Radioembolization of hepatocarcinoma with 90Y glass microspheres: development of an individualized treatment planning strategy based on dosimetry and radiobiology

Chiesa, Carlo; Mira, M.; Maccauro, Marco; Spreafico, Carlo; Romito, Raffaele; Morosi, Carlo; Camerini, Tiziana; Carrara, M.; Pellizzari, S; Negri, A.; Aliberti, Gianluca; Sposito, Carlo; Bhoori, Sherrie; Facciorusso, Antonio; Civelli, Enrico; Lanocita, Rodolfo; Padovano, Barbara; Migliorisi, M.; Nile, M.C. De; Seregni, Ettore; Marchianò, Alfonso; Crippa, Flavio; Mazzaferro, Vincenzo

doi:10.1007/s00259-015-3068-8

Cited by 133 publications

(190 citation statements)

References 42 publications

Supporting

Mentioning

173

Contrasting

Unclassified

Order By: Relevance

“…In some works, lesions smaller than 2 cm were not evaluated, considering this size a limiting value to perform accurate dosimetry. 16,58 Conversely for HP, ∆D(%) values are distributed around zero, but the data trend is less clear. The discrepancies can be mitigated by correction for attenuation and scatter.…”

mentioning

confidence: 98%

“…Some discrepancies between microspheres and MAA distributions were observed in some patients; [11][12][13][14][15] however, assuming that they are identical provides advantages largely overcoming their limitations. 16 An optimal treatment planning should include 3D voxelbased dosimetry, accounting for nonuniform absorbed dose distributions when studying dose-effect correlations. 9,[17][18][19][20][21][22][23] Image-based 3D dosimetry can be performed in several ways: direct Monte Carlo (MC) simulation, which is considered the gold standard; 9,[24][25][26][27][28][29][30] convolution calculations by voxel S-values, reliable in nearly uniform density tissue; 19,[31][32][33][34][35][36] local energy deposition method.…”

Section: Introductionmentioning

confidence: 99%

“…In a recent study, the levels of dose-response correlation for lesions obtained with EUD and EUBED were rarely higher than that of the mean absorbed dose, even with an optimized reconstruction protocol. 16 In other therapeutic contexts, greater efforts for more sophisticated image corrections in 3D dosimetry gave better correlation results. 59 Patient breathing has been hitherto scarcely considered for dosimetry in TARE, but image correction would be needed, above all for lesions close to liver dome.…”

mentioning

confidence: 99%

“…16,49,64 Several additional issues affecting dosimetric uncertainty should be addressed in the clinical context. For instance, it is reminded that International Guidelines recommend that imaging begins within at least 60 min of administration and not to exceed 4 h, 9 due to: stability over time of the albumin 99m Tc labeling, and clearance from the lungs.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Impact of SPECT corrections on 3D‐dosimetry for liver transarterial radioembolization using the patient relative calibration methodology

