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

Abstract

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!

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

“…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 ].…”

“…Tumor absorbed doses can be corrected for heterogeneity using Equivalent Uniform Dose (EUD) [ 59 ]. In a series of HCC tumors, the tumor control probability reached 95% for an EUD over 100 Gy, estimated with post therapy 90 Y PET/CT [ 56 ]. This EUD was achieved for a large range of tumor absorbed doses, varying from 190 (homogeneous distribution) to 1800 Gy (heterogeneous distribution).…”