULTS Infusion of radioactive microspheres was performed from the main cystic artery (n = 6), the deep cystic artery (n = 9), and small feeders from the cystic artery (n = 9). The cystic artery supplied the primary index tumor in 21 patients. The median radiation activity delivered via the cystic artery was 0.19 GBq (range, 0.02-0.43 GBq). The median total radiation activity administered was 4.1 GBq (range, 0.9-10.8 GBq). There was no case of symptomatic cholecystitis requiring invasive intervention. One patient experienced abdominal pain during injection of radioactive microspheres via the cystic artery. Eleven (46%) patients received pain medication during or within 2 days of the procedure. Twelve (50%) patients had gallbladder wall thickening on a 1-month follow-up computed tomography scan. Based on follow-up imaging, 23 (96%) patients showed an objective response (complete or partial response) of the tumor supplied by the cystic artery. CONCLUSION Radioembolization via the cystic artery may be safe in patients with HCC partially supplied by the cystic artery.
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Affiliation(s)
- Rebecca Choi
- Department of Radiology, the Johns Hopkins Hospital, Baltimore, Maryland
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kis B, Shridhar R, Mhaskar R, Gyano M, Frakes JM, El-Haddad G, Choi J, Kim RD, Hoffe SE. Radioembolization with Yttrium-90 Glass Microspheres as a First-Line Treatment for Unresectable Intrahepatic Cholangiocarcinoma-A Prospective Feasibility Study. J Vasc Interv Radiol 2023; 34:1547-1555. [PMID: 37210030 DOI: 10.1016/j.jvir.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/22/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of yttrium-90 (90Y) radioembolization as first-line treatment for unresectable intrahepatic cholangiocarcinoma (ICC). MATERIALS AND METHODS This prospective study enrolled patients who had never received chemotherapy, liver embolization, and radiation therapy. The tumors were solitary in 16 patients, multiple in 8 patients, unilobar in 14 patients, and bilobar in 10 patients. Patients underwent transarterial radioembolization with 90Y-labeled glass microspheres. The primary end point was hepatic progression-free survival (HPFS). Secondary end points were overall survival (OS), tumor response, and toxicity. RESULTS Twenty-four patients (age, 72.3 years ± 9.3; 12 women) were included in the study. The median delivered radiation dose was 135.5 Gy (interquartile range, 77.6 Gy). The median HPFS was 5.5 months (95% CI, 3.9-7.0 months). Analysis failed to identify any prognostic factor associated with HPFS. Imaging response at 3 months showed 56% disease control, and the best radiographic response was 71% disease control. The median OS from the radioembolization treatment was 19.4 months (95% CI, 5.0-33.7). Patients with solitary ICC had significantly longer median OS than patients with multifocal ICC: 25.9 months (95% CI, 20.8-31.0 months) versus 10.7 months (95% CI, 8.0-13.4 months) (P = .02). Patients with progression on the 3-month imaging follow-up had significantly shorter median OS than patients who had stable disease at 3 months: 10.7 months (95% CI, 0.7-20.7 months) versus 37.3 months (95% CI, 16.5-58.1 months) (P = .003). Two (8%) Grade 3 toxicities were reported. CONCLUSIONS First-line treatment of ICC with radioembolization showed promising OS and minimal toxicity, especially in patients with solitary tumor. Radioembolization may be considered as a first-line treatment option for unresectable ICC.
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Affiliation(s)
- Bela Kis
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida.
| | - Ravi Shridhar
- Radiation Oncology, AdventHealth Cancer Institute, Orlando, Florida
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Marcell Gyano
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida
| | - Jessica M Frakes
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ghassan El-Haddad
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida
| | - Junsung Choi
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida
| | - Richard D Kim
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Sarah E Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
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Auditore L, Pistone D, Italiano A, Amato E, Gnesin S. Monte Carlo Simulations Corroborate PET-Measured Discrepancies in Activity Assessments of Commercial 90Y Vials. J Nucl Med 2023; 64:1471-1477. [PMID: 37442605 DOI: 10.2967/jnumed.123.265494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/25/2023] [Indexed: 07/15/2023] Open
Abstract
In a recent multicenter study, discrepancies between PET/CT-measured activity and vendor-calibrated activity for 90Y glass and resin microspheres were found. In the present work, the origin of these discrepancies was investigated by Monte Carlo (MC) simulations. Methods: Three vial configurations, containing 90Y-chloride, 90Y-labeled glass microspheres, and 90Y-labeled resin microspheres, were modeled with GAMOS, and the electric signal generated in an activity meter was simulated. Energy deposition was scored in the activity meter-active regions and converted into electric current per unit activity. Internal bremsstrahlung (IB) photons, always accompanying β-decay, were simulated in addition to 90Y decays. The electric current per source activity obtained for 90Y glass and resin microspheres, Iglass and Iresin, was compared in terms of relative percentage difference with that of 90Y-chloride ([Formula: see text] and [Formula: see text]) and each other (δ). The findings of this work were compared with the ones obtained through PET measurements in the multicenter study. Results: With the inclusion of IB photons as primary particles in MC simulations, the [Formula: see text] and [Formula: see text] results were 24.6% ± 3.9% and -15.0% ± 2.2%, respectively, whereas δ was 46.5% ± 1.9%, in very good agreement with the values reported in the multicenter study. Conclusion: The MC simulations performed in this study indicate that the discrepancies recently found between PET/CT-measured activity and vendor-calibrated activity for 90Y glass and resin microspheres can be attributed to differences in the geometry of the respective commercial vials and to the metrologic approach adopted for activity meter calibration with a 90Y-chloride liquid source. Furthermore, IB photons were shown to play a relevant role in determining the electric current in the activity meter.
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Affiliation(s)
- Lucrezia Auditore
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Messina, Italy
- National Institute for Nuclear Physics, Catania, Italy
| | - Daniele Pistone
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Messina, Italy
- National Institute for Nuclear Physics, Catania, Italy
| | - Antonio Italiano
- National Institute for Nuclear Physics, Catania, Italy;
- Department of Mathematical and Computer Science, Physical Sciences, and Earth Sciences, University of Messina, Messina, Italy
| | - Ernesto Amato
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Messina, Italy;
- National Institute for Nuclear Physics, Catania, Italy
- Health Physics Unit, University Hospital "Gaetano Martino," Messina, Italy; and
| | - Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Harrison CH, Taquet M, Harrison PJ, Watkinson PJ, Rowland MJ. Sex and age effects on risk of non-traumatic subarachnoid hemorrhage: Retrospective cohort study of 124,234 cases using electronic health records. J Stroke Cerebrovasc Dis 2023; 32:107196. [PMID: 37230056 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES The epidemiology of non-traumatic subarachnoid hemorrhage (SAH) is unclear. This study describes the antecedent characteristics of SAH patients, compares the risk of SAH between women and men, and explores if this changes with age. MATERIALS AND METHODS Retrospective cohort study using an electronic health records network based in the USA (TriNetX). All patients aged 18-90y with at least one healthcare visit were included. Antecedent characteristics of SAH patients (ICD-10 code I60) were measured. The incidence proportion and the relative risk between women and men, were estimated overall, in the 55-90y age group, and in five-year age categories. RESULTS Of 58.9 million eligible patients, with 190.8 million person-years of observations, 124,234 (0.21%; 63,467 female, 60,671 male) had a first SAH, with a mean age of 56.8 (S.D. 16.8) y (women: 58.2 [16.2] y, men 55.3 [17.2] y). 9,758 SAH cases (7.8%) occurred in people aged 18-30y. Prior to the SAH, an intracranial aneurysm had been diagnosed in 4.1% (women: 5.8% men: 2.5%), hypertension in 25.1% and nicotine dependence in 9.1%. Overall, women had a lower risk of SAH compared to men (RR 0.83, 95% CI 0.83-0.84), with a progressive increase in risk ratio across age groups: from RR 0.36 (0.35-0.37) in people aged 18-24y, to RR 1.07 (1.01-1.13) aged 85-90y. CONCLUSIONS Men are at greater risk of SAH than women overall, driven by younger adult age groups. Women are at greater risk than men only in the over 75-year age groups. The excess of SAH in young men merits investigation.
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Affiliation(s)
- Charlotte H Harrison
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| | - Maxime Taquet
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK; Oxford Critical Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Matthew J Rowland
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Blain E, Nishikawa K, Faye SA, Roselan A, Burn AG, Torres MA, Semkow TM. Detection Capability of 89Sr and 90Sr Using Liquid Scintillation Counting. Health Phys 2023; 125:123-136. [PMID: 37384913 PMCID: PMC10361665 DOI: 10.1097/hp.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
ABSTRACT We developed a new method for simultaneous determination of 89Sr and 90Sr with an emphasis on detectability. The samples were digested, and Sr was chemically purified followed by a single count on a liquid scintillation counter in three windows overlapping the 90Sr, 89Sr, and 90Y peaks. Gamma spectrometry was used to measure 85Sr, added for chemical recovery. The method was tested on 18 water samples spiked at levels from 9 to 242 Bq of 89Sr and 90Sr, with either single radionuclides or their mixtures. In addition, eight method blanks were measured. The data were analyzed numerically by solving a system of linear equations for 89Sr and 90Sr activities as analytes and 90Y activity as a participating component. The total uncertainties of the results were calculated numerically using variances and covariances. The average bias from the known activities was -0.3% (range from -3.6 to 3.1%) for 90Sr and - 1.5% (range from -10.1 to 5.1%) for 89Sr. The En-scores were within -1.0 and 1.0 at 95% confidence level. The detection capabilities of this method were determined by means of the decision threshold LC and the limit of detection referred to as the minimum detectable activity. All relevant uncertainties were propagated into the LC and minimum detectable activity. In addition, detection limits were calculated for the purpose of Safe Drinking Water Act monitoring. The detection capabilities were compared with the regulatory requirements in the US and EU for food and water. For samples spiked with either pure 89Sr or 90Sr, false positives were observed for the opposite radionuclide exceeding the above LC values. This was attributed to interference by the spiked activity. A new method was developed to calculate decision and detectability curves in the presence of interference.
