Predictive Value of 99mTc-MAA-based Dosimetry in Personalized 90Y-SIRT planning for Liver Malignancies

Abstract

Background Selective internal radiation therapy (SIRT) with 90Y radioembolization aims to selectively irradiate liver tumors by administering radioactive microspheres under the theragnostic assumption that the pre-therapy injection of 99mTc labeled macro-aggregated albumin (99mTc-MAA) provides an estimation of the 90Y microspheres biodistribution, which is not always the case. Due to the growing interest in theragnostic dosimetry for personalized radionuclide therapy, a robust relationship between the delivered and pre-treatment radiation doses is required. In this work, we aim to investigate the predictive value of absorbed dose metrics calculated from 99mTc-MAA (simulation) compared to those obtained from 90Y post-therapy SPECT/CT.Results A total of 79 patients were analyzed. Pre- and post-therapy 3D-voxel dosimetry was calculated on 99mTc-MAA and 90Y SPECT/CT, respectively, based on Local Deposition Method (LDM). Mean absorbed dose, tumor-to-normal ratio, and dose distribution in terms of dose-volume histogram (DVH) metrics were obtained and compared for each volume of interest (VOIs). Mann-Whitney U-test and Pearson’s correlation coefficient was used to assess the correlation between both methods. The effect of the tumoral liver volume on the absorbed dose metrics was also investigated. Strong correlation was found between simulation and therapy mean absorbed doses for all VOIs, although simulation tended to overestimate tumor absorbed doses by 26%. DVH metrics showed good correlation too, but significant differences were found for several metrics, mostly on non-tumoral liver. It was observed that the tumoral liver volume does not significantly affect the differences between simulation and therapy absorbed dose metrics.Conclusion This study supports the strong correlation between absorbed dose metrics from simulation and therapy dosimetry based on 90Y SPECT/CT, highlighting the predictive ability of 99mTc-MAA, not only in terms of mean absorbed dose but also of the dose distribution.