General Theory of Predictive Dosimetry for Yttrium-90 Radioembolization to Sites Other than the Liver

Kao, Yung Hsiang

doi:10.1007/s00270-013-0783-z

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…A general theory of predictive dosimetry based on MIRD macrodosimetry to guide radioembolization to sites other than the liver has recently been proposed. 98 Since 2013, there have been reports of radioembolization to the kidney, spleen, lung and adrenal gland. 98 A clinical trial investigating kidney radioembolization for renal cell carcinoma is currently ongoing in Australia.…”

Section: Future Directions and Researchmentioning

confidence: 99%

“…98 Since 2013, there have been reports of radioembolization to the kidney, spleen, lung and adrenal gland. 98 A clinical trial investigating kidney radioembolization for renal cell carcinoma is currently ongoing in Australia. 99 With the increasing sophistication of interventional radiology and nuclear medicine techniques, there is no doubt that radioembolization to sites other than the liver will continue to expand in the years to come.…”

Section: Future Directions and Researchmentioning

confidence: 99%

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Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry

Tong¹,

Kao²,

Too³

et al. 2016

BJR

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In recent years, yttrium-90 ((90)Y) microsphere radioembolization has been establishing itself as a safe and efficacious treatment for both primary and metastatic liver cancers. This extends to both first-line therapies as well as in the salvage setting. In addition, radioembolization appears efficacious for patients with portal vein thrombosis, which is currently a contraindication for surgery, transplantation and transarterial chemoembolization. This article reviews the efficacy and expanding use of (90)Y microsphere radioembolization with an added emphasis on recent advances in personalized dosimetry and interventional radiology techniques. Directions for future research into combination therapies with radioembolization and expansion into sites other than the liver are also explored.

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Section: Future Directions and Researchmentioning

confidence: 99%

Section: Future Directions and Researchmentioning

confidence: 99%

Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry

Tong¹,

Kao²,

Too³

et al. 2016

BJR

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“…The so-called partition method is a tissue level dosimetry method that is used widely as a tool to predict mean absorbed dose in the tumor and healthy liver. This method assumes uniform activity in tumor and normal liver compartments [25]. However, there are some concerns about using the mean absorbed dose in SIRT because of the inherent activity heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

Multi-modal image analysis for semi-automatic segmentation of the total liver and liver arterial perfusion territories for radioembolization

et al. 2019

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We have developed a multi-modal imaging approach for SIRT, combining 99m Tc-MAA SPECT/CT and/or 90 Y PET, 18 F-FDG PET/CT, and contrast-enhanced CBCT for voxel-based dosimetry, as a tool for treatment planning and verification. For radiation dose prediction calculations, a segmentation of the total liver volume and of the liver perfusion territories is required. Method: In this paper, we proposed a procedure for multi-modal image analysis to assist SIRT treatment planning. The pre-treatment 18 F-FDG PET/CT, 99m Tc-MAA SPECT/CT, and contrast-enhanced CBCT images were registered to a common space using an initial rigid, followed by a deformable registration. The registration was scored by an expert using Likert scores. The total liver was segmented semi-automatically based on the PET/CT and SPECT/CT images, and the liver perfusion territories were determined based on the CBCT images. The segmentations of the liver and liver lobes were compared to the manual segmentations by an expert on a CT image. Result: Our methodology showed that multi-modal image analysis can be used for determination of the liver and perfusion territories using CBCT in SIRT using all pre-treatment studies. The results for image registration showed acceptable alignment with limited impact on dosimetry. The image registration performs well according to the expert reviewer (scored as perfect or with little misalignment in 94% of the cases). The semi-automatic liver segmentation agreed well with manual liver segmentation (dice coefficient of 0.92 and an average Hausdorff distance of 3.04 mm). The results showed disagreement between lobe segmentation using CBCT images compared to lobe segmentation based on CT images (average Hausdorff distance of 14.18 mm), with a high impact on the dosimetry (differences up to 9 Gy for right and 21 Gy for the left liver lobe). Conclusion: This methodology can be used for pre-treatment dosimetry and for SIRT planning including the determination of the activity that should be administered to achieve the therapeutical goal. The inclusion of perfusion CBCT enables perfusion-based definition of the liver lobes, which was shown to be markedly different from the anatomical definition in some of the patients.

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“…[2]. Again, the case series described in our paper represents a pilot study at best, and the experiences made have only helped us to design a Phase I study, which currently is under review by government authorities.…”

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confidence: 97%