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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-05-2021 | Hepatocellular Carcinoma | Guidelines

International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

Authors: Hugo Levillain, Oreste Bagni, Christophe M. Deroose, Arnaud Dieudonné, Silvano Gnesin, Oliver S. Grosser, S. Cheenu Kappadath, Andrew Kennedy, Nima Kokabi, David M. Liu, David C. Madoff, Armeen Mahvash, Antonio Martinez de la Cuesta, David C. E. Ng, Philipp M. Paprottka, Cinzia Pettinato, Macarena Rodríguez-Fraile, Riad Salem, Bruno Sangro, Lidia Strigari, Daniel Y. Sze, Berlinda J. de Wit van der veen, Patrick Flamen

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 5/2021

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.

Available only for authorised users

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Title: International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres
Authors: Hugo Levillain
Oreste Bagni
Christophe M. Deroose
Arnaud Dieudonné
Silvano Gnesin
Oliver S. Grosser
S. Cheenu Kappadath
Andrew Kennedy
Nima Kokabi
David M. Liu
David C. Madoff
Armeen Mahvash
Antonio Martinez de la Cuesta
David C. E. Ng
Philipp M. Paprottka
Cinzia Pettinato
Macarena Rodríguez-Fraile
Riad Salem
Bruno Sangro
Lidia Strigari
Daniel Y. Sze
Berlinda J. de Wit van der veen
Patrick Flamen
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 5/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-020-05163-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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