scholarly journals Individualised dosimetry and safety of SIRT for intrahepatic cholangiocarcinoma

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Kathy P. Willowson ◽  
Enid M. Eslick ◽  
Dale L. Bailey
Keyword(s):  
Liver Function ◽  
Dose Response ◽  
Intrahepatic Cholangiocarcinoma ◽  
Uptake Rate ◽  
Metabolic Response ◽  
Absorbed Dose ◽  
Normal Liver ◽  
Equivalent Uniform Dose ◽  
Liver Malignancy ◽  
Liver Uptake

Abstract Background The aim of this study was to investigate the safety and efficacy of selective internal radiation therapy (SIRT) with 90Y resin microspheres for the treatment of Intrahepatic Cholangiocarcinoma (ICC). A total of 23 SIRT procedures from 18 ICC subjects were analysed to determine a lesion-based dose/response relationship with absorbed dose measures from 90Y PET and metabolic response as measured on [18F]FDG PET. Average absorbed dose (Davg), minimum dose to 70% of the volume (D70), volume receiving at least 50 Gy (V50), biological effective dose (BED) and equivalent uniform dose (EUD), were compared to changes in metabolic volume, maximum standardised uptake value (SUVmax) and total lesion glycolysis (TLG). Dose to normal liver was assessed with changes in liver uptake rate as measured with [99mTc]mebrofenin scintigraphy for a cohort of 20 subjects with primary liver malignancy (12 ICC, 8 hepatocellular carcinoma (HCC)). Results Thirty-four lesions were included in the analysis. A relationship was found between metabolic response and both Davg and EUD similar to that seen previously in metastatic colorectal cancer (mCRC), albeit trending towards a lower response plateau. Both dose and SUV coefficient of variation within the lesion (CoVdose and CoVSUV), baseline TLG and EUD were found to be mildly significant predictors of response. No strong correlation was seen between normal liver dose and change in [99mTc]mebrofenin liver uptake rate; low baseline uptake rate was not indicative of declining function following SIRT, and no subjects dropped into the ‘poor liver function’ category. Conclusions ICC lesions follow a similar dose–response trend as mCRC, however, despite high lesion doses a full metabolic response was rarely seen. The CoV of lesion dose may have a significant bearing on response, and EUD correlated more tightly with metabolic response compared to Davg. SIRT in primary liver malignancy appears safe in terms of not inducing a clinically significant decline in liver function, and poor baseline uptake rate is not predictive of a reduction in function post SIRT.

PEDIATRIC APPLICATION OF THE RADIOIODINE (1-131) ROSE BENGAL METHOD IN HEPATIC AND BILIARY SYSTEM DISEASE

PEDIATRICS ◽  
1963 ◽  
Vol 32 (2) ◽  
pp. 239-250
Author(s):  
William E. White ◽  
John S. Welsh ◽  
Daniel C. Darrow ◽  
Thomas M. Holder
Keyword(s):  
Liver Function ◽  
Rose Bengal ◽  
Pediatric Patients ◽  
Normal Liver ◽  
Normal Amount ◽  
Liver Uptake ◽  
System Disease ◽  
Intestinal Activity ◽  
Normal Subject ◽  
Biliary Ducts

Rose bengal tagged with radioiodine (I-131) injected in the vein of a normal subject is rapidly cleared from the blood by the liver and conveyed by the biliary ducts to the intestine. By counting the radioactivity over the heart, liver, and intestine, the liver function (rate of clearing the blood of activity and rate of liver uptake) and patency of the biliary ducts (appearance of activity in the intestines) can be assessed. Patients with hepatitis clear the blood of dye slowly and exhibit a slow liver uptake. Intestinal activity appears somewhat slower than normal but in normal amount. In patients with biliary atresia, the blood is cleared of activity somewhat more slowly than normal. Liver activity, though rising slowly, continues to increase for a much longer period of time than in the normal subject. No activity reaches the intestine. Sixty-five nose bengal studies were carried out in 50 pediatric patients. The test is of most value in evaluating the jaundiced neonate. More experience with it will be necessary to evaluate fully the usefulness of this test.

scholarly journals Impact of contouring methods on pre-treatment and post-treatment dosimetry for the prediction of tumor control and survival in HCC patients treated with selective internal radiation therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guillaume Nodari ◽  
Romain Popoff ◽  
Jean Marc Riedinger ◽  
Olivier Lopez ◽  
Julie Pellegrinelli ◽  
...  
Keyword(s):  
Absorbed Dose ◽  
Normal Liver ◽  
Post Treatment ◽  
Tumor Control ◽  
Clinical Workflow ◽  
Liver Uptake ◽  
Advanced Hcc ◽  
Dose Metrics ◽  
Pre Treatment ◽  
The Impact

Abstract Introduction The aim of this study was to evaluate the impact of the contouring methods on dose metrics and their predictive value on tumor control and survival, in both situations of pre-treatment and post-treatment dosimetry, for patients with advanced HCC treated with SIRT. Methods Forty-eight patients who underwent SIRT between 2012 and 2020 were retrospectively included in this study. Target volumes were delineated using two methods: MRI-based contours manually drawn by a radiologist and then registered on SPECT/CT and PET/CT via deformable registration (Pre-CMRI and Post-CMRI), 99mTc-MAA-SPECT and 90Y-microspheres-PET 10% threshold contouring (Pre-CSPECT and Post-CPET). The mean absorbed dose (Dm) and the minimal absorbed dose delivered to 70% of the tumor volume (D70) were evaluated with both contouring methods; the tumor-to-normal liver uptake ratio (TNR) was evaluated with MRI-based contours only. Tumor response was assessed using the mRECIST criteria on the follow-up MRIs. Results No significant differences were found for Dm and TNR between pre- and post-treatment. TNR evaluated with radiologic contours (Pre-CMRI and Post-CMRI) were predictive of tumor control at 6 months on pre- and post-treatment dosimetry (OR 5.9 and 7.1, respectively; p = 0.02 and 0.01). All dose metrics determined with both methods were predictive of overall survival (OS) on pre-treatment dosimetry, but only Dm with MRI-based contours was predictive of OS on post-treatment images with a median of 23 months for patients with a supramedian Dm versus 14 months for the others (p = 0.04). Conclusion In advanced HCC treated with SIRT, Dm and TNR determined with radiologic contours were predictive of tumor control and OS. This study shows that a rigorous clinical workflow (radiologic contours + registration on scintigraphic images) is feasible and should be prospectively considered for improving therapeutic strategy.

scholarly journals A Monte Carlo Determination of Dose and Range Uncertainties for Preclinical Studies with a Proton Beam

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1889
Author(s):  
Arthur Bongrand ◽  
Charbel Koumeir ◽  
Daphnée Villoing ◽  
Arnaud Guertin ◽  
Ferid Haddad ◽  
...  
Keyword(s):  
Monte Carlo ◽  
Monte Carlo Simulations ◽  
Proton Beam ◽  
Dose Response ◽  
Small Animal ◽  
Absorbed Dose ◽  
Normal Tissue Damage ◽  
Dose Homogeneity ◽  
And Control ◽  
The Impact

Proton therapy (PRT) is an irradiation technique that aims at limiting normal tissue damage while maintaining the tumor response. To study its specificities, the ARRONAX cyclotron is currently developing a preclinical structure compatible with biological experiments. A prerequisite is to identify and control uncertainties on the ARRONAX beamline, which can lead to significant biases in the observed biological results and dose–response relationships, as for any facility. This paper summarizes and quantifies the impact of uncertainty on proton range, absorbed dose, and dose homogeneity in a preclinical context of cell or small animal irradiation on the Bragg curve, using Monte Carlo simulations. All possible sources of uncertainty were investigated and discussed independently. Those with a significant impact were identified, and protocols were established to reduce their consequences. Overall, the uncertainties evaluated were similar to those from clinical practice and are considered compatible with the performance of radiobiological experiments, as well as the study of dose–response relationships on this proton beam. Another conclusion of this study is that Monte Carlo simulations can be used to help build preclinical lines in other setups.

Management of Obscurely Dilated Common Bile Duct with Normal Liver Function Tests: A Pragmatic Approach

2021 ◽  
Author(s):  
Sundeep Singh Saluja ◽  
Vaibhav Kumar Varshney ◽  
Vidya Sharada Bhat ◽  
Phani Kumar Nekarakanti ◽  
Asit Arora ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Liver Function ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Pragmatic Approach ◽  
Normal Liver Function ◽  
Function Tests

EQUIVALENT UNIFORM DOSE SENSITIVITY TO CHANGES IN ABSORBED DOSE DISTRIBUTION

2013 ◽  
Vol 06 (01) ◽  
pp. 1250069
Author(s):  
FRANCISCO CUTANDA-HENRÍQUEZ ◽  
SILVIA VARGAS-CASTRILLÓN
Keyword(s):  
Treatment Planning ◽  
Dose Distribution ◽  
Absorbed Dose ◽  
Target Volume ◽  
Simple Expression ◽  
External Beam Radiation ◽  
Equivalent Uniform Dose ◽  
Beam Radiation ◽  
Dose Volume Histograms ◽  
Small Change

Treatment planning in external beam radiation therapy (EBRT) utilizes dose volume histograms (DVHs) as optimization and evaluation tools. They present the fraction of planning target volume (PTV) receiving more than a given absorbed dose, against the absorbed dose values, and a number of radiobiological indices can be computed with their help. Equivalent uniform dose (EUD) is the absorbed dose that, uniformly imparted, would yield the same biological effect on a tumor as the dose distribution described by the DVH. Uncertainty and missing information can affect the dose distribution, therefore DVHs can be modeled as samples from a set of possible outcomes. This work studies the sensitivity of the EUD index when a small change in absorbed dose distribution takes place. EUD is treated as a functional on the set of DVHs. Defining a Lévy distance on this set and using a suitable expansion of the functional, a very simple expression for a bound on the variation of EUD when the dose distribution changes is found. This bound is easily interpreted in terms of standard treatment planning practice.

Persistently raised aspartate aminotransferase (AST) due to macro-AST in a rheumatology clinic

Diagnosis ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Wycliffe Mbagaya ◽  
Joanne Foo ◽  
Ahai Luvai ◽  
Claire King ◽  
Sarah Mapplebeck ◽  
...  
Keyword(s):  
Liver Function ◽  
Aspartate Aminotransferase ◽  
Normal Liver ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Analytical Investigation ◽  
Normal Liver Function ◽  
Rheumatology Clinic ◽  
History Of ◽  
Liver Biopsies

AbstractMacrocomplexes between immunoglobins and aspartate aminotransferase (macro-AST) may result in persistently increased AST concentration. The presence of macro-AST in patients has been implicated in unnecessary investigations of abnormal liver function tests. We report the case of a 44-year-old female who presented to the rheumatology clinic with a 12-months’ history of constant widespread pain affecting her limbs and was found to have an elevated AST concentration. Further information from her GP revealed a 14-years’ history of elevated AST with otherwise normal liver function. Previous abdominal ultrasound and two liver biopsies carried out 2 years apart were normal. This prompted further analytical investigation by the biochemistry department which identified macro-AST as the cause. This case illustrates that persistently raised isolated AST concentration with no other abnormal indices may warrant macroenzyme analysis potentially avoiding unnecessary invasive investigations.

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