Need, feasibility and convenience of dosimetric treatment planning in liver selective internal radiation therapy with (90)Y microspheres: the experience of the National Tumor Institute of Milan
- PMID: 21386789
Need, feasibility and convenience of dosimetric treatment planning in liver selective internal radiation therapy with (90)Y microspheres: the experience of the National Tumor Institute of Milan
Abstract
In most centres, the choice of the optimal activity to be administered in selective intra-arterial radioembolization with microspheres is nowadays based on empirical models which do not take into account the evaluation of tumour and non tumour individual absorbed dose, despite plenty of published data which showed that local efficacy is correlated to tumour absorbed dose, and that the mean absorbed dose is a toxicity risk factor. A pitfall of the crudest, empirical tumour involvement method are 20 deaths in a single centre which adopted it to administer the whole liver, or the need of systematic 25% subjective reduction of activity prescribed with body surface area method. In order to develop a possibly safer and more effective strategy based on real individual dosimetry, we examine first external beam liver radiation therapy results. The half century experience has something to be borrowed: the volume effect, according to which the smaller the fraction of the irradiated liver volume, the higher the tolerated dose. Different tolerance for different underlying disease or previous non radiation treatment is to be expected. Radiobiological models experience also has to be inherited, but not their dose reference values. Then we report the published dosimetric experience about (90)Y microsphere radioembolization of primary and metastatic liver tumours. In addition we also present original data from our growing preliminary experience of more refined (99m)Tc MAA SPECT based calculations in hepatocarcinoma patients. This overcame the mean dose approach in favour of the evaluation of dose distribution at voxel level. An insight into dosimetry issues at microscopic level (lobule level) is also provided, from which the different radiobiological behaviour between resin and glass spheres can be understood. For tumour treatment, an attenuation corrected (99m)Tc- SPECT based treatment planning strategy can be proposed, although quantitative efficacy thresholds should be differentiated according to the kind of pathology and previous treatment. For non tumour liver parenchyma, data in favour of a relationship between absorbed dose and dangerous effects are encouraging. Unfortunately in hepato-cellular carcinoma, some confounding factors may hamper the adequate estimation of the risk of toxicity. First there is a lack of consensus about the exact definition of toxicity after (90)Y microsphere radioembolization. Second, for HCC patients, progression of both cancer and cirrhosis can simulate a radioinduced toxicity, making the analysis more complex.
Similar articles
-
Radioembolization of hepatocarcinoma with (90)Y glass microspheres: development of an individualized treatment planning strategy based on dosimetry and radiobiology.Eur J Nucl Med Mol Imaging. 2015 Oct;42(11):1718-1738. doi: 10.1007/s00259-015-3068-8. Epub 2015 Jun 27. Eur J Nucl Med Mol Imaging. 2015. PMID: 26112387
-
Clinical feasibility of fast 3-dimensional dosimetry of the liver for treatment planning of hepatocellular carcinoma with 90Y-microspheres.J Nucl Med. 2011 Dec;52(12):1930-7. doi: 10.2967/jnumed.111.095232. Epub 2011 Nov 8. J Nucl Med. 2011. PMID: 22068894
-
A dosimetric treatment planning strategy in radioembolization of hepatocarcinoma with 90Y glass microspheres.Q J Nucl Med Mol Imaging. 2012 Dec;56(6):503-8. Q J Nucl Med Mol Imaging. 2012. PMID: 23358402
-
[Selective internal radiotherapy (SIRT) for hepatocellular carcinoma].Rofo. 2010 Aug;182(8):660-70. doi: 10.1055/s-0029-1245380. Epub 2010 Apr 19. Rofo. 2010. PMID: 20405369 Review. German.
-
Pathologic response and microdosimetry of (90)Y microspheres in man: review of four explanted whole livers.Int J Radiat Oncol Biol Phys. 2004 Dec 1;60(5):1552-63. doi: 10.1016/j.ijrobp.2004.09.004. Int J Radiat Oncol Biol Phys. 2004. PMID: 15590187 Review.
Cited by
-
Role of Flex-Dose Delivery Program in Patients Affected by HCC: Advantages in Management of Tare in Our Experience.J Clin Med. 2024 Apr 10;13(8):2188. doi: 10.3390/jcm13082188. J Clin Med. 2024. PMID: 38673461 Free PMC article.
-
99mTc-macroaggregated albumin SPECT/CT predictive dosimetry and dose-response relationship in uveal melanoma liver metastases treated with first-line selective internal radiation therapy.Sci Rep. 2023 Aug 12;13(1):13118. doi: 10.1038/s41598-023-39994-7. Sci Rep. 2023. PMID: 37573346 Free PMC article.
-
Predictive Value of [99mTc]-MAA-Based Dosimetry in Hepatocellular Carcinoma Patients Treated with [90Y]-TARE: A Single-Center Experience.Diagnostics (Basel). 2023 Jul 20;13(14):2432. doi: 10.3390/diagnostics13142432. Diagnostics (Basel). 2023. PMID: 37510175 Free PMC article.
-
Predictive value of 99mTc-MAA-based dosimetry in personalized 90Y-SIRT planning for liver malignancies.EJNMMI Res. 2023 Jul 3;13(1):63. doi: 10.1186/s13550-023-01011-3. EJNMMI Res. 2023. PMID: 37395912 Free PMC article.
-
Improved Survival after Transarterial Radioembolisation for Hepatocellular Carcinoma Gives the Procedure Added Value.J Clin Med. 2022 Dec 16;11(24):7469. doi: 10.3390/jcm11247469. J Clin Med. 2022. PMID: 36556085 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical