Clinical implications of the body surface area method versus partition model dosimetry for yttrium-90 radioembolization using resin microspheres: a technical review

Abstract

Yttrium-90 (Y-90) radioembolization is becoming established as an effective therapeutic modality for inoperable liver tumors. For resin microspheres, the 'body surface area (BSA)' method and the partition model can both be used for Y-90 activity calculation. The BSA method is semi-empirical, but more commonly used due its simplicity. The partition model is more accurate, scientifically sound and personalized, but less popular due to its complexity. This article provides a technical comparison of both methods with an emphasis on its clinical implications. Future dosimetric techniques for Y-90 radioembolization based on emerging technologies are also discussed.

Personalized Dosimetry with Intensification Using 90Y-Loaded Glass Microsphere Radioembolization Induces Prolonged Overall Survival in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis

“…The body-surface-area method was used for activity calculation, despite the fact that the partition method is now the technique preferred by several experts (23,24). Moreover, some patients were treated with radioembolization despite presenting with inappropriately high lung shunting, leading to death, and no personalized dosimetric approach used.…”

90Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

“…The second method, the body surface area method, is semiempiric and has been used safely in many clinical trials. Its main limitation is the absence of target volume in the calculation method, which can result in undertreatment (small patient with large liver) or overtreatment (large patient with small liver) (35,36). Furthermore, it does not correct for the individual intrahepatic distribution differences, calculated by the so-called tumor-to-nontumor ratio, which is to the disadvantage of patients with hyper-or hypovascular tumors.…”

Resin Versus Glass Microspheres for 90Y Transarterial Radioembolization: Comparing Survival in Unresectable Hepatocellular Carcinoma Using Pretreatment Partition Model Dosimetry

“…Resin microspheres manufacturer-recommended 90 Y activity prescription is based on a semiempiric formula including body surface area (9,10) and tumor burden. This approach can be refined using a 3-compartment partition model (11) including the lungs and tumoral (TV) and targeted nontumoral liver volumes derived from pretreatment 99m Tc-macroaggregated albumin ( 99m Tc-MAA) SPECT/CT.…”