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Affiliation(s)
- Ezekiel Blain
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Kimi Nishikawa
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Sherry A. Faye
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
- Department of Environmental Health Sciences, School of Public Health, University at Albany (SUNY), Rensselaer, NY 12144, USA
| | - Amy Roselan
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Adam G. Burn
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
- Department of Environmental Health Sciences, School of Public Health, University at Albany (SUNY), Rensselaer, NY 12144, USA
| | - Miguel A. Torres
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Thomas M. Semkow
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
- Department of Environmental Health Sciences, School of Public Health, University at Albany (SUNY), Rensselaer, NY 12144, USA
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Fortunati E, Bonazzi N, Zanoni L, Fanti S, Ambrosini V. Molecular imaging Theranostics of Neuroendocrine Tumors. Semin Nucl Med 2023; 53:539-554. [PMID: 36623974 DOI: 10.1053/j.semnuclmed.2022.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 01/08/2023]
Abstract
Neuroendocrine neoplasms (NEN) are rare and heterogeneous tumors, originating mostly from the gastro-entero-pancreatic (GEP) tract followed by the lungs. Multidisciplinary discussion is mandatory for optimal diagnostic and therapeutic management. Well-differentiated NEN (NET) present a high expression of somatostatin receptors (SSTR) and can be studied with [68Ga]-DOTA-peptides ([68Ga]Ga-DOTANOC, [68Ga]Ga-DOTATOC, [68Ga]Ga-DOTATATE) PET/CT to assess disease extension and the eligibility for peptide receptor radionuclide therapy (PRRT). SSTR-analogues labelled with 90Y or 177Lu have been used since mid-90s for NET therapy. PRRT is now considered an effective and safe treatment option for SSTR-expressing NET: following the approval of 177Lu-DOTATATE by FDA and EMA, PRRT is now part of the therapeutic algorithms of the main scientific societies. New strategies to improve PRRT efficacy and to reduce its toxicity are under evaluation (eg, personalization of treatment schemes, the selection of the most suitable patients, improvement of response assessment criteria, optimization of treatment sequencing, feasibility of PRRT-retreatment, combination of PRRT with other treatments options). Recently, several emerging radiopharmaceuticals showed encouraging results for both imaging and therapy (eg, SSTR-analogues labelled with 18F, SSTR-antagonists for both diagnosis and therapy, alpha-labelling for therapy, radiopharmaceuticals binding to new cellular targets). Aim of this review is to focus on current knowledge and to outline emerging perspectives for NEN's diagnosis and therapy.
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Affiliation(s)
- Emilia Fortunati
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Norma Bonazzi
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lucia Zanoni
- Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy; Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valentina Ambrosini
- Nuclear Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy; Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Gnesin S, Mikell JK, Conti M, Prior JO, Carlier T, Lima TVM, Dewaraja YK. A Multicenter Study on Observed Discrepancies Between Vendor-Stated and PET-Measured 90Y Activities for Both Glass and Resin Microsphere Devices. J Nucl Med 2023; 64:825-828. [PMID: 36418169 PMCID: PMC10152131 DOI: 10.2967/jnumed.122.264458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Dosimetry-guided treatment planning in selective internal radiation therapy relies on accurate and reproducible measurement of administered activity. This 4-center, 5-PET-device study compared the manufacturer-declared 90Y activity in vials with quantitative 90Y PET/CT assessment of the same vials. We compared 90Y PET-measured activity (APET) for 56 90Y-labeled glass and 18 90Y-labeled resin microsphere vials with the calibrated activity specified by the manufacturer (AM). Additionally, the same analysis was performed for 4 90Y-chloride vials. The mean APET/AM ratio was 0.79 ± 0.04 (range, 0.71-0.89) for glass microspheres and 1.15 ± 0.06 (range, 1.05-1.25) for resin microspheres. The mean APET/AM ratio for 90Y-chloride vials was 1.00 ± 0.04 (range, 0.96-1.06). Thus, we found an average difference of 46% between glass and resin microsphere activity calibrations, whereas close agreement was found for chloride solutions. We expect that the reported discrepancies will promote further investigations to establish reliable and accurate patient dosimetry and dose-effect assessments.
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Affiliation(s)
- Silvano Gnesin
- Institute of Radiation Physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Justin K Mikell
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, and Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Maurizio Conti
- Department of Molecular Imaging, Siemens Medical Solutions, Knoxville, Tennessee
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland;
| | - Thomas Carlier
- Nuclear Medicine Department, University Hospital of Nantes, Nantes, France
| | - Thiago V M Lima
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, Luzern, Switzerland; and
| | - Yuni K Dewaraja
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
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23
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Mangieri CW, Valenzuela CD, Strode MA, Erali RA, Shen P, Howerton R, Clark CJ. Effect of preoperative liver-directed therapy prior to hepatic resection. Am J Surg 2023; 225:703-708. [PMID: 36307334 DOI: 10.1016/j.amjsurg.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Hepatobiliary malignancies present with advanced disease precluding upfront resection. Liver-directed therapy (LDT), particularly Y-90 radioembolization and transarterial chemoembolization (TACE), has become increasingly utilized to facilitate attempt at oncologic resection. However, the safety profile of preoperative LDT is limited. METHODS Retrospective review of the ACS NSQIP main and targeted hepatectomy registries for 2014-2016. Primary objective was evaluation of outcomes between preoperative LDT cases and those that received upfront resection. RESULTS A total of 8923 cases met selection criteria. 192 cases (2.15%) received either Y-90 or TACE prior to hepatectomy. Multivariate analysis for all study patients revealed preoperative LDT significantly increased the risk of perioperative transfusion (OR 2.19, 95% CI 1.445-3.328, P < 0.0001), sepsis (OR 2.21, 95% CI 1.104-4.411, P = 0.022), and liver failure (OR 2.72, 95% CI 1.562-4.747, P < 0.0001). Subgroup analysis found for primary hepatobiliary malignancies LDT only increased the risk for liver failure. While for secondary hepatic tumors LDT significantly increased perioperative transfusion, sepsis, cardiac failure, renal failure, liver failure, and mortality. The complication profile also significantly increased with advanced T stage. Conversely, on propensity score matching preoperative LDT did not significantly increase perioperative complications. CONCLUSION Preoperative LDT has the potential to convert inoperable hepatic tumors into resectable disease but there is a general increased risk for significant postoperative complications, most notable liver failure. However, on controlled analysis preoperative LDT does not increase perioperative complications and should not be considered a contraindication to resection.
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Affiliation(s)
- Christopher W Mangieri
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States.
| | - Cristian D Valenzuela
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
| | - Matthew A Strode
- Womack Army Medical Center, Department of General Surgery, United States
| | - Richard A Erali
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
| | - Perry Shen
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
| | - Russell Howerton
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
| | - Clancy J Clark
- Wake Forest Baptist Health Medical Center, Division of Surgical Oncology, United States
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24
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Liu Q, Kulkarni HR, Zhao T, Schuchardt C, Chen X, Zhu Z, Zhang J, Baum RP. Peptide Receptor Radionuclide Therapy in Patients With Advanced Progressive Medullary Thyroid Cancer: Efficacy, Safety, and Survival Predictors. Clin Nucl Med 2023; 48:221-227. [PMID: 36723881 DOI: 10.1097/rlu.0000000000004539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Progressive metastatic medullary thyroid carcinoma (MTC) is often characterized by rapid disease progression and poor prognosis, with only few therapeutic options available. Peptide receptor radionuclide therapy (PRRT) has demonstrated remarkable success in the management of gastroenteropancreatic neuroendocrine tumors and has also been suggested to treat MTC. However, evidence on its effectiveness and long-term outcome for this indication is still limited. The objective of this study was to assess the safety and efficacy of PRRT in patients with advanced, progressive MTC and to determine survival. Potential predictors of survival were also evaluated. METHODS From September 2003 to June 2019, 28 patients (15 men and 13 women; mean age, 49 ± 14 years) with progressive, somatostatin receptor-positive advanced MTC received PRRT with 177Lu- or 90Y-labeled somatostatin analogs at Zentralklinik Bad Berka, Germany. Toxicity was graded according to Common Terminology Criteria for Adverse Events version 5.0. Treatment response was evaluated according to RECIST (Response Evaluation Criteria in Solid Tumors) 1.1, as well as molecular imaging criteria (European Organisation for Research and Treatment of Cancer). Kaplan-Meier analysis was used to calculate progression-free survival (PFS) and overall survival (OS), defined from the start of PRRT. Univariate and multivariate Cox regression analyses were performed to identify parameters associated with PFS and OS. RESULTS Seventy-seven cycles of PRRT were administered (mean cumulative administered activity, 16.0 ± 7.8 GBq). No acute or long-term grade 3/4 toxicity was recorded with a follow-up of 3 to 140 months, except for 1 patient (4%) who suffered from grade 3 anemia (possibly related to disease progression). According to the RECIST criteria, the disease control rate after 3 to 4 months of PRRT was 56% (partial remission, 12%; stable disease, 44%). The disease control rate (72%) was higher by molecular response evaluation. Median OS and PFS were 63.7 and 10.1 months, respectively. The annual OS rates were 84% at 1 year, 65% at 3 years, 57% at 5 years, and 18% at 10 years. The annual PFS rates were 42% at 1 year, 21% at 2 years, and 13% at 5 years. Patients with bone metastases had poorer OS and PFS than those without metastases (median OS, 58.7 vs 92.3 months [P = 0.035; hazard ratio, 2.7; 95% confidence interval, 0.92-7.84]; median PFS, 8.5 vs 12.8 months [P = 0.592; hazard ratio, 1.2; 95% confidence interval, 0.56-2.76]). CONCLUSIONS Peptide receptor radionuclide therapy was well tolerated and effective in patients with advanced, aggressive MTC. Bone metastasis was an independent adverse prognostic factor for OS.
