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Current status of transarterial radioembolization.

ABSTRACT: Unresectable primary and secondary liver malignancies present a major problem in the treatment of solid tumors. Transarterial radioembolization (TARE) is an increasingly used technique for treating various types of malignant liver tumors. This approach is appealing, as the mechanism of action is independent from other loco-regional treatments and potentially complementary to systemic therapies. There are two commercially available products in use for TARE: (90)Y-resin and (90)Y-glass microspheres. Currently available data indicates TARE so be safe and effective in hepatocellular carcinoma (HCC) and metastatic liver disease. In HCC the results compare well with chemoembolization, while the role of TARE in combination with kinase inhibitors has yet to be established. Current data on TARE in metastatic liver disease is promising, but there is a strong need for prospective randomized trials comparing TARE and modern chemotherapeutic regimen to support the growing role of TARE in metastatic liver disease.

SUBMITTER: Mahnken AH

PROVIDER: S-EPMC4882402 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Current status of transarterial radioembolization.

Mahnken Andreas H AH

World journal of radiology 20160501 5

Unresectable primary and secondary liver malignancies present a major problem in the treatment of solid tumors. Transarterial radioembolization (TARE) is an increasingly used technique for treating various types of malignant liver tumors. This approach is appealing, as the mechanism of action is independent from other loco-regional treatments and potentially complementary to systemic therapies. There are two commercially available products in use for TARE: (90)Y-resin and (90)Y-glass microsphere ...[more]

PMID: 27247711

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Project description:Transarterial radioembolization (TARE) effectively treats unresectable primary and metastatic liver tumors through intra-arterial injection of Yttrium-90 (90 Y) beta particle emitting microspheres which implant around the tumor. Current dosimetry models are highly simplistic and there is a large need for an image-based dosimetry post-TARE, which would improve treatment safety and efficacy. Current post-TARE imaging is 90 Y bremsstrahlung SPECT/CT and we study the use of these images for dosimetry. Retrospective image review of ten patients having a Philips HealthcareTM SPECT/CT following TARE SIR-Spheres® implantation. Emission series with attenuation correction were resampled to 3 mm 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 a dose convolution method (WFBH). We sought to implement a patient-specific background subtraction prior to dose calculation to make these noisy bremsstrahlung SPECT images suitable for post-TARE dosimetry. On average the percentage of mean background counts to maximum count in the image across all patients was 9.4 ± 4.9% (maximum = 7.6%, minimum = 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 was statistically the same. As background subtraction value increased, the DVH curves become unrealistic and distorted. Background subtraction on bremsstrahlung SPECT image has a large effect on post-TARE dosimetry. The background contour 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. Using the mean count in the background contour as a subtraction across the entire image gave the most realistic dose distributions. This methodology is independent of microsphere and software manufacturer allowing for use with any available products or tools.

Project description:INTRODUCTION:Strong correlation has been demonstrated between tumor dose and response and between healthy liver dose and side effects. Individualized dosimetry is increasingly recommended in the current clinical routine. However, hepatic and tumor segmentations could be complex in some cases. The aim of this study is to assess the reproducibility of the tumoral and non-tumoral liver dosimetry in selective internal radiation therapy (SIRT). MATERIAL AND METHODS:Twenty-three patients with hepatocellular carcinoma (HCC) who underwent SIRT with glass microspheres were retrospectively included in the study. Tumor (TV) and total liver volumes (TLV), and mean absorbed doses in tumoral liver (TD) and non-tumoral liver (THLD) were determined on the 90Y PET/CT studies using Simplicit90YTM software, by three independent observers. Dosimetry datasets were obtained by a medical physicist helped by a nuclear medicine (NM) physician with 10?years of experience (A), by a NM physician with 4-year experience (B), and by a resident who first performed 10 dosimetry assessments as a training (C). Inter-observer agreement was evaluated using intra-class correlation coefficients (ICC), coefficients of variation (CV), Bland-Altman plots, and reproducibility coefficient (RDC). RESULTS:A strong agreement was observed between all three readers for estimating TLV (ICC 0.98) and THLD (ICC 0.97). Agreement was lower for TV delineation (ICC 0.94) and particularly for TD (ICC 0.73), especially for the highest values. Regarding TD, the CV (%) was 26.5, 26.9, and 20.2 between observers A and B, A and C, and B and C, respectively, and the RDC was 1.5. Regarding THLD, it was 8.5, 12.7, and 9.4, and the RDC was 1.3. CONCLUSION:Using a standardized methodology, and regardless of the different experiences of the observers, the estimation of THLD is highly reproducible. Although the reproducibility of the assessment of tumor irradiation is overall quite high, large variations may be observed in a limited number of patients.

Dataset Information

Current status of transarterial radioembolization.

Publications

Current status of transarterial radioembolization.

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