Holmium-166 Microsphere Radioembolization of Hepatic Malignancies

Reinders, Margot T.M.; Smits, Maarten L. J.; Roekel, Caren van; Braat, Arthur J. A. T.

doi:10.1053/j.semnuclmed.2019.01.008

Cited by 70 publications

(52 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Microspheres can be functionalized with active ligands to impart them properties of selectivity. Nowadays, there are three types of radioactive microspheres approved for clinical use—TheraSpheres (BTG, London, UK), SIR-Spheres (Sirtex Medical Limited, North Sydney NSW, Australia) and QuiremSpheres (Quirem Medical BV, Deventer, the Netherlands) [242].…”

Section: Introductionmentioning

confidence: 99%

Current outlook on radionuclide delivery systems: from design consideration to translation into clinics

et al. 2019

View full text Add to dashboard Cite

Radiopharmaceuticals have proven to be effective agents, since they can be successfully applied for both diagnostics and therapy. Effective application of relevant radionuclides in pre-clinical and clinical studies depends on the choice of a sufficient delivery platform. Herein, we provide a comprehensive review on the most relevant aspects in radionuclide delivery using the most employed carrier systems, including, (i) monoclonal antibodies and their fragments, (ii) organic and (iii) inorganic nanoparticles, and (iv) microspheres. This review offers an extensive analysis of radionuclide delivery systems, the approaches of their modification and radiolabeling strategies with the further prospects of their implementation in multimodal imaging and disease curing. Finally, the comparative outlook on the carriers and radionuclide choice, as well as on the targeting efficiency of the developed systems is discussed.

show abstract

Section: Introductionmentioning

confidence: 99%

Current outlook on radionuclide delivery systems: from design consideration to translation into clinics

et al. 2019

View full text Add to dashboard Cite

show abstract

“…PLLA microspheres have a density of 1.4 g/ml. The weight of 1 million microspheres is 20 mg, the Holmium content is 19-20% [3]. The speci c activity of microspheres delivered for HSD ("QuiremScout") is lower than that used for RE procedures ("QuiremSpheres") due to different duration and intensity of neutron irradiation during production (4.2-4.7 MBq/mg and 11.6-15.3 MBq/mg, respectively, in this study).…”

Section: Methodsmentioning

confidence: 68%

“…Glass and resin microspheres loaded with Yttrium-90, and poly-L-lactic acid (PLLA) microspheres loaded with Holmium-166 are available. Potential advantages are the shorter half-life of Ho-166 (26.8 h) compared with Y-90 (64.1 h), its paramagnetic properties facilitating localisation and quanti cation by magnetic resonance (MR) imaging, and better visibility by SPECT due to its gamma radiation (81 keV peak, abundance 6.7%) [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…This "delivery set" should be used for planning and treatment procedures. For PLLA microspheres, an option is to perform the planning procedure (Holmium scout dose, HSD) with the same type of microspheres used for radioembolisation treatment (RE) instead of using Tc-99m macro-aggregated albumin (MAA) or similar radiopharmaceuticals, that are commonly used for glass and resin microsphere RE procedures [3]. The Ho-166 activity for a HSD procedure of the whole liver should not exceed 250 MBq Ho-166.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Radioembolisation with Holmium-166 Polylactic Acid Microspheres: Distribution of Residual Activity and Flow Dynamics During Planning and Treatment Procedures

Freesmeyer

Seifert

Gühne

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose:To evaluate the application dynamics and residual Ho-166 activity during and after transarterial radioembolisation planning and treatment procedures, and to assess the distribution and predilection sites of residual activity in the proprietary delivery set and microcatheter.Methods:16 planning (Holmium Scout Dose, HSD) and 12 therapeutic radioembolisation (RE) procedures were performed with poly-L-lactic acid (PLLA) microspheres loaded with Ho-166. The amount and distribution of residual activity was assessed by dose calibrator measurements and SPECT imaging. For 8 HSD and 5 RE procedures, the dynamic of the microsphere flow were assessed. For HSD procedures, different injection methods were evaluated. Results:The mean residual activities for HSD and RE procedures were 20.5 +/-9.7% (range 7.2-44.1%) and 4.8 +/-1.2% (range 3.5-6.9%), respectively. HSD residual activity could be decreased significantly with injections methods similar to RE procedures, from 31.2 +/-9.6% to 17.7 +/-6.9% and 15.0 +/-6.0% (p=0.005). Main predilection sites of residual microspheres were the 3-way stopcock (HSD) and the outflow needle connector (RE). During RE procedures, >80% of the injected activity is transferred during the first three injection cycles.Conclusion: After treatment procedures with PLLA microspheres, mean residual activity in the delivery set is reproducibly low and between reported values for glass and resin microspheres. The majority of microspheres is transferred to the patient during the second and third injection cycle. An estimated residual waste of 3%-4% may be included in the treatment activity calculation. For planning procedures, a modified injection technique should be used to avoid high residual activities.

