PET-CT post therapy dosimetry in radioembolization with resin 90Y microspheres: Comparison with pre-treatment SPECT-CT 99mTc-MAA results

Richetta, E.; Pasquino, Massimo; Poli, Matteo Umberto; Cutaia, C.; Valero, Chiara; Tabone, M.; Paradisi, Benedetta Peiretti; Pacilio, Massimiliano; Pellerito, R.; Stasi, M.

doi:10.1016/j.ejmp.2019.05.025

Cited by 39 publications

(48 citation statements)

References 12 publications

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“…Previous work has shown comparable results in terms of better MAA dose predictions for NL dose as compared to tumor dose, 20,30,34 and similar performance of the PM model for NL voxel dose calculations. 6 The specific quantitative results on NL dosimetry in this study are very encouraging for the use of MAA-SPECT/CT in predicting NL doses after 90 Y SIRT.…”

Section: Discussionmentioning

confidence: 71%

“…Nevertheless, large deviations in catheter tip location between MAA and 90 Y procedures naturally lead to changes in the intensity and distribution of particles in treatment perfused volumes (whole liver, lobar, segmental). 16,18,30 We therefore concluded that such cases would not be included in our analysis of predicting 90 Y voxel dosimetry using MAA.…”

Section: D Congruence Between Maa and 90 Y Distributionsmentioning

confidence: 99%

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Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

et al. 2020

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Purpose: 99m Tc-MAA-SPECT/CT may be used in 90 Y-glass microsphere radioembolization treatment planning to assess perfused liver volumes and absorbed dose distributions. The partition model (PM) offers a more detailed planning dosimetry option beyond the single-compartment model more traditionally used in 90 Y radioembolization. As 90 Y radioembolization treatments shift toward activities and doses that aim to achieve tumor control, accurate and reliable treatment planning dosimetry for both tumors and normal liver (NL) becomes more critical. In this work, we explore the accuracy and precision of 90 Y dosimetry predictions from pretherapy 99m Tc-MAA and PM. Methods: Both PM and voxel dosimetry models were used to calculate tumor and NL mean doses using both planning 99m Tc-MAA and verification 90 Y-SPECT/CT in this retrospective analysis of hepatocellular carcinoma cases treated with glass microspheres (NCT01900002, n = 32). Linear regression models were developed at first access, and then later correct, the estimates by (a) 99m Tc-MAA for 90 Y voxel dosimetry and (b) 99m Tc-MAA PM for voxel dosimetry, separately for both tumors and NL. Bland-Altman analysis was then used to evaluate the accuracy and precision of the regression model predictions with the mean bias and 95% prediction intervals (PI, AE1.96σ). Two categories of cases were stratified (catheter matched vs catheter unmatched) by establishing the level of 99m Tc-MAA and 90 Y catheter position alignment. Only catheter-matched cases were included in the 99m Tc-MAA vs 90 Y voxel dosimetry comparison, while all cases were used to compare dosimetry models (PM vs voxel). Results: Half (16/32) of cases were deemed catheter matched. 99m Tc-MAA could reliably predict NL doses in catheter-matched cases after application of the linear model, with mean bias (PI) of −1% (AE31%). PM was equivalent to voxel dosimetry for NL doses with mean bias (PI) of 0% (AE1%). Even among catheter-matched cases, 99m Tc-MAA planning for 90 Y tumor voxel doses was poor, overestimating dose by an average of nearly 40%. Upon application of the linear model, 99m Tc-MAA predictions for 90 Y tumor voxel dose were only minimally biased (−4%) but possessed very large PI (AE104%). PM predictions for tumor voxel dose using the linear model also showed small bias (−6%) but maintained similarly high PI of AE90%. Cases with tumors representing a large majority (>80%) of the total tumor volume demonstrated the best scenarios for 99m Tc-MAA and PM tumor dose predictions, with mean biases (PI) of −3% (AE53%) and −4% (AE21%), respectively. Conclusion: The unconditional use of 99m Tc-MAA to predict 90 Y dosimetry across all cases is not recommended due to: (a) demonstrated the risk of unmatched catheter positions between procedures, and (b) large bias and uncertainty in 99m Tc-MAA predictions in cases with matched catheter locations. However, NL voxel dose predictions with 99m Tc-MAA are clinically viable and either PM or voxel dosimetry can be used to produce equivalent predictions. Both 99m Tc-MAA a...

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Section: Discussionmentioning

confidence: 71%

Section: D Congruence Between Maa and 90 Y Distributionsmentioning

confidence: 99%

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

et al. 2020

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“…One of the main contributors to over-or underestimation of the predicted and measured doses, is the method used for VOI definition. In many studies, fixed or tumor-specific 99m Tc-MAA thresholding is used for TV definition [6,7]. By thresholding the activity map, one considers that tumors correspond to high uptake regions, while the low-activity areas correspond to the non-tumoral liver compartment, which can be questionable if some fraction of the tumor has low uptake (which results in an overestimation of the tumor dose) or if some part of the non-tumoral tissue has a high activity accumulation (underestimation of non-tumoral liver dose) in pre-and/or post-treatment session.…”

Section: Introductionmentioning

confidence: 99%

Quantitative comparison of pre-treatment predictive and post-treatment measured dosimetry for selective internal radiation therapy using cone-beam CT for tumor and liver perfusion territory definition

Rangraz

Tang

Laeken

et al. 2020

Preprint

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Background: Selective internal radiation therapy (SIRT) is a promising treatment for unresectable hepatic malignancies. Predictive dose calculation based on a simulation using technetium-99m-labeled macro-aggregated albumin ( 99m Tc-MAA) before the treatment is considered as a potential tool for patient-specific treatment planning. Post-treatment dose measurement is mainly performed to confirm the planned absorbed dose to the tumor and non-tumor liver volumes. This study compared the predicted and measured absorbed dose distributions. Methods: Thirty-one patients (67 tumors) treated by SIRT with resin microspheres were analyzed. Predicted and delivered absorbed dose was calculated using 99m Tc-MAA-SPECT and 90 Y TOF-PET imaging. The voxel-level dose distribution was derived using the local deposition model. Liver perfusion territories and tumors have been delineated on contrast-enhanced CBCT images, which have been acquired during the 99m Tc-MAA work-up. Several dose-volume histogram (DVH) parameters together with the mean dose for liver perfusion territories, non-tumoral and tumoral compartments were evaluated. Results: A strong correlation between the predicted and measured mean dose for non-tumoral volume was observed (r=0.937). The ratio of measured and predicted mean dose to this volume has a first, second, and third quartile range of 0.83, 1.05, and 1.25. The difference between the measured and predicted mean dose did not exceed 11 Gy. The correlation between predicted and measured mean dose to the tumor was moderate (r=0.623) with a mean difference of -9.3 Gy. The ratio of measured and predicted tumor mean dose had a median of 1.01 with the first and third quartile ranges of 0.58 and 1.59, respectively. Our results suggest that 99m Tc-MAA-based dosimetry could predict under or over dosing of the non-tumoral liver parenchyma for almost all cases. For more than two-thirds of the tumors, a predictive absorbed dose correctly indicated either good tumor dose coverage or under-dosing of the tumor. Conclusion: Our results highlight the predictive value of 99m Tc-MAA-based dose estimation to predict non-tumor liver irradiation, which can be applied to prescribe an optimized activity aiming at avoiding liver toxicity. Predictive dosimetry is also moderately reliable to estimate the tumor absorbed dose.

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“…According to all these studies, the situation is definitely better for normal liver, with a median (range) ratio of 0.88 (0.56, 1.00) for glass, and 0.86 (0.58, 1.35) for resin spheres according to Gnesin et al [13], while bias and (95% C.I.) of − 1.4 Gy (− 16 Gy, 13 Gy) for HCC with glass spheres, with resin spheres 0.2 Gy (− 6 Gy, 6 Gy) for HCC, and − 1.4 Gy (− 12 Gy ; 9 Gy) for metastases according to Jadoul et al [14], about 0 Gy (− 12 Gy, + 11 Gy) for Kafrouni et al [15], and 1 Gy (− 7 Gy, 9 Gy) for Richetta et al [16].…”

mentioning

confidence: 95%

“…Kafrouni et al [15], with glass spheres on 24 patients, obtained lower but still important C.I., of about (− 50 Gy, + 40 Gy) for lesions. Richetta et al [16] with 10 patients treated with resin spheres obtained − 6 Gy (− 80 Gy, 68 Gy).…”

mentioning

confidence: 98%

166Ho microsphere scout dose for more accurate radioembolization treatment planning

Chiesa

Maccauro

2019

Eur J Nucl Med Mol Imaging

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PET-CT post therapy dosimetry in radioembolization with resin 90Y microspheres: Comparison with pre-treatment SPECT-CT 99mTc-MAA results

Cited by 39 publications

References 12 publications

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

Quantitative comparison of pre-treatment predictive and post-treatment measured dosimetry for selective internal radiation therapy using cone-beam CT for tumor and liver perfusion territory definition

166Ho microsphere scout dose for more accurate radioembolization treatment planning

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PET-CT post therapy dosimetry in radioembolization with resin 90Y microspheres: Comparison with pre-treatment SPECT-CT 99mTc-MAA results

Cited by 39 publications

References 12 publications

Planning dosimetry for 90Y radioembolization with glass microspheres: Evaluating the fidelity of 99mTc‐MAA and partition model predictions

Planning dosimetry for 90Y radioembolization with glass microspheres: Evaluating the fidelity of 99mTc‐MAA and partition model predictions

Quantitative comparison of pre-treatment predictive and post-treatment measured dosimetry for selective internal radiation therapy using cone-beam CT for tumor and liver perfusion territory definition

166Ho microsphere scout dose for more accurate radioembolization treatment planning

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Product

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Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions