Yttrium 90 Microsphere Selective Internal Radiation Treatment of Hepatic Colorectal Metastases

2008 ◽  
Vol 143 (3) ◽  
pp. 313 ◽  
Author(s):  
Timothy J. Price
Keyword(s):  
Radiation Treatment ◽  
Colorectal Metastases ◽  
Internal Radiation ◽  
Selective Internal Radiation ◽  
Yttrium 90

scholarly journals International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

2021 ◽  
Author(s):  
Hugo Levillain ◽  
Oreste Bagni ◽  
Christophe M. Deroose ◽  
Arnaud Dieudonné ◽  
Silvano Gnesin ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Absorbed Dose ◽  
Steering Committee ◽  
Selective Internal Radiation Therapy ◽  
Internal Radiation ◽  
Selective Internal Radiation ◽  
Internal Radiation Therapy ◽  
Resin Microspheres ◽  
Yttrium 90 ◽  
Strong Agreement

Abstract Purpose A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-resin microspheres. Methods A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99mTc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion Practitioners are encouraged to work towards adoption of these recommendations.

Yttrium-90 microsphere selective internal radiation treatment (SIRT) with concomitant chemotherapy (Chemo-SIRT) as first/second-line therapy in patients with colorectal cancer liver metastases

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14589-14589 ◽  
Author(s):  
K. L. Pennington ◽  
D. Bruetman ◽  
G. Mesoloras ◽  
R. Hostetter ◽  
S. A. Gulec
Keyword(s):  
Radiation Treatment ◽  
Absorbed Dose ◽  
Second Line ◽  
First Line ◽  
Internal Radiation ◽  
Colorectal Cancer Liver Metastases ◽  
Line Therapy ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Yttrium 90

14589 Background: Yttrium-90 (Y-90) microsphere selective internal radiation treatment (SIRT) has been studied in patients (pts) with colorectal cancer liver metastases (CRCLM) in combination with FUDR and 5FU-LV with promising results. This is a phase II trial of SIRT and concurrent contemporary chemotherapy in the frontline management of CRCLM. Methods: Pts with metastatic disease limited predominantly to the liver were eligible for the study. Other entry criteria included KPS 70 or >, 3 month life expectancy and adequate marrow and renal reserve. Pre-treatment evaluations included the assessment of liver function, CEA level, 18F-FDG-PET/CT imaging, an angiogram and a 99mTc-MAA (macroagregate albumin) scan. SIRT with Y-90 resin microspheres (Sirtex Medical, Lake Forest, IL) was administered on day 2 of the first chemotherapy (Fol-Fox or Fol-Firi) course in either lobar or whole-liver fashion. Chemotherapy was repeated on a biweekly schedule. CEA levels and 18F-FDG-PET/CT based anatomic and functional volume (Vf) changes were used to determine tumor response at 4, 8, and 12 weeks after therapy. CTC v3 toxicity grades were used to classify adverse events. Results: 6 pts were treated as first-line and 2 pts as second-line. 5 pts received single lobe and 3 pts received whole liver treatment. Administered activity of Y-90 microspheres ranged from 0.9 to 3.1 GBq (mean 2.3 GBq). Mean tumor radiation absorbed dose was 203.6 Gy (Range 91.0–351.4 Gy). Mean liver absorbed dose was 47.8 Gy (Range 7.9–85.9 Gy). 6/8 pts had complete/near-complete metabolic response with a mean tumor Vf decrease in target lobe(s) of 98%). The remaining 2 pts demonstrated > 50% reduction in Vf in target lobe(s). A parallel decrease in CEA level was observed in responding pts. Surgical downstaging was attained in 3/8 pts. 2 pts developed grade III toxicity (one gastric ulcer and one alkaline phosphatase elevation). Conclusion: Chemo-SIRT as first-line therapy has a high level of response in CRCLM as measured by reductions in functional tumor volume and CEA level. Further follow-up of these pts is needed to confirm that this response is of clinical significance in terms of improved surgical downstaging and survival. [Table: see text]

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