Quantitative comparison of pre-treatment predictive and post-treatment measured dosimetry for selective internal radiation therapy using cone-beam CT for tumor and liver perfusion territory definition

Abstract Background: Selective internal radiation therapy (SIRT) is a promising treatment for unresectable hepatic malignancies. Predictive dose calculation based on a simulation using technetium-99m-labeled macro-aggregated albumin ( 99m Tc-MAA) before the treatment is considered as a potential tool for patient-specific treatment planning. Post-treatment dose measurement is mainly performed to confirm the planned absorbed dose to the tumor and non-tumor liver volumes. This study compared the predicted and measured absorbed dose distributions. Methods: Thirty-one patients (67 tumors) treated by SIRT with resin microspheres were analyzed. Predicted and delivered absorbed dose was calculated using 99m Tc-MAA-SPECT and 90 Y TOF-PET imaging. The voxel-level dose distribution was derived using the local deposition model. Liver perfusion territories and tumors have been delineated on contrast-enhanced CBCT images, which have been acquired during the 99m Tc-MAA work-up. Several dose-volume histogram (DVH) parameters together with the mean dose for liver perfusion territories, non-tumoral and tumoral compartments were evaluated. Results: A strong correlation between the predicted and measured mean dose for non-tumoral volume was observed (r=0.937). The ratio of measured and predicted mean dose to this volume has a first, second, and third quartile range of 0.83, 1.05, and 1.25. The difference between the measured and predicted mean dose did not exceed 11 Gy. The correlation between predicted and measured mean dose to the tumor was moderate (r=0.623) with a mean difference of -9.3 Gy. The ratio of measured and predicted tumor mean dose had a median of 1.01 with the first and third quartile ranges of 0.58 and 1.59, respectively. Our results suggest that 99m Tc-MAA-based dosimetry could predict under or over dosing of the non-tumoral liver parenchyma for almost all cases. For more than two-thirds of the tumors, a predictive absorbed dose correctly indicated either good tumor dose coverage or under-dosing of the tumor. Conclusion: Our results highlight the predictive value of 99m Tc-MAA-based dose estimation to predict non-tumor liver irradiation, which can be applied to prescribe an optimized activity aiming at avoiding liver toxicity. Predictive dosimetry is also moderately reliable to estimate the tumor absorbed dose.

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Quantitative comparison of pre-treatment predictive and post-treatment measured dosimetry for selective internal radiation therapy using cone-beam CT for tumor and liver perfusion territory definition

10.21203/rs.3.rs-17076/v2 ◽

2020 ◽

Author(s):

Esmaeel Jafargholi Rangraz ◽

Xikai Tang ◽

Charlotte Van Laeken ◽

Geert Maleux ◽

Jeroen Dekervel ◽

...

Keyword(s):

Radiation Therapy ◽

Liver Perfusion ◽

Specific Treatment ◽

Absorbed Dose ◽

Post Treatment ◽

Patient Specific ◽

Selective Internal Radiation Therapy ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy

Abstract Background: Selective internal radiation therapy (SIRT) is a promising treatment for unresectable hepatic malignancies. Predictive dose calculation based on a simulation using technetium-99m-labeled macro-aggregated albumin ( 99m Tc-MAA) before the treatment is considered as a potential tool for patient-specific treatment planning. Post-treatment dose measurement is mainly performed to confirm the planned absorbed dose to the tumor and non-tumor liver volumes. This study compared the predicted and measured absorbed dose distributions. Methods: Thirty-one patients (67 tumors) treated by SIRT with resin microspheres were analyzed. Predicted and delivered absorbed dose was calculated using 99m Tc-MAA-SPECT and 90 Y TOF-PET imaging. The voxel-level dose distribution was derived using the local deposition model. Liver perfusion territories and tumors have been delineated on contrast-enhanced CBCT images, which have been acquired during the 99m Tc-MAA work-up. Several dose-volume histogram (DVH) parameters together with the mean dose for liver perfusion territories, non-tumoral and tumoral compartments were evaluated. Results: A strong correlation between the predicted and measured mean dose for non-tumoral volume was observed (r=0.937). The ratio of measured and predicted mean dose to this volume has a first, second, and third quartile range of 0.83, 1.05, and 1.25. The difference between the measured and predicted mean dose did not exceed 11 Gy. The correlation between predicted and measured mean dose to the tumor was moderate (r=0.623) with a mean difference of -9.3 Gy. The ratio of measured and predicted tumor mean dose had a median of 1.01 with the first and third quartile ranges of 0.58 and 1.59, respectively. Our results suggest that 99m Tc-MAA-based dosimetry could predict under or over dosing of the non-tumoral liver parenchyma for almost all cases. For more than two-thirds of the tumors, a predictive absorbed dose correctly indicated either good tumor dose coverage or under-dosing of the tumor. Conclusion: Our results highlight the predictive value of 99m Tc-MAA-based dose estimation to predict non-tumor liver irradiation, which can be applied to prescribe an optimized activity aiming at avoiding liver toxicity. Predictive dosimetry is also moderately reliable to estimate the tumor absorbed dose.