et al. 2016

View full text Add to dashboard Cite

Purpose: Many centers aim to plan liver transarterial radioembolization (TARE) with dosimetry, even without CT-based attenuation correction (AC), or with unoptimized scatter correction (SC) methods. This work investigates the impact of presence vs absence of such corrections, and limited spatial resolution, on 3D dosimetry for TARE. Methods: Three voxelized phantoms were derived from CT images of real patients with different body sizes. Simulations of 99m Tc-SPECT projections were performed with the SIMIND code, assuming three activity distributions in the liver: uniform, inside a "liver's segment," or distributing multiple uptaking nodules ("nonuniform liver"), with a tumoral liver/healthy parenchyma ratio of 5:1. Projection data were reconstructed by a commercial workstation, with OSEM protocol not specifically optimized for dosimetry (spatial resolution of 12.6 mm), with/without SC (optimized, or with parameters predefined by the manufacturer; dual energy window), and with/without AC. Activity in voxels was calculated by a relative calibration, assuming identical microspheres and 99m Tc-SPECT counts spatial distribution. 3D dose distributions were calculated by convolution with lesions and healthy parenchyma from different reconstructions were compared with those obtained from the reference biodistribution (the "gold standard," GS), assessing differences for D95%, D70%, and D50% (i.e., minimum value of the absorbed dose to a percentage of the irradiated volume). γ tool analysis with tolerance of 3%/13 mm was used to evaluate the agreement between GS and simulated cases. The influence of deep-breathing was studied, blurring the reference biodistributions with a 3D anisotropic gaussian kernel, and performing the simulations once again. Results: Differences of the dosimetric indicators were noticeable in some cases, always negative for lesions and distributed around zero for parenchyma. Application of AC and SC reduced systematically the differences for lesions by 5%-14% for a liver segment, and by 7%-12% for a nonuniform liver. For parenchyma, the data trend was less clear, but the overall range of variability passed from −10%/40% for a liver segment, and −10%/20% for a nonuniform liver, to −13%/6% in both cases. Applying AC, SC with preset parameters gave similar results to optimized SC, as confirmed by γ tool analysis. Moreover, γ analysis confirmed that solely AC and SC are not sufficient to obtain accurate 3D dose distribution. With breathing, the accuracy worsened severely for all dosimetric indicators, above all for lesions: with AC and optimized SC, −38%/−13% in liver's segment, −61%/−40% in the nonuniform liver. For parenchyma, D50% resulted always less sensitive to breathing and sub-optimal correction methods (difference overall range: −7%/13%). Conclusions: Reconstruction protocol optimization, AC, SC, PVE and respiratory motion corrections should be implemented to obtain the best possible dosimetric accuracy. On the other side, thanks to the relative calibration, D50% inaccuracy for the healthy paren...

show abstract

mentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Impact of SPECT corrections on 3D‐dosimetry for liver transarterial radioembolization using the patient relative calibration methodology

et al. 2016

View full text Add to dashboard Cite

show abstract

“…By experience from Milan group [4], favourable cases (high predicted tumour dose close to 500 Gy, small tumours, good perfusion of PVT, no lung shunt) can be administered with curative intent close to the 75 Gy whole parenchyma limit, accepting a 15 % risk of liver decompensation. In unfavourable cases (poor tumour perfusion, large tumours, tumours with hypoperfused regions, poor PVT perfusion, PVT IIIb or IV), dose reduction appears safer to reduce the administered activity with respect to the 75 Gy limit, reducing the LD risk with the goal of a palliative treatment.…”

mentioning

confidence: 99%

The impact of clinical factor on dosimetry in radioembolisation

Maccauro

Salem²

2016

Clin Transl Imaging

Self Cite

View full text Add to dashboard Cite

Primary liver cancer represents the fifth most common cancer in the world and the third most common cause of cancer mortality. Furthermore liver is the most site of metastases and up to 25 % of patients with oncological malignancies develop hepatic lesions, especially from colorectal, pancreatic and breast cancer. Only a minority of patients, less than 10 %, with hepatocellular carcinoma (HCC) or liver metastases are candidates for radical treatment due to stage of presentation, hepatic disfunction or co-morbidities. Local treatment, as radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are alternative treatment in patients with unresectable disease.Radioembolisation is a well-known and described therapeutic procedure based on intra-arterial injection of micro-spheres of glass or resin loaded with the radioactive isotope Yttrium-90. This is a pure beta emitter with the maximal beta energy among the nuclide for therapy of 2280 keV, corresponding to a maximum range of 11 mm in soft tissues and a physical half-life of 64.2 h. TARE is an emerging and promising approach of nuclear medicine therapy. It takes advantage of the predominant arterial vascularisation typical of focal liver lesions and of the small size of the spheres (around 25 microns). Indeed micro-particles carried by the arterial flow remain trapped in the arterioles and capillaries of the tumour and release their energy there. The final result is a highly targeted and selective intra-arterial radiotherapy.The role and the clinical impact of TARE is under investigation in phase III randomized international multicenter trials [NCT0095930; NCT01482442; NCT01135056; NCT0 1126645; NCT01887717; NCT01556490; NCT00867750] in order to define its proper allocation as standard of care.To accomplish this selective and effective therapy, it is mandatory to simulate the treatment through the study of the biodistribution of particles similar to the therapeutic microspheres.99m Tc-macroaggregated albumin (MAA) are administered for the simulation, and planar scintigraphy and abdominal SPECT/CT scan are performed. This diagnostic procedure helps to exclude the presence of extrahepatic gastrointestinal shunts (absolute contraindication to the treatment), to quantify the lung shunting percentage, and permits pre-treatment dose calculation (3D treatment planning).The success of this multidisciplinary therapy is based on several elements. It primarily depends on the capability to perform selective microsphere injections into tumors, translating to improved perfusion and higher tumor dose. The selective injection also allows a reduction of liver toxicity. The ideal situation is when the treatment covers the entire arterial circulation of the cancer, so as to leave no part excluded, preserving as much of the cancer-free parenchyma as possible. For this reason, it is of fundamental importance to identify the best point for the infusion of micro-spheres during the angiographic workup. To maximize the tumor dose reduc...

