Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular carcinoma

Sangro, Bruno; Bilbao, J.I.; Boan, Jose; Martínez-Cuesta, Antonio; Benito, Alberto; Rodríguez, Javier Jacob; Panizo, Ángel; Gil, Belen; Iñarrairaegui, Mercedes; Herrero, Ignacio; Quiroga, Jorge; Prieto, Jesús

doi:10.1016/j.ijrobp.2006.05.065

Cited by 198 publications

(136 citation statements)

References 24 publications

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“…The safe liver radiation absorbed dose estimates reported using noncompartmental MIRD macrodosimetry clearly overestimate the radiation tolerance of liver tissue (25). Significant liver toxicity, particularly in high-risk patient populations, could occur at doses selected on the basis of empiric and nondosimetric guidance (9,26). The deductions drawn on the basis of this reported structural dosimetry study are subject to the limitations of the lobular model design.…”

Section: Discussionmentioning

confidence: 81%

Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Güleç¹,

Sztejnberg²,

Siegel³

et al. 2010

J Nucl Med

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Selective internal radiation treatment (SIRT) via intrahepatic arterial administration of 90 Y microspheres is an effective therapeutic modality. The conventional and generally applied MIRD schema is based on the premise that the distribution of microspheres in the liver parenchyma is uniform. In reality, however, the distribution of the microspheres follows a distinct pattern, requiring that a model be developed to more appropriately estimate radiation absorbed doses to the different structural/functional elements of the hepatic microanatomy. Methods: A systematic investigation was performed encompassing a conventional average absorbed dose assessment, a compartmental macrodosimetric approach that accounts for the anticipated higher tumor-to-normal liver activity concentration ratio, dose point-kernel convolution-derived estimates, and Monte Carlo dose estimates employing a spherical and 3-dimensional hexagonal liver model, including various subunits of the hepatic anatomy, down to the micrometer level. Results: Detailed specifics of the radiation dose deposition of 90 Y microspheres demonstrated a rapid decrease in absorbed dose in and around the portal tracts where the microspheres are deposited. The model also demonstrated that the hepatocellular parenchymal and central vein doses could be at significant levels because of a cross-fire effect. Conclusion: The reported microstructural dosimetry models can help in the detailed assessment of the dose distributions in the hepatic functional subunits and in relating these doses to their effects. These models have also revealed that the there is a consistent relationship between the average liver dose as calculated by MIRD macrodosimetry and the structural dosimetry estimates in support of the clinical utility of the MIRD methodology. This relationship could be used to more realistically assess patterns of hepatic toxicity associated with the 90 Y SIRT treatment.

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Section: Discussionmentioning

confidence: 81%

Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Güleç¹,

Sztejnberg²,

Siegel³

et al. 2010

J Nucl Med

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“…SIR-Spheres ® (Sirtex Medical Europe, Bonn, Germany) are resin microspheres of around 35 microns in diameter loaded with yttrium-90, a beta-emitter with a halflife of about 64 h and an average penetration in tissues of around 2.4 mm. Microspheres are embolized into the hepatic artery and they become lodged within the microvasculature of the tumor where they emit the beta radiation (1). SIR-Spheres allow, on average, 200-300 Gy to be delivered to liver tumors irrespective of their number, size, and location (2).…”

Section: Introductionmentioning

confidence: 99%

Gastroduodenal Injury After Radioembolization of Hepatic Tumors

et al. 2007

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BACKGROUNDRadioembolization is a new tool for the treatment of hepatic tumors that consists in the injection of biocompatible microspheres carrying radioisotopes into the hepatic artery or its branches. METHODSWe have performed radioembolization in 78 patients with hepatic tumors using resinbased microspheres loaded with yttrium-90. All patients were previously evaluated to minimize the risk of hazardous irradiation to nontarget organs and to obtain the data needed for dose calculation. RESULTSWe report a complication found in three cases (3.8%) that consists of abdominal pain resulting from gastroduodenal lesions and that had a chronic, insidious course. Microscopically, microspheres were detected in the specimens obtained from all affected gastric areas. Since these gastroduodenal lesions do not appear when nonradiating microspheres are injected in animals, lesions are likely to be due to radiation and not to an ischemic effect of vascular occlusion by spheres. CONCLUSIONSWe believe that a pretreatment evaluation that includes a more thorough scrutiny of the hepatic vascularization in search of small collaterals connecting to the gastroduodenal tract can help prevent this awkward complication.

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“…In recent years, 90 Y radioembolization has been investigated in numerous cancer types and has shown promising results in patients with hcc [26][27][28][29][30][31][32][33][34][35][36] . The 2008 meta-analysis of 90 Y studies by Vente et al 37 showed a 78% response from treatment with glass microspheres in patients with hcc.…”

Section: Y Therapymentioning

confidence: 99%

Combined Sorafenib and Yttrium-90 Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma

et al. 2016

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Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular carcinoma

Cited by 198 publications

References 24 publications

Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Gastroduodenal Injury After Radioembolization of Hepatic Tumors

Combined Sorafenib and Yttrium-90 Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma

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Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular carcinoma

Cited by 198 publications

References 24 publications

Hepatic Structural Dosimetry in 90Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Hepatic Structural Dosimetry in 90Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Gastroduodenal Injury After Radioembolization of Hepatic Tumors

Combined Sorafenib and Yttrium-90 Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma

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Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy