Retrospective Voxel-Based Dosimetry for Assessing the Ability of the Body-Surface-Area Model to Predict Delivered Dose and Radioembolization Outcome

Kafrouni, Marilyne; Allimant, Carole; Fourcade, Marjolaine; Vauclin, Sébastien; Delicque, Julien; Ilonca, A.D.; Guiu, Boris; Manna, Federico; Molinari, Nicolas; Mariano‐Goulart, Denis; Bouallègue, Fayçal Ben

doi:10.2967/jnumed.117.202937

Cited by 36 publications

(26 citation statements)

References 24 publications

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“…However, pre-treatment activity planning based on 99m Tc-MAA lacks dosimetric accuracy and needs improvement in order to increase the clinical benefit of radioembolization treatment. A recent study by Kafrouni et al showed that body surface area (BSA) based activity planning (i.e., the "BSAmethod") often leads to under-dosing, most likely because it insufficiently corrects for the tumor-to-normal (T/N) uptake ratios [21]. Despite this limitation, the BSA-method currently is the most commonly used treatment planning method [22].…”

Section: Discussionmentioning

confidence: 99%

The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

Smits

Dassen

Prince

et al. 2019

Eur J Nucl Med Mol Imaging

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Purpose As an alternative to technetium-99m-macroaggregated albumin (99m Tc-MAA), a scout dose of holmium-166 (166 Ho) microspheres can be used prior to 166 Ho-radioembolization. The use of identical particles for pre-treatment and treatment procedures may improve the predictive value of pre-treatment analysis of distribution. The aim of this study was to analyze the agreement between 166 Ho-scout and 166 Ho-therapeutic dose in comparison with the agreement between 99m Tc-MAA and 166 Ho-therapeutic dose. Methods Two separate scout dose procedures were performed (99m Tc-MAA and 166 Ho-scout) before treatment in 53 patients. First, qualitative assessment was performed by two blinded nuclear medicine physicians who visually rated the agreement between the 99m Tc-MAA, 166 Ho-scout, and 166 Ho-therapeutic dose SPECT-scans (i.e., all performed in the same patient) on a 5-point scale. Second, agreement was measured quantitatively by delineating lesions and normal liver on FDG-PET/CT. These volumes of interest (VOIs) were co-registered to the SPECT/CT images. The predicted absorbed doses (based on 99m Tc-MAA and 166 Ho-scout) were compared with the actual absorbed dose on post-treatment SPECT. Results A total of 23 procedures (71 lesions, 22 patients) were included for analysis. In the qualitative analysis, 166 Ho-scout was superior with a median score of 4 vs. 2.5 for 99m Tc-MAA (p < 0.001). The quantitative analysis showed significantly narrower 95%-limits of agreement for 166 Ho-scout in comparison with 99m Tc-MAA when evaluating lesion absorbed dose (− 90.3 and 105.3 Gy vs. − 164.1 and 197.0 Gy, respectively). Evaluation of normal liver absorbed dose did not show difference in agreement between both scout doses and 166 Ho-therapeutic dose (− 2.9 and 5.5 Gy vs − 3.6 and 4.1 Gy for 99m Tc-MAA and 166 Ho-scout, respectively). Conclusions In this study, 166 Ho-scout was shown to have a superior predictive value for intrahepatic distribution in comparison with 99m Tc-MAA.

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Section: Discussionmentioning

confidence: 99%

The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

Smits

Dassen

Prince

et al. 2019

Eur J Nucl Med Mol Imaging

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“…It was in good agreement with the treated liver lobe or liver segment, when displayed with the corresponding CT and MR images as verified by an experienced nuclear medicine physician. The quantitative whole liver 99m Tc-MAA SPECT/CT was divided by the total administered 99m Tc activity and then scaled with the total administered 90 Y therapy activity within the treated liver volume VOI using an in-house developed MATLAB code (R2018b; The MathWorks, Inc. Natick, MA), similar to the normalization approach by Kafrouni et al [39]. Outside the VOI of the treated liver volume, the image contents were set to zero.…”

Section: Dosimetry Calculation 231 Generation Of Absorbed Dose Imagesmentioning

confidence: 99%

3D image-based dosimetry for Yttrium-90 radioembolization of hepatocellular carcinoma: Impact of imaging method on absorbed dose estimates

et al. 2020

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Background: To improve therapy outcome of Yttrium-90 selective internal radiation therapy (90 Y SIRT), patientspecific post-therapeutic dosimetry is required. For this purpose, various dosimetric approaches based on different available imaging data have been reported. The aim of this work was to compare post-therapeutic 3D absorbed dose images using Technetium-99m (99m Tc) MAA SPECT/CT, Yttrium-90 (90 Y) bremsstrahlung (BRS) SPECT/CT, and 90 Y PET/CT. Methods: Ten SIRTs of nine patients with unresectable hepatocellular carcinoma (HCC) were investigated. The 99m Tc SPECT/CT data, obtained from 99m Tc-MAA-based treatment simulation prior to 90 Y SIRT, were scaled with the administered 90 Y therapy activity. 3D absorbed dose images were generated by dose kernel convolution with scaled 99m Tc/ 90 Y SPECT/CT, 90 Y BRS SPECT/CT, and 90 Y PET/CT data of each patient. Absorbed dose estimates in tumor and healthy liver tissue obtained using the two SPECT/CT methods were compared against 90 Y PET/CT. Results: The percentage deviation of tumor absorbed dose estimates from 90 Y PET/CT values was on average − 2 ± 18% for scaled 99m Tc/ 90 Y SPECT/CT, whereas estimates from 90 Y BRS SPECT/CT differed on average by − 50 ± 13%. For healthy liver absorbed dose estimates, all three imaging methods revealed comparable values. Conclusion: The quantification capabilities of the imaging data influence 90 Y SIRT tumor dosimetry, while healthy liver absorbed dose values were comparable for all investigated imaging data. When no 90 Y PET/CT image data are available, the proposed scaled 99m Tc/ 90 Y SPECT/CT dosimetry method was found to be more appropriate for HCC tumor dosimetry than 90 Y BRS SPECT/CT based dosimetry.

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“…Dieudonné et al reported the feasibility of voxel-based three-dimensional (3D) dose mapping based on 99m Tc-MAA single-photon emission computed tomography (SPECT)/computed tomography (CT) performed for pretreatment planning of yttrium-90 ( 90 Y) microsphere TARE [9]. Kafrouni et al demonstrated the correlation between treatment response and mean absorbed radiation dose derived from voxel-based dosimetry based on post-treatment 90 Y-microsphere positron emission tomography (PET) [10].…”

Section: Introductionmentioning

confidence: 99%

Response to Trans-arterial Radioembolization Therapy for Liver Cancer According to Voxel-Based Dosimetry: A Retrospective Study

Yoo¹,

Paeng²,

Kim³

et al. 2020

Preprint

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BackgroundUsual clinical dosimetry models for trans-arterial radioembolization (TARE) is based on assumption of uniform dose distribution in each tissue compartment. We performed a simple voxel-based dosimetry using post-treatment yttrium-90 (90Y) microsphere PET in TARE and investigated the prognostic value of dosimetry parameters from the voxel-based dosimetry.MethodTwenty-eight patients with hepatocellular carcinoma who underwent TARE using 90Y-microsphere were retrospectively included. Mean absorbed dose of each lesion (TDv) was analyzed using voxel-based dose maps derived from posttreatment 90Y-microsphere PET and voxel-wise S-value kernels. Heterogeneity of intra-tumoral absorbed dose was investigated using standard deviation and coefficient of variation of voxel doses in a tumor. The response of each lesion was classified as local control success (LCS) and local control failure (LCF) based on follow-up MRI or CT. Prognostic values of dosimetry parameters and clinicopathologic factors were evaluated using survival analysis for progression-free survival. ResultsFourteen lesions from 10 patients were analyzed. The LCS and LCF groups showed significant differences in TDv and intra-tumoral absorbed dose heterogeneity, but not in the tumor size. Univariate survival analysis identified high serum aspartate transaminase level (> 40 IU/L), large tumor size (> 66 mm), and low TDv (< 81 Gy) as significant prognostic factors. However, on multivariate analysis, only low TDv was identified as an independent predictive factor (P = 0.022; HR, 21.018; 95% CI: 1.549–258.204), with a cutoff value of 80–120 Gy. Spearman’s correlation analysis also showed a significant correlation between TDv and PFS (P = 0.009, r = 0.669). ConclusionsIn TARE using 90Y-microspheres, voxel-wise absorbed dose can be easily estimated on post-treatment 90Y PET using a simple method. The TDv calculated by the voxel-based dosimetry is an effective prognostic factor for PFS with a cutoff value of 80–120 Gy.

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Retrospective Voxel-Based Dosimetry for Assessing the Ability of the Body-Surface-Area Model to Predict Delivered Dose and Radioembolization Outcome

Cited by 36 publications

References 24 publications

The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

3D image-based dosimetry for Yttrium-90 radioembolization of hepatocellular carcinoma: Impact of imaging method on absorbed dose estimates

Response to Trans-arterial Radioembolization Therapy for Liver Cancer According to Voxel-Based Dosimetry: A Retrospective Study

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