Feasibility of 90Y TOF PET-based dosimetry in liver metastasis therapy using SIR-Spheres

Lhommel, Renaud; Elmbt, Larry van; Goffette, Pierre; Eynde, Marc Van den; Jamar, François; Pauwels, Stanislas; Walrand, Stéphan

doi:10.1007/s00259-010-1470-9

Cited by 179 publications

(184 citation statements)

References 30 publications

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“…In a recent study (8), we showed by Monte Carlo simulations that the random and asymmetric spreading of microspheres between the daughter vessels at the nodes of the hepatic arterial tree induces a large nonuniformity of microscale dose distribution as observed on PET (9,10) (Fig. 1).…”

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confidence: 81%

A Hepatic Dose-Toxicity Model Opening the Way Toward Individualized Radioembolization Planning

et al. 2014

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The 50% normal-tissue complication probability (NTCP) after lobar irradiation of the liver results in highly variable biologic effective doses depending on the modality used: a biologic effective dose for 50% (BED 50 ) of 115, 93, and 250 Gy for external-beam radiotherapy, resin microsphere radioembolization, and glass microsphere radioembolization, respectively. This misunderstood property has made it difficult to predict the maximal tolerable dose as a function of microsphere activity and targeted liver volume. The evolution toward more selective catheterization techniques, resulting in more variable targeted volumes, makes it urgent to solve this issue. Methods: We computed by Monte Carlo simulations the microsphere distribution in the portal triads based on microsphere transport dynamics through a synthetically grown hepatic arterial tree. Afterward, the microscale dose distribution was computed using a dose deposition kernel. We showed that the equivalent uniform dose cannot handle microscale dosimetry and fails to solve the discordance between the BED 50 values. Consequently, we developed a new radiobiologic model to compute the liver NTCP from the microscale dose distribution. Results: The new model explains all the observed BED 50 values and provides a way to compute the hepatic dose-toxicity relationship as a function of microsphere activity and targeted liver volume. The NTCP obtained is in agreement with the data reported from clinical radioembolization studies. Conclusion:The results should encourage interventional radiologists to fine-tune the delivered dose to the liver as a function of the targeted volume. The present model could be used as the backbone of the treatment planning, allowing optimization of the absorbed dose to the tumors. Sel ective internal radiation therapy by radioembolization with 90 Y-loaded microspheres is becoming a common procedure in patients with primary hepatic neoplasia and liver-dominant metastatic disease. The evolution toward more selective catheterization techniques makes it urgent to use a model predicting the maximal tolerable delivered dose as a function of the radioembolization device and the targeted liver volume.Recommendations for lobar radioembolization of the liver differ in maximal tolerable absorbed dose according to the medical device: less than 70 Gy when using 50 Bq of loaded resin microspheres (1) and less than 120 Gy when using 2,500 Bq of loaded glass microspheres (2). Recent voxel-based dosimetry SPECT/CT studies (3,4) support a similar difference in hepatic toxicity risk per gray for these 2 therapies. For hepatocarcinoma treated with resin spheres, Strigari et al. (3) The biologic effective dose (BED) formalism accounts for the difference in dose rates between irradiation modalities (3,6). However, the resulting biologic effective dose for 50% (BED 50 ) is still highly discordant: 115, 93, and 250 Gy for EBRT, resin microsphere radioembolization, and glass microsphere radioembolization, respectively. The values used to compute BED (a/b 5 2.5 Gy a...

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confidence: 81%

A Hepatic Dose-Toxicity Model Opening the Way Toward Individualized Radioembolization Planning

et al. 2014

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“…A physical and mathematical phantom with filled spheres and convoluted via a VSV technique showed approximately 9% difference (using PSF, recovery coefficients and TOF) in absorbed dose when compared to a known ground truth [124]. They noted that the use of the TOF in the reconstruction improved the accuracy of absorbed dose calculations for the simulated tumours with the lowest activities.…”

Section: Y Pet Imagingmentioning

confidence: 99%

“…They showed however, that 15% leaching occurred at 45 min post-injection and thus it would prove difficult to provide accurate activity quantification using 18 F microspheres. A recent review highlighted the issues inherent with "non-pure" positron emitters such as 86 Y, 124 I, 94m Tc because of prompt gamma rays emitted in the PET acquisition window, and also higher energy gamma rays that may scatter into the same window [131]. Significant corrections are required in order to accurately image these isotopes especially for quantitative 3D PET where the potential for spurious coincidence contamination is much increased.…”

Section: Preplanning With Pet Isotopesmentioning

confidence: 99%

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Doherty¹

2015

J Diagn Imaging Ther

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Yttrium-90 radioembolization ( 90 Y-RE) is a well-established therapy for the treatment of hepatocellular carcinoma (HCC) and also of metastatic liver deposits from other malignancies. Nuclear Medicine and Cath Lab diagnostic imaging takes a pivotal role in the success of the treatment, and in order to fully exploit the efficacy of the technique and provide reliable quantitative dosimetry that are related to clinical endpoints in the era of personalized medicine, technical challenges in imaging need to be overcome. In this paper, the extensive literature of current 90 Y-RE techniques and challenges facing it in terms of quantification and dosimetry are reviewed, with a focus on the current generation of 3D dosimetry techniques. Finally, new emerging techniques are reviewed which seek to overcome these challenges, such as highresolution imaging, novel surgical procedures and the use of other radiopharmaceuticals for therapy and pre-therapeutic planning.

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“…Recent studies report the feasibility of high-resolution 90 Y positron emission tomography/computed tomography (PET/ CT) imaging using time-of-flight (TOF) technology and the possibility of the posttreatment evaluation of 90 Y microsphere distribution with 90 Y PET/CT [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Semi-Quantitative Analysis of Post-Transarterial Radioembolization 90Y Microsphere Positron Emission Tomography Combined with Computed Tomography (PET/CT) Images in Advanced Liver Malignancy: Comparison With 99mTc Macroaggregated Albumin (MAA) Single Photon Emission Computed Tomography (SPECT)

Rhee

Kim

Cho

et al. 2015

Nucl Med Mol Imaging

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Feasibility of 90Y TOF PET-based dosimetry in liver metastasis therapy using SIR-Spheres

Abstract: This supports the implementation of (90)Y PET in selective internal radiation therapy of the liver.

Cited by 179 publications

References 30 publications

A Hepatic Dose-Toxicity Model Opening the Way Toward Individualized Radioembolization Planning

A Hepatic Dose-Toxicity Model Opening the Way Toward Individualized Radioembolization Planning

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Semi-Quantitative Analysis of Post-Transarterial Radioembolization 90Y Microsphere Positron Emission Tomography Combined with Computed Tomography (PET/CT) Images in Advanced Liver Malignancy: Comparison With 99mTc Macroaggregated Albumin (MAA) Single Photon Emission Computed Tomography (SPECT)

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