Patient-Specific 3-D Image-Based Dose Estimates for Transarterial Radioembolization of Liver Tumors with Yttrium-90 Microspheres

Abstract Background: Transarterial Radioembolization (TARE) effectively treats unresectable primary and metastatic liver tumors through local injection of Yttrium-90 (90Y) beta particle emitting microspheres. These microspheres implant around the tumor, damaging tumorous cells while sparing healthy liver tissue. Current dosimetry models are highly simplistic and based patient characteristics such as body surface area and fail to consider many important factors. There is a large need for an imaged based dosimetry post-TARE which would improve treatment safety and efficacy. Current post-TARE imaging is 90Y bremsstrahlung SPECT/CT and we study the use of these images for post-TARE dosimetry. Methods: Retrospective image review of 10 patients having a Philips HealthcareTM SPECT/CT following TARE SIR-Spheres® implantation. Emission series with attenuation correction were resampled to 3mm resolution and used to create image based dose distributions. Dose distributions and analysis were performed in MIM Software SurePlanTM utilizing SurePlanTM Local Deposition Method (LDM) and our own dose convolution method (WFBH). We sought to implement a patient specific background subtraction technique prior to dose calculation to make these noisy bremsstrahlung SPECT images suitable for post-TARE dosimetry calculations. Results: On average the percentage of mean background counts to maximum count in the image across all patients was 9.4 ± 4.9% with a maximum of 17.6% and minimum of 2.3%. Absolute dose increased and profile line width decreased as background subtraction value increased. The average value of the LDM and WFBH dose methods were statistically the same. As background subtraction value increased, we found the DVH curves to become unrealistic and distorted.Conclusion: Background subtraction on bremsstrahlung SPECT image had a large effect on post-TARE dosimetry. The background contour we defined provides a systematic estimate to the activity background that accounts for the scanner and patient conditions at the time of the image study and is easily implemented using commercially available software. We found using the mean count in the background contour as a constant subtraction across the entire image gave the most realistic dose distributions. Comparison of dosimetry from background subtracted SPECT images to image based dosimetry obtained via 90Y PET images will be the subject of our next analysis.

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Recognizing and Managing Adverse Events in Y-90 Radioembolization

Seminars in Interventional Radiology ◽

10.1055/s-0041-1735617 ◽

2021 ◽

Vol 38 (04) ◽

pp. 453-459

Author(s):

Grace L. Laidlaw ◽

Guy E. Johnson

Keyword(s):

Adverse Events ◽

Patient Care ◽

Liver Tumors ◽

Hepatic Metastases ◽

Systemic Effects ◽

Primary Liver Tumors ◽

Transarterial Radioembolization ◽

Prevention And Treatment ◽

Yttrium 90

AbstractTransarterial radioembolization using yttrium-90 (Y-90) microspheres is an important therapy in the management of unresectable primary liver tumors or hepatic metastases. While radioembolization is generally well-tolerated, it is not free from adverse events, and familiarity with the prevention and treatment of radioembolization-specific complications is an important component of patient care. This article aims to review radioembolization-specific toxicities stratified by hepatic, extrahepatic, and systemic effects, with a focus on preventing and mitigating radioembolization-induced morbidity.

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Labeling of Hinokitiol with 90Y for Potential Radionuclide Therapy of Hepatocellular Carcinoma

Processes ◽

10.3390/pr9060940 ◽

2021 ◽

Vol 9 (6) ◽

pp. 940

Author(s):

Christelle Bouvry ◽

Valérie Ardisson ◽

Nicolas Noiret ◽

Etienne Garin ◽

Nicolas Lepareur

Keyword(s):

Hepatocellular Carcinoma ◽

Radionuclide Therapy ◽

Liver Tumors ◽

Potential Treatment ◽

Primary Liver Tumors ◽

Transarterial Radioembolization ◽

The World ◽

Yttrium 90

Hepatocellular carcinoma (HCC), the most common form of primary liver tumors, is the fifth cancer in the world in terms of incidence, and third in terms of mortality. Despite significant advances in the treatment of HCC, its prognosis remains bleak. Transarterial radioembolization with radiolabeled microspheres and Lipiodol has demonstrated significant effectiveness. Here we present a new, simple radiolabeling of Lipiodol with Yttrium-90, for the potential treatment of HCC.

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Clinical Outcomes Of Patients With Primary Or Metastatic Liver Tumors Treated With Dose-Escalated Yttrium-90 (Y-90) Transarterial Radioembolization (TARE)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.1952 ◽

2020 ◽

Vol 108 (3) ◽

pp. e650

Author(s):

A. Bommireddy ◽

R.I. Chin ◽

C. Malone ◽

S.K. Kim ◽

G. Foltz ◽

...

Keyword(s):

Clinical Outcomes ◽

Liver Tumors ◽

Transarterial Radioembolization ◽

Metastatic Liver Tumors ◽

Metastatic Liver ◽

Yttrium 90

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Abstract No. 439 Histological outcomes in resected tumor specimens after Yttrium-90 transarterial radioembolization using resin microspheres

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2021.03.248 ◽

2021 ◽

Vol 32 (5) ◽

pp. S105-S106

Author(s):

A. Ali ◽

J. Weinstein ◽

I. Nasser ◽

M. Morrow ◽

S. Faintuch ◽

...

Keyword(s):

Transarterial Radioembolization ◽

Resin Microspheres ◽

Resected Tumor ◽

Yttrium 90

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Transarterial Radioembolization of Hepatocellular Carcinoma, Liver-Dominant Hepatic Colorectal Cancer Metastases, and Cholangiocarcinoma Using Yttrium90 Microspheres: Eight-Year Single-Center Real-Life Experience

Diagnostics ◽

10.3390/diagnostics11010122 ◽

2021 ◽

Vol 11 (1) ◽

pp. 122

Author(s):

Julie Pellegrinelli ◽

Olivier Chevallier ◽

Sylvain Manfredi ◽

Inna Dygai-Cochet ◽

Claire Tabouret-Viaud ◽

...

Keyword(s):

Colorectal Cancer ◽

Hepatocellular Carcinoma ◽

Liver Tumors ◽

Progression Free Survival ◽

Single Center ◽

Free Survival ◽

Risk Of Death ◽

Transarterial Radioembolization ◽

Cancer Metastases ◽

Colorectal Cancer Metastases

Liver tumors are common and may be unamenable to surgery or ablative treatments. Consequently, other treatments have been devised. To assess the safety and efficacy of transarterial radioembolization (TARE) with Yttrium-90 for hepatocellular carcinoma (HCC), liver-dominant hepatic colorectal cancer metastases (mCRC), and cholangiocarcinoma (CCA), performed according to current recommendations, we conducted a single-center retrospective study in 70 patients treated with TARE (HCC, n = 44; mCRC, n = 20; CCA, n = 6). Safety and toxicity were assessed using the National Cancer Institute Common Terminology Criteria. Treatment response was evaluated every 3 months on imaging studies using Response Evaluation Criteria in Solid Tumors (RECIST) or mRECIST criteria. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. The median delivered dose was 1.6 GBq, with SIR-Spheres® or TheraSphere® microspheres. TARE-related grade 3 adverse events affected 17.1% of patients. Median follow-up was 32.1 months. Median progression-free survival was 5.6 months and median overall time from TARE to death was 16.1 months and was significantly shorter in men. Progression-free survival was significantly longer in women (HR, 0.49; 95%CI, 0.26–0.90; p = 0.031). Risk of death or progression increased with the number of systemic chemotherapy lines. TARE can be safe and effective in patients with intermediate- or advanced-stage HCC, CCA, or mCRC refractory or intolerant to appropriate treatments.

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