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Affiliation(s)
| | - Harshad R Kulkarni
- THERANOSTICS Center for Molecular Radiotherapy and Precision Oncology, ENETS Center of Excellence, Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - Christiane Schuchardt
- THERANOSTICS Center for Molecular Radiotherapy and Precision Oncology, ENETS Center of Excellence, Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - Zhaohui Zhu
- From the Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing
| | | | - Richard P Baum
- CURANOSTICUM Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, Wiesbaden, Germany
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25
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Patel MV, McNiel D, Brunson C, Kuo PH, Hennemeyer CT, Woodhead G, McGregor H. Prior ablation and progression of disease correlate with higher tumor-to-normal liver 99mTc-MAA uptake ratio in hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:752-757. [PMID: 36344658 DOI: 10.1007/s00261-022-03718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Factors affecting tumor-to-normal tissue ratio (T:N) have implications for patient selection, dosimetry, and outcomes when considering radioembolization for HCC. This study sought to evaluate patient, disease specific, and technical parameters that predict T:N as measured on planning pre-90Y radioembolization 99mTc-MAA scintigraphy for hepatocellular carcinoma (HCC). METHODS 99mTc-MAA hepatic angiography procedures with SPECT/CT over a 4-year period were reviewed. Data recorded included patient demographics, details of underlying liver disease, tumor size, history of prior treatments for HCC and technical parameters from angiography. Anatomic-based segmentation was performed in 93 cases for measurement of tumor and perfused liver volumes and SPECT counts. T:N were calculated and correlated with collected variables. RESULTS Mean calculated T:N was 2.52. History of prior ablation was significantly correlated with higher T:N (mean 3.39 vs 2.24, p = 0.003). Cases in which mapping was being performed for treatment of disease progression was significantly correlated with higher T:N (mean 3.35 vs 2.14, p = 0.001). Larger tumor size trended toward lower T:N (p = 0.052). CONCLUSION Patients with history of ablation and those undergoing treatment for disease progression have higher T:N and, therefore, could be considered for radioembolization preferentially over alternative treatments.
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Affiliation(s)
- Mikin V Patel
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, MC 2026, Chicago, IL, 60637, USA.
| | - David McNiel
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Christopher Brunson
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Phillip H Kuo
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Charles T Hennemeyer
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Gregory Woodhead
- Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ, USA
| | - Hugh McGregor
- Department of Radiology, University of Washington Medicine, Seattle, WA, USA
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26
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Zhang Q, Huang ZS, Hu QQ, Qin W, Liang LL, Cui F, Wang Y, Pan F, Liu XL, Tang L, Ma C, Yin ZD, Wang FZ. [Quality of life and risk factors in patients with herpes zoster]. Zhonghua Yi Xue Za Zhi 2022; 102:3395-3400. [PMID: 36372770 DOI: 10.3760/cma.j.cn112137-20220627-01416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To evaluate the quality of life and influencing factors of patients with herpes zoster (HZ) seen in hospitals. Methods: Based on Zoster Brief Pain Inventory (ZBPI) and Five-level EuroQol Five-dimensional Questionnaire (EQ-5D-5L), a cross-sectional survey was conducted to evaluate the pain severity and quality of life of 332 HZ cases seen in 22 hospitals of Lu'an City (Anhui Province), Zibo City (Shandong Province) and Tongchuan City (Shaanxi Province) from October to December 2021. The censored least absolute deviations (CLAD) model was used to analyze the related factors affecting the changes of patients' health utility values. Results: The 45.5% of 332 HZ cases were male. The median (Q1,Q3) age was 59 (50, 68) years. 59.64% of them assessed by ZBPI had moderate to severe pain in the past 24 hours (worst pain score≥5), and that of PHN cases was 84.8%(39/46). 77.7% (258/332), 77.4% (257/332) and 74.1% (246/332) of all patients reported that pain interfered with sleep, mood and general activities, respectively. Aging [β40-49y (95%CI)=-0.11 (-0.15, -0.08); β50-59y (95%CI)=-0.03 (-0.05, 0.00); β60-69y (95%CI)=-0.09 (-0.12, -0.06); β70-90y(95%CI)=-0.16 (-0.19, -0.12)], working status (unemployed) [βfarmer (95%CI)=0.15 (0.13, 0.18); βretirees(95%CI)=0.21 (0.18, 0.24); βemployee (95%CI)=0.13 (0.10, 0.16) ], complications[βPHN (95%CI)=-0.08 (-0.13, -0.04); βother complications (95%CI)=-0.12 (-0.15, -0.08)], within 30 days after onset [β(95%CI)=-0.01 (-0.03, 0.01)] and treatment [βother complications (95%CI)=-0.09 (-0.11, -0.06)] were related factors for the decline of health utility value (all P values <0.05). Conclusions: More than half of the patients with HZ had moderate to severe pain in the past 24 hours, which had a serious negative impact on the physical and mental health of the patients. Elderly patients, acute patients and patients with complications had lower health utility values and worse health status. We suggest that eligible people be vaccinated with HZ vaccine as soon as possible.
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Affiliation(s)
- Q Zhang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z S Huang
- Department of Immunization Program, Zibo Municipal Center for Disease Control and Prevention, Zibo 255026, China
| | - Q Q Hu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - W Qin
- Department of Immunization Program, Lu'an Municipal Center for Disease Control and Prevention, Lu'an 237000, China
| | - L L Liang
- Department of Immunization Program, Tongchuan Municipal Center for Disease Control and Prevention, Tongchuan 727031, China
| | - F Cui
- Zibo Municipal Center for Disease Control and Prevention, Zibo 255026, China
| | - Y Wang
- Department of Immunization Program, Lu'an Municipal Center for Disease Control and Prevention, Lu'an 237000, China
| | - F Pan
- Department of Immunization Program, Lu'an Municipal Center for Disease Control and Prevention, Lu'an 237000, China
| | - X L Liu
- Tongchuan Municipal Center for Disease Control and Prevention, Tongchuan 727031, China
| | - L Tang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - C Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z D Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - F Z Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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27
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Schaarschmidt BM, Kloeckner R, Dertnig T, Demircioglu A, Müller L, Auer TA, Santos DPD, Steinle V, Miederer M, Gebauer B, Radunz S, Kasper S, Weber M, Theysohn J. Real-life experience in the treatment of intrahepatic cholangiocarcinoma by 90Y radioembolization: A multicenter retrospective study. J Nucl Med 2022; 64:529-535. [PMID: 36328487 DOI: 10.2967/jnumed.122.264598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Limited treatment options in patients with intrahepatic cholangiocarcinoma (iCCA) demand the introduction of new, catheter-based treatment options. Especially, 90Y radioembolization may expand therapeutic abilities beyond surgery or chemotherapy. Therefore, the purpose of this study was to identify factors associated with an improved median overall survival (mOS) in iCCA patients receiving radioembolization in a retrospective study at 5 major tertiary-care centers. Methods: In total, 138 radioembolizations in 128 patients with iCCA (female, 47.7%; male, 52.3%; mean age ± SD, 61.1 ± 13.4 y) were analyzed. Clinical data, imaging characteristics, and radioembolization reports, as well as data from RECIST, version 1.1, analysis performed 3, 6, and 12 mo after radioembolization, were collected. mOS was compared among different subgroups using Kaplan-Meier curves and the log-rank test. Results: Radioembolization was performed as first-line treatment in 25.4%, as second-line treatment in 38.4%, and as salvage treatment in 36.2%. In patients receiving first-line, second-line, and salvage radioembolization, the disease control rate was 68.6%, 52.8%, and 54.0% after 3 mo; 31.4%, 15.1%, and 12.0% after 6 mo; and 17.1%, 5.7%, and 6.0% after 1 y, respectively. In patients receiving radioembolization as first-line, second-line, and salvage treatment, mOS was 12.0 mo (95% CI, 7.6-23.4 mo), 11.8 mo (95% CI, 9.1-16.6 mo), and 8.4 mo (95% CI, 6.3-12.7 mo), respectively. No significant differences among the 3 groups were observed (P = 0.15). Hepatic tumor burden did not significantly influence mOS (P = 0.12). Conclusion: Especially in advanced iCCA, second-line and salvage radioembolization may be important treatment options. In addition to ongoing studies investigating the role of radioembolization as first-line treatment, the role of radioembolization in the later treatment stages of the disease demands further attention.
