Early Dose Response to Yttrium-90 Microsphere Treatment of Metastatic Liver Cancer by a Patient-Specific Method Using Single Photon Emission Computed Tomography and Positron Emission Tomography

Campbell, Janice; Wong, Ching-Yee Oliver; Muzik, Otto; Marples, Brian; Joiner, Michael C.; Burmeister, Jay

doi:10.1016/j.ijrobp.2008.12.058

Cited by 39 publications

(31 citation statements)

References 10 publications

(13 reference statements)

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“…Nonetheless, the partition model based on pretreatment 99m Tc-MAA SPECT/CT should be preferred by nuclear physicians and interventional radiologists, because lesionbased dosimetry on pretreatment 99m Tc-MAA SPECT/CT has been shown to correlate with response and survival (39)(40)(41)(42)(43). The aim of radioembolization is to deliver the highest possible absorbed dose to tumor cells ("tumor dose") in order to induce apoptosis and tumor load reduction.…”

Section: Pretreatment Imaging and Dosimetrymentioning

confidence: 99%

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

et al. 2015

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Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the status of the current literature regarding new indications for radioembolization; (2) describe standard hepatic vascularization, identify common routes for extrahepatic depositions, and judge when "skeletization" of hepatic arteries could be unnecessary; and (3) appraise the different methods of activity calculation and recognize the strengths and pitfalls of pretreatment and posttreatment dosimetry.Financial Disclosure: Dr. Lam is a consultant/advisor for BTG International and a meeting participant/lecturer for SirTex Medical. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through July 2018.Radioembolization is an established treatment modality that has been subjected to many improvements over the last decade. Developments are occurring at a high pace, affecting patient selection and treatment. The aim of this review is therefore to provide an overview of current practice, with a focus on recent developments in the field of radioembolization. Several practical issues and recommendations in the application of radioembolization will be discussed, ranging from patient selection to treatment response and future applications.

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Section: Pretreatment Imaging and Dosimetrymentioning

confidence: 99%

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

et al. 2015

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“…Phantom studies have shown that 99m Tc-MAA SPECT/CT volume measurements are accurate and reproducible (13). To date, no standardized technique exists for the calculation of SPECT/CT-based T/N ratios, although several methods have been described (21)(22)(23).…”

mentioning

confidence: 99%

Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective ⁹⁰Y Radioembolization

Kao¹,

Tan²,

Burgmans³

et al. 2012

J Nucl Med

150

131

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Compliance with radiobiologic principles of radionuclide internal dosimetry is fundamental to the success of 90 Y radioembolization. The artery-specific SPECT/CT partition model is an image-guided personalized predictive dosimetric technique developed by our institution, integrating catheter-directed CT hepatic angiography (CTHA), 99m Tc-macroaggregated albumin SPECT/CT, and partition modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates 99m Tc-macroaggregated albumin hepatic biodistribution. The partition model is validated for 90 Y resin microspheres based on MIRD macrodosimetry. Methods: This was a retrospective analysis of ourearly clinical outcomes for inoperable hepatocellular carcinoma. Mapping hepatic angiography was performed according to standard technique with the addition of catheter-directed CTHA. 99m Tc-MAA planar scintigraphy was used for liver-tolung shunt estimation, and SPECT/CT was used for liver dosimetry. Artery-specific SPECT/CT partition modeling was planned by experienced nuclear medicine physicians. Results: From January to May 2011, 20 arterial territories were treated in 10 hepatocellular carcinoma patients. Median follow-up was 21 wk (95% confidence interval [CI], 12-50 wk). When analyzed strictly as brachytherapy, 90 Y radioembolization planned by predictive dosimetry achieved index tumor regression in 8 of 8 patients, with a median size decrease of 58% (95% CI, 40%-72%). Tumor thrombosis regressed or remained stable in 3 of 4 patients with baseline involvement. The best a-fetoprotein reduction ranged from 32% to 95%. Clinical success was achieved in 7 of 8 patients, including 2 by sublesional dosimetry, in 1 of whom there was radioembolization lobectomy intent. Median predicted mean radiation absorbed doses were 106 Gy (95% CI, 105-146 Gy) to tumor, 27 Gy (95% CI, 22-33 Gy) to nontumorous liver, and 2 Gy (95% CI, 1.3-7.3 Gy) to lungs. Across all patients, tumor, nontumorous liver, and lungs received predicted $91 Gy, #51 Gy, and #16 Gy, respectively, via at least 1 target arterial territory. No patients developed significant toxicities within 3 mo after radioembolization. The median time to best imaging response was 76 d (95% CI, 55-114 d). Median time to progression and overall survival were not reached. SPECT/CT-derived mean tumor-to-normal liver ratios varied widely across all planning target volumes (median, 5.4; 95% CI, 4.1-6.7), even within the same patient. Conclusion: Imageguided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling achieves high clinical success rates for safe and effective 90 Y radioembolization. Asaformofart erial territory-specific point-source brachytherapy, 90 Y radioembolization is always effective when delivered at the right location, in the right dose, and with the right intent. 90 Y radioembolization failure is invariably due to one or a combination of these 3 factors being incorrectly addressed. Responsibility for this triad of factors is ...

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“…The estimated T/N ratio can predict the success or failure of Y-90 radioembolization, and its importance has been increasingly recognized [14,[16][17][18][19]. The BSA method does not require the physician to calculate the estimated T/N ratio [7].…”

Section: Clinical Implications Of the Body Surface Area Methodsmentioning

confidence: 99%

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

Kao

Tan

et al. 2011

Ann Nucl Med

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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.

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Early Dose Response to Yttrium-90 Microsphere Treatment of Metastatic Liver Cancer by a Patient-Specific Method Using Single Photon Emission Computed Tomography and Positron Emission Tomography

Cited by 39 publications

References 10 publications

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

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

Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective ⁹⁰Y Radioembolization

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

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Early Dose Response to Yttrium-90 Microsphere Treatment of Metastatic Liver Cancer by a Patient-Specific Method Using Single Photon Emission Computed Tomography and Positron Emission Tomography

Cited by 39 publications

References 10 publications

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

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

Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective 90Y Radioembolization

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

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

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

Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective ⁹⁰Y Radioembolization