show abstract

SPECT/CT image‐based dosimetry for Yttrium‐90 radionuclide therapy: Application to treatment response

Potrebko

Shridhar

Biagioli

et al. 2018

J Applied Clin Med Phys

View full text Add to dashboard Cite

This work demonstrates the efficacy of voxel‐based 90Y microsphere dosimetry utilizing post‐therapy SPECT/CT imaging and applies it to the prediction of treatment response for the management of patients with hepatocellular carcinoma (HCC). A 90Y microsphere dosimetry navigator (RapidSphere) within a commercial platform (Velocity, Varian Medical Systems) was demonstrated for three microsphere cases that were imaged using optimized bremsstrahlung SPECT/CT. For each case, the 90Y SPECT/CT was registered to follow‐up diagnostic MR/CT using deformable image registration. The voxel‐based dose distribution was computed using the local deposition method with known injected activity. The system allowed the visualization of the isodose distributions on any of the registered image datasets and the calculation of dose‐volume histograms (DVHs). The dosimetric analysis illustrated high local doses that are characteristic of blood‐flow directed brachytherapy. In the first case, the HCC mass demonstrated a complete response to treatment indicated by a necrotic region in follow‐up MR imaging. This result was dosimetrically predicted since the gross tumor volume (GTV) was well covered by the prescription isodose volume (V150 Gy = 85%). The second case illustrated a partial response to treatment which was characterized by incomplete necrosis of an HCC mass and a remaining area of solid enhancement in follow‐up MR imaging. This result was predicted by dosimetric analysis because the GTV demonstrated incomplete coverage by the prescription isodose volume (V470 Gy = 18%). The third case demonstrated extrahepatic activity. The dosimetry indicated that the prescription (125 Gy) isodose region extended outside of the liver into the duodenum (178 Gy maximum dose). This was predictive of toxicity as the patient later developed a duodenal ulcer. The ability to predict outcomes and complications using deformable image registration, calculated isodose distributions, and DVHs, points to the clinical utility of patient‐specific dose calculations for 90Y radioembolization treatment planning.

show abstract

Radioembolization of hepatocarcinoma with 90Y glass microspheres: development of an individualized treatment planning strategy based on dosimetry and radiobiology

Abstract: A dosimetric treatment planning criterion for Child A patients without complete obstruction of the portal vein was developed.

Cited by 133 publications

References 42 publications

Impact of SPECT corrections on 3D‐dosimetry for liver transarterial radioembolization using the patient relative calibration methodology

Impact of SPECT corrections on 3D‐dosimetry for liver transarterial radioembolization using the patient relative calibration methodology

The impact of clinical factor on dosimetry in radioembolisation

SPECT/CT image‐based dosimetry for Yttrium‐90 radionuclide therapy: Application to treatment response

Contact Info

Product

Resources

About