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Affiliation(s)
- Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany;
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Dertnig
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Aydin Demircioglu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Alexander Auer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Daniel Pinto Dos Santos
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Verena Steinle
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Matthias Miederer
- Clinic of Nuclear Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Sonia Radunz
- Department of General, Visceral, and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; and
| | - Manuel Weber
- Clinic of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Jens Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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28
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Vukadinović A, Milanović Z, Ognjanović M, Janković D, Radović M, Mirković M, Karageorgou MA, Bouziotis P, Erić S, Vranješ-Đurić S, Antić B, Prijović Ž. 90Y-CA/SPIONs for dual magnetic hyperthermia-radionuclide nanobrachytherapy of solid tumours. Nanotechnology 2022; 33:405102. [PMID: 35728572 DOI: 10.1088/1361-6528/ac7ac0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
Radiolabelled superparamagnetic iron oxide nanoparticles (SPIONs) are a promising nanomaterial for the development of dual radiation/hyperthermia cancer therapy. To that purpose, flower-shaped SPIONs with an exceptional heating capability were synthesised and coated with citrate, dextran or (3-aminopropyl)triethoxysilane. Both non-coated and coated SPIONs were nontoxic to CT-26 mouse colon cancer cells up to 1.0 mg ml-1in vitro. In an oscillating magnetic field, citrate-coated SPIONs (CA/SPIONs) displayed the highest heating rate (SAR ∼ 253 W g-1) and the strongest hyperthermia effects against CT-26 cells. Labelling of the CA/SPIONs by the90Y radionuclide, emitting β-radiation with an average/maximum energy of 0.94/2.23 MeV, and deep tissue penetration generated90Y-CA/SPIONs intended for the therapy of solid tumours. However, intravenous injection of90Y-CA/SPIONs in CT-26 xenograft-bearing mice resulted in low tumour accumulation. On the contrary, intratumoural injection resulted in long-term retention at the injection site. A single intratumoural injection of 0.25 mg CA/SPIONs followed by 30-min courses of magnetic hyperthermia for four consecutive days caused a moderate antitumour effect against CT-26 and 4T1 mouse tumour xenografts. Intratumoural application of 1.85 MBq/0.25 mg90Y-CA/SPIONs, alone or combined with hyperthermia, caused a significant (P ≤ 0.01) antitumour effect without signs of systemic toxicity. The results confirm the suitability of90Y-CA/SPIONs for monotherapy or dual magnetic hyperthermia-radionuclide nanobrachytherapy (NBT) of solid tumours.
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Affiliation(s)
- Aleksandar Vukadinović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Zorana Milanović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Miloš Ognjanović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Drina Janković
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Magdalena Radović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Marija Mirković
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Maria-Argyro Karageorgou
- Department of Physics, National and Kapodistrian University of Athens, Zografou Panepistimioupolis, GR-15784 Athens, Greece
- Institute of Nuclear & Radiological Sciences & Technology, Energy & Safety, National Center for Scientific Research 'Demokritos', Aghia Paraskevi, 15341 Athens, Greece
| | - Penelope Bouziotis
- Institute of Nuclear & Radiological Sciences & Technology, Energy & Safety, National Center for Scientific Research 'Demokritos', Aghia Paraskevi, 15341 Athens, Greece
| | - Slavica Erić
- Faculty of Pharmacy, University of Belgrade, 11001 Belgrade, Serbia
| | - Sanja Vranješ-Đurić
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Bratislav Antić
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
| | - Željko Prijović
- Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, 11001 Belgrade, Serbia
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29
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Stella M, Braat AJAT, van Rooij R, de Jong HWAM, Lam MGEH. Holmium-166 Radioembolization: Current Status and Future Prospective. Cardiovasc Intervent Radiol 2022; 45:1634-1645. [PMID: 35729423 PMCID: PMC9626412 DOI: 10.1007/s00270-022-03187-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/22/2022] [Indexed: 12/05/2022]
Abstract
Since its first suggestion as possible option for liver radioembolization treatment, the therapeutic isotope holmium-166 (166Ho) caught the experts’ attention due to its imaging possibilities. Being not only a beta, but also a gamma emitter and a lanthanide, 166Ho can be imaged using single-photon emission computed tomography and magnetic resonance imaging, respectively. Another advantage of 166Ho is the possibility to perform the scout and treatment procedure with the same particle. This prospect paves the way to an individualized treatment procedure, gaining more control over dosimetry-based patient selection and treatment planning. In this review, an overview on 166Ho liver radioembolization will be presented. The current clinical workflow, together with the most relevant clinical findings and the future prospective will be provided.
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Affiliation(s)
- Martina Stella
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Rob van Rooij
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, UMC Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
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30
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Zhuang KD, Tong AKT, Ng DCE, Tay KH. The Role of Catheter-Directed CT-Angiography in Radioembolisation. Cardiovasc Intervent Radiol 2022; 45:1651-1658. [PMID: 35595985 DOI: 10.1007/s00270-022-03157-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
Radioembolisation is an established transarterial therapy for hepatocellular carcinoma and liver metastasis. Success of radioembolisation depends on meticulous angiography and accurate dosimetry. Intra-procedure catheter-directed CT-angiography is commonly performed to improve the efficacy and safety of radioembolisation. This review article will (1) introduce the differences between cone beam CT and hybrid angiography-CT, and (2) describe the benefits of catheter-directed CT-angiography in radioembolisation from both an interventional radiology and nuclear medicine perspective.
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Affiliation(s)
- Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Aaron Kian-Ti Tong
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - David Chee Eng Ng
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Kiang Hiong Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Mugweru J, Elman S, Rieter WJ, Gutjahr C, Elojeimy S. Unusual Radiotracer Deposition to the Forearm After Intrahepatic Injection of 99mTc-Macroaggregated Albumin Using a Transradial Approach. Clin Nucl Med 2022; 47:e366-e367. [PMID: 35143459 DOI: 10.1097/rlu.0000000000004090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Arterial mapping and 99mTc-macroaggregated albumin (99mTc-MAA) hepatic perfusion imaging are routinely performed before 90Y radioembolization of hepatic tumors. These procedures serve multiple purposes, including an anatomical survey of hepatic arterial anatomy, interrogating expected microsphere distribution to avoid nontargeted embolization during therapy, and evaluating for possible hepatopulmonary shunting. We present a case where 99mTc-MAA planar images revealed unexpected soft tissue uptake within the left forearm, an unexpected complication that may result from residual 99mTc-MAA in the catheter being expelled as the catheter is removed, which is particularly important to avoid during the 90Y radioembolization procedure given the risk for associated radionecrosis.
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Affiliation(s)
- Jon Mugweru
- From the Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Shana Elman
- From the Department of Radiology, University of New Mexico, Albuquerque, NM
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Frazzitta AE, Kay MD, Warhadpande D, Kuo PH. Diagnosis of Pulmonary Embolism on 99mTc-Labeled Macroaggregated Albumin Lung Imaging After Hepatic Arterial Injection for Planning of Radioembolization. Clin Nucl Med 2022; 47:e246-e248. [PMID: 35025793 DOI: 10.1097/rlu.0000000000004026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 54-year-old man with hepatocellular carcinoma from alcohol-induced cirrhosis presented with hepatic encephalopathy and refractory ascites related to decompensated liver disease. MRI confirmed disease progression adjacent the site of prior radiofrequency ablation, performed 2 years prior, with associated right hepatic vein tumor thrombus. 99mTc-labeled macroaggregated albumin lung shunt imaging performed before 90Y radioembolization identified a left lower lobe wedge-shaped defect, confirmed as pulmonary embolism on CT pulmonary angiography and MRI.
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Affiliation(s)
- Aubrey E Frazzitta
- From the Department of Medical Imaging, University of Arizona College of Medicine
| | - Matthew D Kay
- From the Department of Medical Imaging, University of Arizona College of Medicine
| | - Devdutta Warhadpande
- From the Department of Medical Imaging, University of Arizona College of Medicine
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Kramer SJ, Amanavicius N, Staanum PF, Villadsen GE, Arveschoug AK. Incidental Finding of Pulmonary Embolism at Workup Before SIRT. Clin Nucl Med 2022; 47:e201-e202. [PMID: 34507328 DOI: 10.1097/rlu.0000000000003883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Selective internal radiation therapy (SIRT) is a catheter-guided treatment offered to selected patients with primary and secondary liver malignancies. SIRT is preceded by a workup procedure, where 99mTc-MAA (macroaggregated albumin) is injected in the tumor supplying artery/arteries followed by MAA scintigraphy. SIRT is frequently offered to patients with hepatocellular carcinoma (HCC), but large HCCs are known to be associated with a high risk of liver-to-lung shunting. We present a HCC patient case where a large lung-shunt enabled diagnosis of pulmonary embolism.
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Ireland A, Mittag U, Degens H, Felsenberg D, Heinonen A, Koltai E, Korhonen MT, McPhee JS, Mekjavic I, Pisot R, Rawer R, Radak Z, Simunic B, Suominen H, Rittweger J. Age-Related Declines in Lower Limb Muscle Function are Similar in Power and Endurance Athletes of Both Sexes: A Longitudinal Study of Master Athletes. Calcif Tissue Int 2022; 110:196-203. [PMID: 34505170 PMCID: PMC8784358 DOI: 10.1007/s00223-021-00907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
The age-related decline in muscle function, particularly muscle power, is associated with increased risk of important clinical outcomes. Physical activity is an important determinant of muscle function, and different types of physical activity e.g. power-based versus endurance-based exercise appear to have differential effects on muscle power. Cross-sectional studies suggest that participation in power-based exercise is associated with greater muscle power across adulthood but this has not been investigated longitudinally. We recruited eighty-nine male and female power and endurance master athletes (sprint and distance runners respectively, baseline age 35-90y). Using jumping mechanography, we measured lower limb muscle function during a vertical jump including at least two testing sessions longitudinally over 4.5 ± 2.4y. We examined effects of time, discipline (power/endurance) and sex in addition to two- and three-way interactions using linear mixed-effects models. Peak relative power, relative force and jump height, but not Esslingen Fitness Index (indicating peak power relative to sex and age-matched reference data) declined with time. Peak power, force, height and EFI were greater in power than endurance athletes. There were no sex, discipline or sex*discipline interactions with time for any variable, suggesting that changes were similar over time for athletes of both sexes and disciplines. Advantages in lower limb muscle function in power athletes were maintained with time, in line with previous cross-sectional studies. These results suggest that improvements in lower limb function in less active older individuals following power-based training persist with continued adherence, although this requires further investigation in interventional studies.
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Affiliation(s)
- Alex Ireland
- Department of Life Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK.
| | - Uwe Mittag
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Hans Degens
- Department of Life Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK
- Lithuanian Sports University, Kaunas, Lithuania
- University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Rumania
| | - Dieter Felsenberg
- Private Praxis ´Osteology and Orphane Bone Diseases´ and Charité - Campus Benjamin Franklin, Centre of Muscle and Bone Research, Humboldt-University Berlin and Free University, Berlin, Germany
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Erika Koltai
- Research Institute of Sport Science, University of Physical Education, Budapest, Hungary
| | - Marko T Korhonen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jamie S McPhee
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Igor Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Rado Pisot
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | | | - Zsolt Radak
- Research Institute of Sport Science, University of Physical Education, Budapest, Hungary
| | - Bostjan Simunic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Harri Suominen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
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Opalińska M, Morawiec-Sławek K, Kania-Kuc A, Al Maraih I, Sowa-Staszczak A, Hubalewska-Dydejczyk A. Potential value of pre- and post-therapy [68Ga]Ga-DOTA-TATE PET/CT in the prognosis of response to PRRT in disseminated neuroendocrine tumors. Front Endocrinol (Lausanne) 2022; 13:929391. [PMID: 36046793 PMCID: PMC9420847 DOI: 10.3389/fendo.2022.929391] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peptide receptor radionuclide therapy (PRRT) is one of the most effective therapeutic options for the treatment of metastatic, well-differentiated neuroendocrine tumors (NETs). It improves progressive disease-free survival and enables the control of hormone secretion in functioning tumors.Currently, there are no clearly established predictors of response to PRRT. The main factors hindering such a prediction are the heterogeneity of somatostatin receptor expression within and between lesions, lack of standardized parameters for functional imaging, and the use of different PRRT protocols.The main goal of our study was to quantify SUVmax changes in [68Ga]Ga-DOTA-TATE PET/CT scans as a potential predictor of long-term response to PRRT. MATERIAL AND METHODS Out of 20 patients treated with PRRT using [177Lu]Lu and/or [177Lu]Lu/[90Y]Y-DOTA-TATE in 2017-2019 due to dissemination of neuroendocrine neoplasm, 12 patients underwent [68Ga]Ga-DOTA-TATE PET/CT on average 3.1 months before and 4.5 months after PRRT and were eligible for the analysis.In total, 76 NET lesions were evaluated. We measured SUVmax for every lesion in both PET/CT scans (before and after PRRT). Those values were corrected by liver SUVmax and liver SUVmean measured in volumetric analysis and specified as SUVlmax and SUVlmean. As a next step, changes in SUVlmax and SUVlmean were assessed based on both PET/CT scans. Finally, results were correlated with the clinical outcome assessed as progressive disease, disease stabilization, or partial response. RESULTS The mean follow-up period was 19.9 months. Progressive disease, partial response, and disease stabilization were found in five, two, and five patients, respectively. Among patients with a partial response, the decrease in mean SUVlmax was 66.3% when compared to baseline. In patients with stable disease, the decrease in SUVlmax was 30.3% when compared to baseline. In patients with progressive disease, the mean increase in SUVlmax was 9.1% when compared to baseline. The changes in SUVlmean were -69,8%, -30.8%, and -3.7%, respectively. CONCLUSIONS A decrease in the SUVmax value in NET lesions, corrected by normal liver tissue uptake assessed in [68Ga]Ga-DOTA-TATE PET/CT scans, indicates a lower risk for NET progressive disease within 20 months after PRRT and may constitute an additional and independent parameter for the estimation of overall risk for disease progression.
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Affiliation(s)
- Marta Opalińska
- Nuclear Medicine Unit, Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | | | - Adrian Kania-Kuc
- Nuclear Medicine Unit, Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | - Ibraheem Al Maraih
- Nuclear Medicine Unit, Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- *Correspondence: Anna Sowa-Staszczak,
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Zhang J, Kulkarni HR, Baum RP. 225Ac-DOTATOC-Targeted Somatostatin Receptor α-Therapy in a Patient With Metastatic Neuroendocrine Tumor of the Thymus, Refractory to β-Radiation. Clin Nucl Med 2021; 46:1030-1031. [PMID: 34238802 DOI: 10.1097/rlu.0000000000003792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Somatostatin receptor-targeted α-therapy using α-emitter 225Ac-labeled somatostatin analogs has been suggested as a treatment option in advanced metastatic neuroendocrine tumors (NETs) failing treatment with β-emitters, such as 177Lu or 90Y. Thymus NETs are rare and usually more aggressive than other neuroendocrine tumor entities. We present here a case with β-radiation refractory metastatic thymus NET, who demonstrated an excellent therapy response (molecular and morphological remission, as well as significantly improved clinical symptoms) after 225Ac-DOTATOC-targeted α-therapy, without any adverse effects during the treatment or in the follow-up period.
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Affiliation(s)
| | | | - Richard P Baum
- Curanosticum Wiesbaden-Frankfurt, Center for Advanced Radiomolecular Precision Oncology, Wiesbaden, Germany
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Rathke H, Fuxius S, Giesel FL, Lindner T, Debus J, Haberkorn U, Kratochwil C. Two Tumors, One Target: Preliminary Experience With 90Y-FAPI Therapy in a Patient With Metastasized Breast and Colorectal Cancer. Clin Nucl Med 2021; 46:842-844. [PMID: 34392291 DOI: 10.1097/rlu.0000000000003842] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT We report a patient with breast cancer (BC) diagnosed in 2009 with metachronous lymph node, liver, and bone metastases. In 2017, colorectal cancer with peritoneal metastases was additionally diagnosed and treated with 8 cycles of capecitabine due to its antitumor activity against both malignancies. At progression of both diseases, FAPI PET/CT demonstrated positive tumor targeting in BC-related metastases and colorectal cancer-related metastases. The patient received an experimental therapy with 90Y-FAPI46. Although there was similar tracer uptake in the PET/CT, the radioligand therapy resulted in mixed response with disappearance of peritoneal metastases but minor efficacy treating the BC-related metastases.