show abstract

“…It has been argued that the different radioembolization devices (e.g., resin or glass) result in differences in microdistribution and, consequently, in the absorbed dose needed for tumor response and toxicity (3). 166 Ho-microspheres are positioned between resin and glass microspheres with respect to the number of injected particles and particle size (19). On the basis of these data, we expect the apparent radiosensitivity of 166 Ho-microspheres to lie in between as well.…”

Section: Discussionmentioning

confidence: 90%

First Evidence for a Dose–Response Relationship in Patients Treated with ¹⁶⁶Ho Radioembolization: A Prospective Study

et al. 2019

Self Cite

View full text Add to dashboard Cite

166 Ho-microspheres have recently been approved for clinical use for hepatic radioembolization in the European Union. The aim of this study was to investigate the absorbed dose-response relationship and its association with overall survival for 166 Ho radioembolization in patients with liver metastases. Methods: Patients treated in the HEPAR I and II studies who underwent an 18 F-FDG PET/CT scan at baseline, a posttreatment 166 Ho SPECT/CT scan, and another 18 F-FDG PET/CT scan at the 3-mo follow-up were included for analysis. The posttreatment 166 Ho-microsphere activity distributions were estimated with quantitative SPECT/ CT reconstructions using a quantitative Monte Carlo-based method. The response of each tumor was based on the change in total lesion glycolysis (TLG) between baseline and follow-up and was placed into 1 of 4 categories, according to the PERCIST criteria, ranging from complete response to progressive disease. Patient-level response was grouped according to the average change in TLG per patient. The absorbed dose-response relationship was assessed using a linear mixed model to account for correlation of tumors within patients. Median overall survival was compared between patients with and without a metabolic liver response, using a log-rank test. Results: Thirty-six patients with a total of 98 tumors were included. The relation between tumor-absorbed dose and both tumor-level and patient-level response was explored. At a tumor level, a significant difference in geometric mean absorbed dose was found between complete response (232 Gy; 95% confidence interval [CI], 178-303 Gy; n 5 32) and stable disease (147 Gy; 95% CI, 113-191 Gy; n 5 28) (P 5 0.01) and between complete response and progressive disease (117 Gy; 95% CI, 87-159 Gy; n 5 21) (P 5 0.0008). This constitutes a robust absorbed dose-response relationship. At a patient level, a significant difference was found between patients with complete or partial response (210 Gy; 95% CI, 161-274 Gy; n 5 13) and patients with progressive disease (116 Gy; 95% CI, 81-165 Gy; n 5 9) (P 5 0.01). Patients were subsequently grouped according to their average change in TLG. Patients with an objective response (complete or partial) exhibited a significantly higher overall survival than nonresponding patients (stable or progressive disease) (median, 19 mo vs. 7.5 mo; log-rank, P 5 0.01). Conclusion: These results confirm a significant absorbed dose-response relationship in 166 Ho radioembolization. Treatment response is associated with a higher overall survival.

show abstract

Holmium-166 Microsphere Radioembolization of Hepatic Malignancies

Cited by 70 publications

References 25 publications

Current outlook on radionuclide delivery systems: from design consideration to translation into clinics

Current outlook on radionuclide delivery systems: from design consideration to translation into clinics

Radioembolisation with Holmium-166 Polylactic Acid Microspheres: Distribution of Residual Activity and Flow Dynamics During Planning and Treatment Procedures

First Evidence for a Dose–Response Relationship in Patients Treated with ¹⁶⁶Ho Radioembolization: A Prospective Study

Contact Info

Product

Resources

About

Holmium-166 Microsphere Radioembolization of Hepatic Malignancies

Cited by 70 publications

References 25 publications

Current outlook on radionuclide delivery systems: from design consideration to translation into clinics

Current outlook on radionuclide delivery systems: from design consideration to translation into clinics

Radioembolisation with Holmium-166 Polylactic Acid Microspheres: Distribution of Residual Activity and Flow Dynamics During Planning and Treatment Procedures

First Evidence for a Dose–Response Relationship in Patients Treated with 166Ho Radioembolization: A Prospective Study

Contact Info

Product

Resources

About

First Evidence for a Dose–Response Relationship in Patients Treated with ¹⁶⁶Ho Radioembolization: A Prospective Study