Toxicity and dosimetry in SORAMIC study

Beyond the MAA-Y90 Paradigm: The Evolution of Radioembolization Dosimetry Approaches and Scout Particles

“…These trials were not designed with a specific dosimetric endpoint and all utilized a simplistic dosimetry approach, primarily using the BSA algorithm for dose calculation. Some works have suggested "the lack of dosimetry-based personalized treatment planning may have diluted the clinical outcomes for radioembolization" 18 and challenge the relevance of these negative results, especially in light of recent publications. Sposito and Mazzaferro 19 highlighted the lack of dosimetric consideration in both SIRveNIB and SARAH which use the BSA dosimetry method and contrast with several other studies utilizing the multicompartment MIRD method, in which a clear tumor-doseresponse relationship was demonstrated.…”

“…Selwyn et al reported on their development of a novel positron-emitting resin microsphere to be used as a PET imaging surrogate for resin 90 Y microspheres. 35 In this study, a new treatment procedure whereby the 99m Tc MAA SPECT was replaced with a PET scan of 18 F-loaded resin microspheres was conducted to capitalize on the benefits of PET. They reported that the radiolabeling process was equivalent to the standard MAA radiolabeling procedure in terms of difficulty and time, and PET-derived uptake ratios were shown to be accurate to histologic ratio to 3%, which leads to the conclusion that this method could be used to determine uptake ratio and tumor dose using the MIRD formalism.…”

“…They reported that the radiolabeling process was equivalent to the standard MAA radiolabeling procedure in terms of difficulty and time, and PET-derived uptake ratios were shown to be accurate to histologic ratio to 3%, which leads to the conclusion that this method could be used to determine uptake ratio and tumor dose using the MIRD formalism. 35 A downside of using 18 F as a surrogate agent is the high dose to (radiopharmacy) personnel and relatively short half-life, which limits the window for distribution to clinical sites. 64 Cu was proposed as an alternative nuclide, which may warrant further investigation due to the longer half-life; however, literature suggested that 64 Cu has a high binding affinity for albumin and so is likely to leach into the blood in vivo.…”