Radioembolization of Hepatocellular Carcinoma with 90Y Glass Microspheres: No Advantage of Voxel Dosimetry with Respect to Mean Dose in Dose–Response Analysis with Two Radiological Methods

Romanò, Chiara; Mazzaglia, S.; Maccauro, Marco; Spreafico, Carlo; Gabutti, Alejandro; Maffi, Gabriele; Morosi, Carlo; Cascella, Tommaso; Mira, M.; Nile, M.C. De; Aliberti, Gianluca; Argiroffi, Giovanni; Fuoco, Valentina; Bhoori, Sherrie; Zanette, Consuelo; Marchianò, Alfonso; Seregni, Ettore; Mazzaferro, Vincenzo; Chiesa, Carlo

doi:10.3390/cancers14040959

Cited by 14 publications

(11 citation statements)

References 48 publications

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“…There are also some studies showing a signi cant correlation between absorbed dose metrics calculated from 90 Y-bSPECT and 90 Y-PET images (46), paving the way for the use of 90 Y-bSPECT to establish a robust dose-response relationship. On the other hand, the use of voxel-dosimetry also remains a subject of discussion, as some authors demonstrate its validity in TARE (32), while others (5) show that it does not improve over MIRD approaches. those used in this study, showed equivalent signal-to-background ratios (50).…”

Section: Discussionmentioning

confidence: 99%

“…As recommended (34) we avoided using threshold-based tumor segmentation on SPECT images as it often does not represent true anatomical extent due to heterogeneous microsphere distribution. In large lesions with a visible necrotic core in CT, the core was excluded from the lesion volume (5). Small tumors with a volume under 4 ml, considered equivalent of a 2-cm-diameter spherical lesions, were excluded from the analysis, as recommended (27,35).…”

Section: Work Ow Image Segmentationmentioning

confidence: 99%

“…Therefore, an accurate treatment planning is required to ensure the safety and e cacy of the therapy by evaluation of the delivered dose to tumoral and non-tumoral liver tissue as well as extra-hepatic regions (4,5). Treatment planning based on patient-speci c dosimetry is predicted to signi cantly improve clinical e cacy and cost-effectiveness and is therefore expected to be used in future trials of targeted internal radiation therapy (6, 7).…”

Section: Introductionmentioning

confidence: 99%

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

Riveira-Martin

Akhavanallaf

Mansouri

et al. 2023

Preprint

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Work Ow Image Segmentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Riveira-Martin

Akhavanallaf

Mansouri

et al. 2023

Preprint

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“…This issue has been empirically solved in several studies by fitting together N and α in Eq. 6 , which resulted in tenfold lower radiosensitivity and unrealistic tumor cells number ranging from 0.4 [ 33 ] to 3.4 [ 4 , 34 ]. In fact, using the tumor cell number corresponding to the mean tumor volume (36 ml) and a standard deviation of 30% around the in vivo HCC cell radiosensitivity between patients is sufficient to rightly predict the observed TCP shape (Fig.…”

Section: Discussionmentioning

confidence: 99%

TCP post-radioembolization and TCP post-EBRT in HCC are similar and can be predicted using the in vitro radiosensitivity

et al. 2022

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Background Tumor equivalent uniform dose (EUD) is proposed as a predictor of patient outcome after liver radioembolization (RE) of hepatocellular carcinoma (HCC) and can be evaluated with 90Y-TOF-PET. The aim is to evaluate the correlation between PET-based tumors EUD and the clinical response evaluated with dual molecular tracer (11C-acetate and 18F-FDG) PET/CT post-RE. Methods 34 HCC tumors in 22 patients were prospectively evaluated. The metabolic response was characterized by the total lesion metabolism variation (ΔTLM) between baseline and follow-up. This response allowed to compute a tumor control probability (TCP) as a function of the tumor EUD. Results The absorbed dose response correlation was highly significant (R = 0.72, P < 0.001). With an absorbed dose threshold of 40 Gy, the metabolic response was strongly different in both groups (median response 35% versus 100%, P < 0.001). Post-RE TCP as a function of the EUD was very similar to that observed in external beam radiation therapy (EBRT), with TCP values equal to 0.5 and 0.95 for a EUD of 51 Gy and 100 Gy, respectively. The TCP was perfectly predicted by the Poisson model assuming an inter tumor radiosensitivity variation of 30% around the HCC cell in vitro value. Conclusions EUD-based 90Y TOF-PET/CT predicts the metabolic response post-RE in HCC assessed using dual molecular PET tracers and provides a similar TCP curve to that observed in EBRT. In vivo and in vitro HCC radiosensitivities are similar. Both TCPs show that a EUD of 100 Gy is needed to control HCC for the three devices (resin spheres, glass spheres, EBRT). Observed absorbed doses achieving this 100 Gy-EUD ranged from 190 to 1800 Gy!

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“…Two dosimetric factors predict SIRT efficacy: a high tumor absorbed dose and homogeneous distribution of the microspheres in the tumor [ 3 , 11 , 56 ]. The tumor response rate will proportionally increase with the absorbed dose, reaching a plateau of complete response for the highest doses [ 50 , 55 , 56 , 57 , 58 ]. From a dosimetric point of view, the main limitation of SIRT effectiveness is the heterogeneity of the microsphere distribution in the tumor [ 3 ].…”

Section: Dosimetry Considerations Using Maa Spect/ctmentioning

confidence: 99%

A Theranostic Approach in SIRT: Value of Pre-Therapy Imaging in Treatment Planning

Dabadie

Walrand

Lhommel

et al. 2022

JCM

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Selective internal radiation therapy (SIRT) is one of the treatment options for liver tumors. Microspheres labelled with a therapeutic radionuclide (90Y or 166Ho) are injected into the liver artery feeding the tumor(s), usually achieving a high tumor absorbed dose and a high tumor control rate. This treatment adopts a theranostic approach with a mandatory simulation phase, using a surrogate to radioactive microspheres (99mTc-macroaggregated albumin, MAA) or a scout dose of 166Ho microspheres, imaged by SPECT/CT. This pre-therapy imaging aims to evaluate the tumor targeting and detect potential contraindications to SIRT, i.e., digestive extrahepatic uptake or excessive lung shunt. Moreover, the absorbed doses to the tumor(s) and the healthy liver can be estimated and used for planning the therapeutic activity for SIRT optimization. The aim of this review is to evaluate the accuracy of this theranostic approach using pre-therapy imaging for simulating the biodistribution of the microspheres. This review synthesizes the recent publications demonstrating the advantages and limitations of pre-therapy imaging in SIRT, particularly for activity planning.

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Radioembolization of Hepatocellular Carcinoma with 90Y Glass Microspheres: No Advantage of Voxel Dosimetry with Respect to Mean Dose in Dose–Response Analysis with Two Radiological Methods

Cited by 14 publications

References 48 publications

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

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

TCP post-radioembolization and TCP post-EBRT in HCC are similar and can be predicted using the in vitro radiosensitivity

A Theranostic Approach in SIRT: Value of Pre-Therapy Imaging in Treatment Planning

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