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Affiliation(s)
- Hendrik Rathke
- From the Department of Nuclear Medicine, Heidelberg University Hospital
| | | | | | - Thomas Lindner
- From the Department of Nuclear Medicine, Heidelberg University Hospital
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital
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Roumeguère T, Aoun F, Albisinni S, Mjaess G. Antibodies targeting Prostate-Specific Membrane Antigen positive prostate cancer: from diagnostic imaging to theranostics. Curr Opin Oncol 2021; 33:500-506. [PMID: 34230440 DOI: 10.1097/cco.0000000000000767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Targeting Prostate-Specific Membrane Antigen (PSMA) has paved the way for personalized medicine in prostate cancer (PCa) patients. This review aims to highlight the role of PSMA targeting antibodies in PCa, for diagnostic and therapeutic purposes. RECENT FINDINGS PSMA Positron Emission Tomography/Computed Tomography has been a game changer in the diagnosis of PCa in the recent decade. Two anti-PSMA monoclonal antibodies have been studied in PCa: 7E11-C35 (limited use) and J591. J591 antibody was used for diagnostic purposes coupled with different radionuclides. Most importantly, it was combined to numerous therapeutic radionuclides such as Lutetium-177 (177Lu), Yttrium-90 (90Y), Indium-111 (111In), and Actinium-225 (225Ac). It was also conjugated to drugs forming antibody-drug conjugates (e.g. MLN2704 and PSMA-ADC). These compounds were tested in recent phase I/II clinical trials. SUMMARY PSMA targeting antibodies are very promising for further clinical investigation and continue to be a momentous research area, for both imaging and therapeutic settings. Although some clinical trials resulted in unfavorably safety profiles for some antibodies, they validated PSMA as a crucial immunoconjugate target.
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Affiliation(s)
- Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Fouad Aoun
- Department of Urology, University Clinics of Brussels, Hôpital Erasme
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, University Clinics of Brussels, Hôpital Erasme
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, University Clinics of Brussels, Hôpital Erasme
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Triviño-Ibáñez EM, Pardo Moreno P, Ciampi Dopazo JJ, Ramos-Font C, Ruiz Villaverde G, González-Flores E, Navarro Vergara PF, Rashki M, Gómez-Río M, Rodríguez-Fernández A. Biomarkers associated with survival and favourable outcome of radioembolization with yttrium-90 glass microspheres for colon cancer liver metastases: Single centre experience. Rev Esp Med Nucl Imagen Mol 2021; 41:231-238. [PMID: 34454892 DOI: 10.1016/j.remnie.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the therapeutic effectiveness and safety of transarterial radioembolization (TARE) with Yttrium-90 in patients with colorectal cancer (CRC) liver metastases and to evaluate the prognostic value of different biomarkers. MATERIAL AND METHODS This prospective longitudinal study enrolled consecutive patients with CRC liver metastases treated with TARE between November 2015 and june 2020. The therapeutic response at three and six months (RECIST1.1 criteria) and the relationship of biomarkers with therapeutic response, by calculating objective tumor response rates (ORR) and disease control (DCR), and overall survival (OS) and progression-free (PFS). RESULTS Thirty TAREs were performed in 23 patients (mean age, 61.61 ± 9.13 years; 56.5% male). At three months, the objective response rate (ORR) was 16.7% and the disease control rate (DCR) 53.3%. At six months, the disease progressed in 80%. The ORR and DCR were significantly associated with age at diagnosis (P = 0.047), previous bevacizumab treatment (P = 0.008), pre-TARE haemoglobin (P = 0.008), NLR (P = 0.040), pre-TARE albumin (P = 0.012), pre-TARE ALT (P = 0.023) and tumour-absorbed dose > 115 Gy (P = 0.033). Median overall survival (OS) was 12 months (95% CI, 4.75-19.25 months) and median progression-free survival (PFS) 3 months (95% CI, 2.41-3.59). OS was significantly associated with primary tumour resection (P = 0.019), KRAS mutation (HR: 5.15; P = 0.024), pre-TARE haemoglobin (HR: 0.50; p = 0.009), pre-TARE NLR (HR: 1.65; P = 0.005) and PLR (HR: 1.01; P = 0.042). CONCLUSION TARE prognosis and therapeutic response were predicted by different biomarkers, ranging from biochemical parameters to tumour dosimetrics.
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Affiliation(s)
- E M Triviño-Ibáñez
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain; IBS, Granada Bio-Health Research Institute, Granada, Spain.
| | - P Pardo Moreno
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J J Ciampi Dopazo
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - C Ramos-Font
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain; IBS, Granada Bio-Health Research Institute, Granada, Spain
| | - G Ruiz Villaverde
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - E González-Flores
- Servicio de Oncología Médica, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - P F Navarro Vergara
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M Rashki
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M Gómez-Río
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain; IBS, Granada Bio-Health Research Institute, Granada, Spain
| | - A Rodríguez-Fernández
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain; IBS, Granada Bio-Health Research Institute, Granada, Spain
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Grygier A, Skubacz K, Chałupnik S. The correction factors for UD802 dosimeters irradiated with different radiation energies and at different incidence angles. J Radiol Prot 2021; 41:526-538. [PMID: 33906175 DOI: 10.1088/1361-6498/abfbee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
Many laboratories around the world work on the issue of protection against ionising radiation. It is a very broad topic, covering both the protection of members of the public and workers exposed to ionising radiation, based on personal or environmental monitoring. Thermoluminescence detectors are commonly used for this purpose, which is accepted in most countries. The entire process of dose evaluation with such dosimeters can be divided into several steps. Undoubtedly, one of the most important steps is the calibration procedure. The calibration should be performed in conditions as similar as possible to those experienced during the exposure. Moreover, the calibration is performed using only the Cs-137 source. This article presents results of Panasonic UD-802 irradiation dosimeters in different radiation fields generated by Cs-137, Kr-85, Sr-90/Y-90 and an x-ray tube, series N, and at different angles such as 0°, 30°, 60°, 90°. On the basis of the obtained results, the calibration coefficients and correction factors were determined in relation to calibration based on Cs-137 or Sr-90/Y-90 irradiated at 0°.
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Affiliation(s)
- Agata Grygier
- Silesian Center for Environmental Radioactivity, Central Mining Institute, Plac Gwarków1, 40166 Katowice
| | - Krystian Skubacz
- Silesian Center for Environmental Radioactivity, Central Mining Institute, Plac Gwarków1, 40166 Katowice
| | - Stanisław Chałupnik
- Silesian Center for Environmental Radioactivity, Central Mining Institute, Plac Gwarków1, 40166 Katowice
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41
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Affiliation(s)
- Yung Hsiang Kao
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Severi S, Bongiovanni A, Ferrara M, Nicolini S, Di Mauro F, Sansovini M, Lolli I, Tardelli E, Cittanti C, Di Iorio V, Mezzenga E, Scarpi E, Ibrahim T, Paganelli G, Zovato S. Peptide receptor radionuclide therapy in patients with metastatic progressive pheochromocytoma and paraganglioma: long-term toxicity, efficacy and prognostic biomarker data of phase II clinical trials. ESMO Open 2021; 6:100171. [PMID: 34139487 PMCID: PMC8219772 DOI: 10.1016/j.esmoop.2021.100171] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pheochromocytoma and paraganglioma (PPGL) have currently only limited treatment options available for patients in the metastatic phase (mPPGL) in either post-surgery or inoperable settings. However, these rare tumors overexpress somatostatin receptors and can thus be treated with peptide receptor radionuclide therapy (PRRT). We present data about our 10-year experience treating 46 consecutive mPPGL patients with 90Y-DOTATOC or 177Lu-DOTATATE. PATIENTS AND METHODS All patients (20 men and 26 women, median age 52 years) showed positive scintigraphic imaging at 111In-octreotide or 68Ga-DOTATOC positron emission tomography/computed tomography (PET/CT). 90Y-DOTATOC was administered in 12 patients, with cumulative dosages ranging from 7.4 to 11 GBq, while 34 patients received 18.5 or 27.5GBq of 177Lu-DOTATATE. We used Southwest Oncology Group Response Evaluation Criteria in Solid Tumors criteria to evaluate treatment efficacy and Common Terminology Criteria for Adverse Events criteria to assess toxicity. The prognostic role of primary tumor site, hormone secretion, succinate dehydrogenase (SDHx) mutation, and metastatic involvement was also evaluated. RESULTS Both 90Y-DOTATOC and 177Lu-DOTATATE PRRT were well tolerated by patients without significant renal or bone marrow toxicity. The median follow-up was 73 months (range 5-146 months). The overall disease control rate (DCR) was 80% [95% confidence interval (CI) 68.9% to 91.9%] with a mean five cycles of therapy. However, 177Lu-DOTATATE patients showed a longer median overall survival (mOS) than those receiving 90Y-Dotatoc and a better DCR when higher dosages were administered, even if a direct comparison was not carried out. Syndromic patients had a poorer mOS. SDHx mutations did not interfere with treatment efficacy. CONCLUSIONS PRRT is safe and effective for the treatment of patients with progressive mPPGL, especially at higher dosages. The longer mOS of 177Lu-DOTATATE-treated patients in our protocols indicates the former radiopharmaceutical as the better candidate for further clinical application.
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Affiliation(s)
- S Severi
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - A Bongiovanni
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS IRST 'Dino Amadori', Meldola, Italy
| | - M Ferrara
- Familial Cancer Clinic, Istituto Oncologico Veneto (IOV) IRCCS, Padua, Italy
| | - S Nicolini
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - F Di Mauro
- Nuclear Medicine, Ospedale 'M. Bufalini', Cesena, Italy
| | - M Sansovini
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - I Lolli
- Medical Oncology, Ospedale IRCCS 'S. De Bellis', Castellana Grotte, Italy
| | - E Tardelli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Ospedale 'San Luca', Lucca, Italy
| | - C Cittanti
- Nuclear Medicine Unit, University of Ferrara, Ferrara, Italy
| | - V Di Iorio
- Oncology Pharmacy, IRCCS IRST 'Dino Amadori', Meldola, Italy
| | - E Mezzenga
- Medical Physics Unit, IRCCS IRST 'Dino Amadori', Meldola, Italy
| | - E Scarpi
- Unit of Biostatistics and Clinical Trials, IRCCS IRST 'Dino Amadori', Meldola, Italy
| | - T Ibrahim
- Familial Cancer Clinic, Istituto Oncologico Veneto (IOV) IRCCS, Padua, Italy
| | - G Paganelli
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy.
| | - S Zovato
- Familial Cancer Clinic, Istituto Oncologico Veneto (IOV) IRCCS, Padua, Italy
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Cheng B, Sethi I, Villalobos A, Wagstaff W, Schuster DM, Bercu Z, Brandon D, Kokabi N. Determination of tumour dose response threshold and implication on survival in patients with HCC treated with Y90 radiation segmentectomy: a simple semi-quantitative analysis. Nucl Med Commun 2021; 42:892-898. [PMID: 33795611 DOI: 10.1097/mnm.0000000000001420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the relationship between Yttrium-90 (Y90) tumour dose and response rate in patients with hepatocellular carcinoma (HCC) who undergo Y90 radiation segmentectomy (Y90-RS) and to determine implication on overall survival (OS). MATERIALS AND METHODS Post Y90-RS Bremsstrahlung single-photon emission computed tomography/CT of 105 HCC patients with 110 treatments performed with glass microspheres was retrospectively analysed. The dose-volume histogram of the targeted tumour was determined with commercially available dosimetry software. Tumour response at 3 months was evaluated using modified Response Evaluation Criteria in Solid Tumours. Tumour dose thresholds associated with the objective response with 80% specificity were then used to evaluate implication on OS using Kaplan-Meier estimation and log-rank analysis. RESULTS Tumour dose thresholds to predict objective response with 80% specificity were the following: maximum tumour dose (748 Gy), mean tumour dose (568 Gy), minimum tumour dose of 30% tumour volume (608 Gy), minimum tumour dose of 50% tumour volume (565 Gy), minimum tumour dose of 70% tumour volume (464 Gy) and minimum tumour dose of 100% tumour volume (213 Gy). These parameters all significantly predicted tumour response with areas under the ROC curve of >0.6. Mean tumour dose of ≥250 Gy predicted median OS of 43.67 vs. 17.87 months for others (P = 0.026). Minimum dose ≥180 Gy to 100% of tumour volume predicted median OS of 44.93 vs. 35.87 months for others (P = 0.043). CONCLUSION In patients with HCC undergoing Y90-RS, mean tumour dose ≥250 Gy and minimum tumour dose of ≥180 Gy to 100% of tumour volume are both significantly correlated with higher objective tumour response and prolonged survival.
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Affiliation(s)
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences
| | - Alex Villalobos
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William Wagstaff
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David M Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences
| | - Zachary Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Roosen J, Klaassen NJM, Westlund Gotby LEL, Overduin CG, Verheij M, Konijnenberg MW, Nijsen JFW. To 1000 Gy and back again: a systematic review on dose-response evaluation in selective internal radiation therapy for primary and secondary liver cancer. Eur J Nucl Med Mol Imaging 2021; 48:3776-3790. [PMID: 33839892 PMCID: PMC8484215 DOI: 10.1007/s00259-021-05340-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/25/2021] [Indexed: 12/21/2022]
Abstract
Purpose To systematically review all current evidence into the dose-response relation of yttrium-90 and holmium-166 selective internal radiation therapy (SIRT) in primary and secondary liver cancer. Methods A standardized search was performed in PubMed (MEDLINE), Embase, and the Cochrane Library in order to identify all published articles on dose-response evaluation in SIRT. In order to limit the results, all articles that investigated SIRT in combination with other therapy modalities (such as chemotherapy) were excluded. Results A total of 3038 records were identified of which 487 were screened based on the full text. Ultimately, 37 studies were included for narrative analysis. Meta-analysis could not be performed due to the large heterogeneity in study and reporting designs. Out of 37 studies, 30 reported a ‘mean dose threshold’ that needs to be achieved in order to expect a response. This threshold appears to be higher for hepatocellular carcinoma (HCC, 100–250 Gy) than for colorectal cancer metastases (CRC, 40–60 Gy). Reported thresholds tend to be lower for resin microspheres than when glass microspheres are used. Conclusion Although the existing evidence demonstrates a dose-response relationship in SIRT for both primary liver tumours and liver metastases, many pieces of the puzzle are still missing, hampering the definition of standardized dose thresholds. Nonetheless, most current evidence points towards a target mean dose of 100–250 Gy for HCC and 40–60 Gy for CRC. The field would greatly benefit from a reporting standard and prospective studies designed to elucidate the dose-response relation in different tumour types. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05340-0.
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Affiliation(s)
- Joey Roosen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nienke J M Klaassen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lovisa E L Westlund Gotby
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark W Konijnenberg
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Frank W Nijsen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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Kubik A, Budzyńska A, Kacperski K, Maciak M, Kuć M, Piasecki P, Wiliński M, Konior M, Dziuk M, Iller E. Evaluation of qualitative and quantitative data of Y-90 imaging in SPECT/CT and PET/CT phantom studies. PLoS One 2021; 16:e0246848. [PMID: 33566845 PMCID: PMC7875374 DOI: 10.1371/journal.pone.0246848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/26/2021] [Indexed: 01/06/2023] Open
Abstract
Introduction We aimed to assess the feasibility of SPECT and PET Y-90 imaging, and to compare these modalities by visualizing hot and cold foci in phantoms for varying isotope concentrations. Materials and methods The data was acquired from the Jaszczak and NEMA phantoms. In the Jaszczak phantom Y-90 concentrations of 0.1 MBq/ml and 0.2 MBq/ml were used, while higher concentrations, up to 1.0 MBq/ml, were simulated by acquisition time extension with respect to the standard clinical protocol of 30 sec/projection for SPECT and 30 min/bed position for PET imaging. For NEMA phantom, the hot foci had concentrations of about 4 MB/ml and the background 0.1 or 0.0 MBq/ml. All of the acquired data was analysed both qualitatively and quantitatively. Qualitative assessment was conducted by six observers asked to identify the number of visible cold or hot foci. Inter-observer agreement was assessed. Quantitative analysis included calculations of contrast and contrast-to-noise ratio (CNR), and comparisons with the qualitative results. Results For SPECT data up to two cold foci were discernible, while for PET four foci were visible. We have shown that CNR (with Rose criterion) is a good measure of foci visibility for both modalities. We also found good concordance of qualitative results for the Jaszczak phantom studies between the observers (corresponding Krippendorf’s alpha coefficients of 0.76 to 0.84). In the NEMA phantom without background activity all foci were visible in SPECT/CT images. With isotope in the background, 5 of 6 spheres were discernible (CNR of 3.0 for the smallest foci). For PET studies all hot spheres were visible, regardless of the background activity. Conclusions PET Y-90 imaging provided better results than Bremsstrahlung based SPECT imaging. This indicates that PET/CT might become the method of choice in Y-90 post radioembolization imaging for visualisation of both necrotic and hot lesions in the liver.
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Affiliation(s)
- Agata Kubik
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
- * E-mail:
| | - Anna Budzyńska
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
- Affidea Mazovian PET/CT Medical Centre, Warsaw, Poland
| | - Krzysztof Kacperski
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
- Particle Acceleration Physics and Technology Division (TJ1), National Centre for Nuclear Research, Otwock—Świerk, Poland
| | - Maciej Maciak
- Radiological Metrology and Biomedical Physics Division (H2), National Centre for Nuclear Research, Otwock—Świerk, Poland
| | - Michał Kuć
- Radiological Metrology and Biomedical Physics Division (H2), National Centre for Nuclear Research, Otwock—Świerk, Poland
| | - Piotr Piasecki
- Department of Interventional Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Wiliński
- Radiological Metrology and Biomedical Physics Division (H2), National Centre for Nuclear Research, Otwock—Świerk, Poland
| | - Marcin Konior
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock—Świerk, Poland
| | - Mirosław Dziuk
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
- Affidea Mazovian PET/CT Medical Centre, Warsaw, Poland
| | - Edward Iller
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock—Świerk, Poland
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Zadrozny M, Hainzer N, Mehilli J, Jochheim D, Gschwendtner S, Steffen J, Theiss H, Braun D, Hagl C, Sadoni S, Massberg S, Hausleiter J, Deseive S. TAVR in nonagenarians: An analysis investigating safety, efficacy, symptomatic improvement, and long-term survival. J Cardiol 2021; 78:44-50. [PMID: 33563507 DOI: 10.1016/j.jjcc.2021.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/04/2021] [Accepted: 01/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the aging western societies, an increasing prevalence of severe, symptomatic aortic stenosis is observed. The aim of this study was to examine the safety and efficacy of transcatheter aortic valve replacement (TAVR) in patients aged 90 years and older. METHODS All patients with severe symptomatic aortic stenosis undergoing TAVR at LMU Munich-University-Hospital between 2013 and 2018 were included. Procedure-related mortality (<30 days) was defined as the primary endpoint and survival rates at two years, device failure, and procedural complications were defined as secondary endpoints according to the Valve Academic Research Consortium II criteria. RESULTS AND CONCLUSIONS Out of 2336 patients, 2183 were younger than 90 years (<90y.-group) and 153 patients were aged 90 or older (≥90y.-group). Procedure-related mortality (3.6% <90y.-group vs. 3.3% ≥90y.-group, log-rank p=0.9) and device success (97.2% <90y.-group vs. 96.0% ≥90y.-group, p=0.44) were similar. Estimated survival rates at 2 years were 62.8% (95% CI 55.3 and 71.4) in the elder and 76.0% (95% CI 74.1 and 77.8) in the younger patients (p<0.01). The incidence of acute kidney injury, stroke, major bleeding, and permanent pacemaker implantations were comparable between both groups. TAVR procedure is equally safe and feasible in patients aged 90 years or older compared to younger patients. Differences in 2-year survival appear to be patient-related rather than procedure-related.
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Affiliation(s)
- Magda Zadrozny
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - Nathalie Hainzer
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - David Jochheim
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - Sarah Gschwendtner
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - Julius Steffen
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - Hans Theiss
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - Daniel Braun
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - Joerg Hausleiter
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany
| | - Simon Deseive
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; DZHK - German Centre for Cardiovascular Research, partner site Munich, Munich, Germany.
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Rigendinger F, Aebersold DM, Cvejic Z, Pajic B. Changes of Corneal Biomechanical Properties upon Exclusive Ytt-/Sr-90 Irradiation of Pterygium. Sensors (Basel) 2021; 21:s21030975. [PMID: 33540506 PMCID: PMC7867194 DOI: 10.3390/s21030975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is known that pterygia above a certain size cause astigmatism and other aberrations of the human cornea and thus impair the quality of vision. Exclusive Sr-/Ytt-90 beta irradiation is a highly effective treatment for primary pterygia. The aim of this retrospective study is to determine the extent to which higher order corneal aberrations are affected by this treatment. METHODS Evaluation of corneal topographies and wavefront aberration data of 20 primary pterygia patients generated before and at different points in time in the first year after irradiation. Additionally, the size of the pterygium was measured. RESULTS The study showed a significant increase in coma and triple leaf aberrations in pterygia with a horizontal length of 2 mm and more. It was also found that a pterygium size greater than 2 mm significantly induces astigmatism. Both phenomena reduce visual quality. In none of the patients could a pterygium recurrence be detected after irradiation. CONCLUSIONS If the pterygium size is less than 2 mm, early exclusive Sr/Ytt-90 beta irradiation can be recommended. If the size is more than 2 mm, a pterygium excision 6 months after beta irradiation can be discussed.
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Affiliation(s)
- Fritz Rigendinger
- Eye Clinic Orasis, Swiss Eye Research Foundation, 5734 Reinach AG, Switzerland;
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland;
| | - Zeljka Cvejic
- Department of Physics, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia;
| | - Bojan Pajic
- Eye Clinic Orasis, Swiss Eye Research Foundation, 5734 Reinach AG, Switzerland;
- Department of Physics, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia;
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +41-62-765-60-80
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Peng H, Gong W, Beckmann CF, Vedaldi A, Smith SM. Accurate brain age prediction with lightweight deep neural networks. Med Image Anal 2021; 68:101871. [PMID: 33197716 PMCID: PMC7610710 DOI: 10.1016/j.media.2020.101871] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/24/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022]
Abstract
Deep learning has huge potential for accurate disease prediction with neuroimaging data, but the prediction performance is often limited by training-dataset size and computing memory requirements. To address this, we propose a deep convolutional neural network model, Simple Fully Convolutional Network (SFCN), for accurate prediction of brain age using T1-weighted structural MRI data. Compared with other popular deep network architectures, SFCN has fewer parameters, so is more compatible with small dataset size and 3D volume data. The network architecture was combined with several techniques for boosting performance, including data augmentation, pre-training, model regularization, model ensemble and prediction bias correction. We compared our overall SFCN approach with several widely-used machine learning models. It achieved state-of-the-art performance in UK Biobank data (N = 14,503), with mean absolute error (MAE) = 2.14y in brain age prediction and 99.5% in sex classification. SFCN also won (both parts of) the 2019 Predictive Analysis Challenge for brain age prediction, involving 79 competing teams (N = 2,638, MAE = 2.90y). We describe here the details of our approach, and its optimisation and validation. Our approach can easily be generalised to other tasks using different image modalities, and is released on GitHub.
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Affiliation(s)
- Han Peng
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, OX3 9DU, United Kingdom; Visual Geometry Group (VGG), University of Oxford, Oxford, OX2 6NN, United Kingdom; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, 6525 EN, the Netherlands.
| | - Weikang Gong
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Christian F Beckmann
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, OX3 9DU, United Kingdom; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, 6525 EN, the Netherlands
| | - Andrea Vedaldi
- Visual Geometry Group (VGG), University of Oxford, Oxford, OX2 6NN, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, OX3 9DU, United Kingdom
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Taebi A, Vu CT, Roncali E. Multiscale Computational Fluid Dynamics Modeling for Personalized Liver Cancer Radioembolization Dosimetry. J Biomech Eng 2021; 143:011002. [PMID: 32601676 PMCID: PMC7580665 DOI: 10.1115/1.4047656] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 06/17/2020] [Indexed: 12/13/2022]
Abstract
Yttrium-90 (90Y) radioembolization is a minimally invasive procedure increasingly used for advanced liver cancer treatment. In this method, radioactive microspheres are injected into the hepatic arterial bloodstream to target, irradiate, and kill cancer cells. Accurate and precise treatment planning can lead to more efficient and safer treatment by delivering a higher radiation dose to the tumor while minimizing the exposure of the surrounding liver parenchyma. Treatment planning primarily relies on the estimated radiation dose delivered to tissue. However, current methods used to estimate the dose are based on simplified assumptions that make the dosimetry results unreliable. In this work, we present a computational model to predict the radiation dose from the 90Y activity in different liver segments to provide a more realistic and personalized dosimetry. Computational fluid dynamics (CFD) simulations were performed in a 3D hepatic arterial tree model segmented from cone-beam CT angiographic data obtained from a patient with hepatocellular carcinoma (HCC). The microsphere trajectories were predicted from the velocity field. 90Y dose distribution was then calculated from the volumetric distribution of the microspheres. Two injection locations were considered for the microsphere administration, a lobar and a selective injection. Results showed that 22% and 82% of the microspheres were delivered to the tumor, after each injection, respectively, and the combination of both injections ultimately delivered 49% of the total administered 90Y microspheres to the tumor. Results also illustrated the nonhomogeneous distribution of microspheres between liver segments, indicating the importance of developing patient-specific dosimetry methods for effective radioembolization treatment.
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Affiliation(s)
- Amirtahà Taebi
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616
| | - Catherine T. Vu
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817
| | - Emilie Roncali
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA 95616
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Brennan VK, Colaone F, Shergill S, Pollock RF. A cost-utility analysis of SIR-Spheres Y-90 resin microspheres versus best supportive care in the treatment of unresectable metastatic colorectal cancer refractory to chemotherapy in the UK. J Med Econ 2020; 23:1588-1597. [PMID: 33084466 DOI: 10.1080/13696998.2020.1839273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Limited treatment options are available in chemotherapy-refractory or -intolerant metastatic colorectal cancer (mCRC). The objective of the present analysis was to evaluate the cost-utility of SIR-Spheres Y-90 resin microspheres relative to best supportive care (BSC) in the treatment of chemotherapy refractory mCRC from the perspective of the UK national healthcare payer. METHODS A cost-utility model was developed in Microsoft Excel to simulate transitions from progression-free survival to post-progression survival and death in patients with mCRC. Unit costs were captured in 2019 pounds sterling (GBP) based on the literature, formulary listings, and National Health Service (NHS) England reference costs. Future costs and effects were discounted at 3.5% per annum. A series of one-way sensitivity analyses, and probabilistic sensitivity analysis (PSA) were conducted. RESULTS The base case analysis showed that SIR-Spheres Y-90 resin microspheres would result in an increase in discounted quality-adjusted life years gained from 0.69 quality-adjusted life years (QALYs) to 1.50 QALYs, with an associated increase in cost from GBP 15,268 to GBP 34,168 yielding an incremental cost-utility ratio of GBP 23,435 per QALY. PSA showed that there would be a 56% likelihood that SIR-Spheres Y-90 resin microspheres would be cost-effective relative to BSC at a willingness-to-pay threshold of GBP 30,000 per QALY gained. CONCLUSIONS This cost-utility analysis showed that, relative to BSC, SIR-Spheres Y-90 resin microspheres would be a cost-effective treatment option for patients with mCRC in the UK setting from the national healthcare payer perspective.
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Affiliation(s)
- V K Brennan
- Sirtex Medical United Kingdom Ltd, London, UK
| | - F Colaone
- Sirtex Medical United Kingdom Ltd, London, UK
| | - S Shergill
- Sirtex Medical United Kingdom Ltd, London, UK
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