Management of Liver Tumors during the COVID-19 Pandemic: The Added Value of Selective Internal Radiation Therapy (SIRT)

Background: In the context of the coronavirus disease 2019 (COVID-19) pandemic, liver-directed therapies (LDTs) may offer minimally invasive integrative tools for tumor control. Among them, selective internal radiation therapy (SIRT) represents a safe, flexible and effective treatment. Purpose of this study is to present our experience with SIRT during the first wave of COVID-19 pandemic and provide an overview of the indications and challenges of SIRT in this scenario. Methods: We retrospectively analyzed the number of patients evaluated by Multidisciplinary Liver Tumor Board (MLTB) and who were undergoing LDTs between March and July 2020 and compared it with 2019. For patients treated with SIRT, clinical data, treatment details and the best radiological response were collected. Results: Compared to 2019, we observed a 27.5% reduction in the number of patients referred to MLTB and a 28.3% decrease in percutaneous ablations; transarterial chemoembolizations were stable, while SIRT increased by 64%. The majority of SIRT patients (75%) had primary tumors, mostly HCC. The best objective response and disease control rates were 56.7% and 72.2%, respectively. Conclusion: The first wave of the COVID-19 pandemic was characterized by an increased demand for SIRT, which represents a safe, flexible and effective treatment, whose manageability will further improve by simplifying the treatment workflow, developing user-friendly and reliable tools for personalized dosimetry and improving interdisciplinary communication.

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Selective internal radiation therapy: an effective treatment for hormonal syndromes in pancreatic neuroendocrine tumors

Hepatic Oncology ◽

10.2217/hep-2017-0025 ◽

2018 ◽

Vol 5 (2) ◽

pp. HEP09

Author(s):

Leyre Zubiri ◽

José I Bilbao ◽

Javier Rodríguez ◽

Bruno Sangro

Keyword(s):

Radiation Therapy ◽

Effective Treatment ◽

Neuroendocrine Tumors ◽

Selective Internal Radiation Therapy ◽

Pancreatic Neuroendocrine Tumors ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy

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Trans-arterial chemoembolization with degradable starch microspheres (DSM-TACE) versus selective internal radiation therapy (SIRT) in multifocal hepatocellular carcinoma

Acta Radiologica ◽

10.1177/0284185120926474 ◽

2020 ◽

pp. 028418512092647

Author(s):

Timo A Auer ◽

Martin Jonczyk ◽

Federico Collettini ◽

Adrian Marth ◽

Gero Wieners ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiation Therapy ◽

Tumor Control ◽

Selective Internal Radiation Therapy ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy ◽

Degradable Starch Microspheres ◽

Significant Difference ◽

Arterial Chemoembolization

Background To date there is no therapy consensus in patients with multifocal hepatocellular carcinoma (mHCC). Purpose To compare outcome of trans-arterial chemoembolization (TACE) with degradable starch microspheres (DSM-TACE) versus selective internal radiation therapy (SIRT) in mHCC. Material and Methods In this single-center study, 36 patients without portal vein invasion, treated between May 2014 and May 2018, were enrolled retrospectively. Eighteen consecutive patients received DSM-TACE and were matched by age, gender, BCLC stage, Child-Pugh status, and tumor volume and 18 patients underwent SIRT. Overall survival (OS), progression-free survival (PFS), and local tumor control (LTC) were evaluated. Toxicity profiles for both therapies were also evaluated and compared. Results In the entire collective, median OS was 9.5, PFS 5.0, and LTC 5.5 months. Subgroup analysis revealed an OS of 9.5 months in both groups ( P = 0.621). PFS was 6 months for the SIRT and 4 months for the DSM-TACE cohort ( P = 0.065). Although not significantly, LTC was lower (4 months) in the SIRT compared to the DSM-TACE cohort (7 months; P = 0.391). When DSM-TACE was performed ≥3 times (n = 11), OS increased, however without statistical difference compared to SIRT, to 11 months, PFS to 7 months, and LTC to 7 months. When DSM-TACE was performed <3 times (n = 7), OS, PFS, and LTC decreased (5 months, P = 0.333; 2 months, P = 0.047; 2 months, P = 0.47). Toxicity profiles and adverse event analysis only revealed a significant difference for nausea and vomiting (more frequent in the SIRT cohort, P = 0.015), while no other parameter showed a significant difference ( P > 0.05). Conclusion DSM-TACE might be an alternative to SIRT in multifocal HCC patients as OS, PFS, and LTC did not differ significantly and toxicity profiles seem to be comparable.

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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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