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Simple calculation using anatomical features on pre-treatment verification CT for bladder volume estimation during radiation therapy for rectal cancer

BMC Cancer ◽

10.1186/s12885-020-07405-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nalee Kim ◽

Hong In Yoon ◽

Jin Sung Kim ◽

Woong Sub Koom ◽

Jee Suk Chang ◽

...

Keyword(s):

Radiation Therapy ◽

Cone Beam Ct ◽

Ct Images ◽

Volume Estimation ◽

Bladder Volume ◽

Cone Beam ◽

Anatomical Features ◽

Treatment Verification ◽

Pre Treatment ◽

Bladder Scanner

Abstract Background Despite detailed instruction for full bladder, patients are unable to maintain consistent bladder filling during a 5-week pelvic radiation therapy (RT) course. We investigated the best bladder volume estimation procedure for verifying consistent bladder volume. Methods We reviewed 462 patients who underwent pelvic RT. Biofeedback using a bladder scanner was conducted before simulation and during treatment. Exact bladder volume was calculated by bladder inner wall contour based on CT images (Vctsim). Bladder volume was estimated either by bladder scanner (Vscan) or anatomical features from the presacral promontory to the bladder base and dome in the sagittal plane of CT (Vratio). The feasibility of Vratio was validated using daily megavoltage or kV cone-beam CT before treatment. Results Mean Vctsim was 335.6 ± 147.5 cc. Despite a positive correlation between Vctsim and Vscan (R2 = 0.278) and between Vctsim and Vratio (R2 = 0.424), Vratio yielded more consistent results than Vscan, with a mean percentage error of 26.3 (SD 19.6, p < 0.001). The correlation between Vratio and Vctsim was stronger than that between Vscan and Vctsim (Z-score: − 7.782, p < 0.001). An accuracy of Vratio was consistent in megavoltage or kV cone-beam CT during treatment. In a representative case, we can dichotomize for clinical scenarios with or without bowel displacement, using a ratio of 0.8 resulting in significant changes in bowel volume exposed to low radiation doses. Conclusions Bladder volume estimation using personalized anatomical features based on pre-treatment verification CT images was useful and more accurate than physician-dependent bladder scanners. Trial registration Retrospectively registered.

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Selective internal radiation therapy in the management of primary and metastatic disease in the liver

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0624 ◽

2021 ◽

pp. 1-11

Author(s):

Emma Preston ◽

Nadeem Shaida

Keyword(s):

Radiation Therapy ◽

Metastatic Disease ◽

Clinical Evidence ◽

Selective Internal Radiation Therapy ◽

Internal Radiation ◽

Targeted Radiotherapy ◽

Selective Internal Radiation ◽

Internal Radiation Therapy ◽

Pre Treatment ◽

Safety Considerations

Selective internal radiation therapy is a type of brachytherapy used to provide targeted radiotherapy, most commonly to treat primary or metastatic disease within the liver. This review outlines current clinical practice, dosimetric considerations, the pre-treatment workup and safety considerations before treatment. It also examines the clinical evidence for its use in patients with both primary and metastatic disease within the liver.

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Liver Selective Internal Radiation Therapy with 90Y resin microspheres: Comparison between pre-treatment activity calculation methods

Physica Medica ◽

10.1016/j.ejmp.2014.05.004 ◽

2014 ◽

Vol 30 (7) ◽

pp. 752-764 ◽

Cited By ~ 10

Author(s):

M. Bernardini ◽

C. Smadja ◽

M. Faraggi ◽

S. Orio ◽

A. Petitguillaume ◽

...

Keyword(s):

Radiation Therapy ◽

Selective Internal Radiation Therapy ◽

Calculation Methods ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy ◽

Resin Microspheres ◽

Pre Treatment ◽

Treatment Activity

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Three-dimensional personalized dosimetry for188Re liver selective internal radiation therapy based on quantitative post-treatment SPECT studies

Physics in Medicine and Biology ◽

10.1088/0031-9155/59/1/119 ◽

2013 ◽

Vol 59 (1) ◽

pp. 119-134 ◽

Cited By ~ 6

Author(s):

S Shcherbinin ◽

J Grimes ◽

A Bator ◽

J B Cwikla ◽

A Celler

Keyword(s):

Radiation Therapy ◽

Three Dimensional ◽

Post Treatment ◽

Selective Internal Radiation Therapy ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy

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Extra-hepatic embolisation of Y-90 microspheres from selective internal radiation therapy (SIRT) of the liver

Pathology ◽

10.1080/00313020307534 ◽

2003 ◽

Vol 35 (4) ◽

pp. 351-353 ◽

Cited By ~ 1

Author(s):

Thomas Thamboo ◽

Kong-Bing Tan ◽

Shih-Chang Wang ◽

Manuel Salto-Tellez

Keyword(s):

Radiation Therapy ◽

Selective Internal Radiation Therapy ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy

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

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-020-05163-5 ◽

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.

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