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European Journal of Nuclear Medicine and Molecular Imaging

Open Access 27-09-2024 | Hepatocellular Carcinoma | Original Article

Utility of pre-procedural [^99mTc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of ⁹⁰Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [^99mTc]TcMAA-based Segmentation

Authors: Marnix Lam, Etienne Garin, Paul Haste, Alban Denys, Brian Geller, S. Cheenu Kappadath, Cuneyt Turkmen, Daniel Y. Sze, Hamad Saleh Alsuhaibani, Ken Herrmann, Marco Maccauro, Murat Cantasdemir, Matthew Dreher, Kirk D. Fowers, Vanessa Gates, Riad Salem

Published in: European Journal of Nuclear Medicine and Molecular Imaging

Abstract

Purpose

Pre-treatment [^99mTc]TcMAA-based radioembolization treatment planning using multicompartment dosimetry involves the definition of the tumor and normal tissue compartments and calculation of the prescribed absorbed doses. The aim was to compare the real-world utility of anatomic and [^99mTc]TcMAA-based segmentation of tumor and normal tissue compartments.

Materials and methods

Included patients had HCC treated by glass [⁹⁰Y]yttrium microspheres, ≥ 1 tumor, ≥ 3 cm diameter and [^99mTc]TcMAA SPECT/CT imaging before treatment. Segmentation was performed retrospectively using dedicated dosimetry software: (1) anatomic (diagnostic CT/MRI-based), and (2) [^99mTc]TcMAA threshold-based (i.e., using an activity-isocontour threshold). CT/MRI was co-registered with [^99mTc]TcMAA SPECT/CT. Logistic regression and Cox regression, respectively, were used to evaluate relationships between total perfused tumor absorbed dose (TAD) and objective response rate (ORR) and overall survival (OS). In a subset-analysis pre- and post-treatment dosimetry were compared using Bland-Altman analysis and Pearson’s correlation coefficient.

Results

A total of 209 patients were enrolled. Total perfused tumor and normal tissue volumes were larger when using anatomic versus [^99mTc]TcMAA threshold segmentation, resulting in lower absorbed doses. mRECIST ORR was higher with increasing total perfused TAD (odds ratio per 100 Gy TAD increase was 1.22 (95% CI: 1.01–1.49; p = 0.044) for anatomic and 1.19 (95% CI: 1.04–1.37; p = 0.012) for [^99mTc]TcMAA threshold segmentation. Higher total perfused TAD was associated with improved OS (hazard ratio per 100 Gy TAD increase was 0.826 (95% CI: 0.714–0.954; p = 0.009) and 0.847 (95% CI: 0.765–0.936; p = 0.001) for anatomic and [^99mTc]TcMAA threshold segmentation, respectively). For pre- vs. post-treatment dosimetry comparison, the average bias for total perfused TAD was + 11.5 Gy (95% limits of agreement: -227.0 to 250.0) with a strong positive correlation (Pearson’s correlation coefficient = 0.80).

Conclusion

Real-world data support [^99mTc]TcMAA imaging to estimate absorbed doses prior to treatment of HCC with glass [⁹⁰Y]yttrium microspheres. Both anatomic and [^99mTc]TcMAA threshold methods were suitable for treatment planning.

Trial registration number

NCT03295006.

Available only for authorised users

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Title: Utility of pre-procedural [99mTc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of 90Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [99mTc]TcMAA-based Segmentation
Authors: Marnix Lam
Etienne Garin
Paul Haste
Alban Denys
Brian Geller
S. Cheenu Kappadath
Cuneyt Turkmen
Daniel Y. Sze
Hamad Saleh Alsuhaibani
Ken Herrmann
Marco Maccauro
Murat Cantasdemir
Matthew Dreher
Kirk D. Fowers
Vanessa Gates
Riad Salem
Publication date: 27-09-2024
Publisher: Springer Berlin Heidelberg
Keywords: Hepatocellular Carcinoma
Hepatocellular Carcinoma
Positron Emission Tomography
Published in: European Journal of Nuclear Medicine and Molecular Imaging
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-024-06920-6

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Utility of pre-procedural [^99mTc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of ⁹⁰Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [^99mTc]TcMAA-based Segmentation

Abstract

Purpose

Materials and methods

Results

Conclusion

Trial registration number

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Trial registration number

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