Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 2/2015

01-04-2015 | Review/State of the Arti

Radioembolization Dosimetry: The Road Ahead

Authors: Maarten L. J. Smits, Mattijs Elschot, Daniel Y. Sze, Yung H. Kao, Johannes F. W. Nijsen, Andre H. Iagaru, Hugo W. A. M. de Jong, Maurice A. A. J. van den Bosch, Marnix G. E. H. Lam

Published in: CardioVascular and Interventional Radiology | Issue 2/2015

Login to get access

Abstract

Methods for calculating the activity to be administered during yttrium-90 radioembolization (RE) are largely based on empirical toxicity and efficacy analyses, rather than dosimetry. At the same time, it is recognized that treatment planning based on proper dosimetry is of vital importance for the optimization of the results of RE. The heterogeneous and often clustered intrahepatic biodistribution of millions of point-source radioactive particles poses a challenge for dosimetry. Several studies found a relationship between absorbed doses and treatment outcome, with regard to both toxicity and efficacy. This should ultimately lead to improved patient selection and individualized treatment planning. New calculation methods and imaging techniques and a new generation of microspheres for image-guided RE will all contribute to these improvements. The aim of this review is to give insight into the latest and most important developments in RE dosimetry and to suggest future directions on patient selection, individualized treatment planning, and study designs.
Literature
1.
Rosenbaum CE, Verkooijen HM, Lam MG, Smits ML, Koopman M et al (2013) Radioembolization for treatment of salvage patients with colorectal cancer liver metastases: a systematic review. J Nucl Med 54:1890–1895CrossRefPubMed
2.
Kennedy A, Coldwell D, Sangro B, Wasan H, Salem R (2012) Radioembolization for the treatment of liver tumors general principles. Am J Clin Oncol 35:91–99CrossRefPubMed
3.
Lewandowski RJ, Sato KT, Atassi B, Ryu RK, Nemcek AA Jr et al (2007) Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol 30:571–592CrossRefPubMed
4.
Hamami ME, Poeppel TD, Muller S, Heusner T, Bockisch A et al (2009) SPECT/CT with 99mTc-MAA in radioembolization with 90Y microspheres in patients with hepatocellular cancer. J Nucl Med 50:688–692CrossRefPubMed
5.
6.
Abdelmaksoud MH, Hwang GL, Louie JD, Kothary N, Hofmann LV et al (2010) Development of new hepaticoenteric collateral pathways after hepatic arterial skeletonization in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol 21:1385–1395CrossRefPubMed
7.
Salem R, Parikh P, Atassi B, Lewandowski RJ, Ryu RK et al (2008) Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution. Am J Clin Oncol 31:431–438CrossRefPubMed
8.
Lambert B, Mertens J, Sturm EJ, Stienaers S, Defreyne L et al (2010) 99mTc-labelled macroaggregated albumin (MAA) scintigraphy for planning treatment with 90Y microspheres. Eur J Nucl Med Mol Imaging 37:2328–2333CrossRefPubMed
9.
Hung JC, Redfern MG, Mahoney DW, Thorson LM, Wiseman GA (2000) Evaluation of macroaggregated albumin particle sizes for use in pulmonary shunt patient studies. J Am Pharm Assoc 40:46–51
10.
Lenoir L, Edeline J, Rolland Y, Pracht M, Raoul JL et al (2012) Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization. Eur J Nucl Med Mol Imaging 39:872–880CrossRefPubMedCentralPubMed
11.
Sangro B, Gil-Alzugaray B, Rodriguez J, Sola I, Martinez-Cuesta A et al (2008) Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer 112:1538–1546CrossRefPubMed
12.
Flamen P, Vanderlinden B, Delatte P, Ghanem G, Ameye L et al (2008) Multimodality imaging can predict the metabolic response of unresectable colorectal liver metastases to radioembolization therapy with yttrium-90 labeled resin microspheres. Phys Med Biol 53:6591–6603CrossRefPubMed
13.
Gray B, Van Hazel G, Hope M, Burton M, Moroz P et al (2001) Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 12:1711–1720CrossRefPubMed
14.
Vauthey JN, Abdalla EK, Doherty DA, Gertsch P, Fenstermacher MJ et al (2002) Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 8:233–240CrossRefPubMed
15.
16.
Lam MG, Louie JD, Abdelmaksoud MH, Fisher GA, Cho-Phan CD et al (2014) Limitations of body surface area-based activity calculation for radioembolization of hepatic metastases in colorectal cancer. J Vasc Interv Radiol 25:1085–1093CrossRefPubMed
17.
18.
Gulec SA, Mesoloras G, Stabin M (2006) Dosimetric techniques in 90Y-microsphere therapy of liver cancer: the MIRD equations for dose calculations. J Nucl Med 47:1209–1211PubMed
19.
Ho S, Lau WY, Leung TW, Johnson PJ (1998) Internal radiation therapy for patients with primary or metastatic hepatic cancer: a review. Cancer 83:1894–1907CrossRefPubMed
20.
Riaz A, Gates VL, Atassi B, Lewandowski RJ, Mulcahy MF et al (2011) Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization. Int J Radiat Oncol Biol Phys 79:163–171CrossRefPubMed
21.
Ho S, Lau WY, Leung TW, Chan M, Ngar YK et al (1996) Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours. Eur J Nucl Med 23:947–952CrossRefPubMed
22.
Lau WY, Kennedy AS, Kim YH, Lai HK, Lee RC et al (2012) Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres. Int J Radiat Oncol Biol Phys 82:401–407CrossRefPubMed
23.
Lam MG, Goris ML, Iagaru AH, Mittra ES, Louie JD et al (2013) Prognostic utility of 90Y radioembolization dosimetry based on fusion 99mTc-macroaggregated albumin-99mTc-sulfur colloid SPECT. J Nucl Med 54:2055–2061CrossRefPubMed
24.
Powerski MJ, Scheurig-Munkler C, Banzer J, Schnapauff D, Hamm B et al (2012) Clinical practice in radioembolization of hepatic malignancies: a survey among interventional centers in Europe. Eur J Radiol 81:e804–e811CrossRefPubMed
25.
Stuart JE, Tan B, Myerson RJ, Garcia-Ramirez J, Goddu SM et al (2008) Salvage radioembolization of liver-dominant metastases with a resin-based microsphere: initial outcomes. J Vasc Interv Radiol 19:1427–1433CrossRefPubMed
26.
Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347CrossRefPubMed
27.
Kao YH, Hock Tan AE, Burgmans MC, Irani FG, Khoo LS et al (2012) Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling for safe and effective 90Y radioembolization. J Nucl Med 53:559–566CrossRefPubMed
28.
Louie JD, Kothary N, Kuo WT, Hwang GL, Hofmann LV et al (2009) Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol 20:606–613CrossRefPubMed
29.
Van de Wiele C, Maes A, Brugman E, D’Asseler Y, De Spiegeleer B et al (2012) SIRT of liver metastases: physiological and pathophysiological considerations. Eur J Nucl Med Mol Imaging 39:1646–1655CrossRefPubMed
30.
Wondergem M, Smits ML, Elschot M, de Jong HW, Verkooijen HM et al (2013) 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic radioembolization. J Nucl Med 54:1294–1301CrossRefPubMed
31.
Jiang M, Fischman A, Nowakowski FS (2012) Segmental perfusion differences on paired Tc-99m macroaggregated albumin (MAA) hepatic perfusion imaging and yttrium-90 (Y-90) bremsstrahlung imaging studies in SIR-sphere radioembolization: associations with angiography. J Nucl Med Radiat Ther 3
32.
33.
Selwyn RG, Avila-Rodriguez MA, Converse AK, Hampel JA, Jaskowiak CJ et al (2007) 18F-labeled resin microspheres as surrogates for 90Y resin microspheres used in the treatment of hepatic tumors: a radiolabeling and PET validation study. Phys Med Biol 52:7397–7408CrossRefPubMed
34.
Avila-Rodriguez MA, Selwyn RG, Hampel JA, Thomadsen BR, Dejesus OT et al (2007) Positron-emitting resin microspheres as surrogates of 90Y SIR-spheres: a radiolabeling and stability study. Nucl Med Biol 34:585–590CrossRefPubMed
35.
Maziere B, Loc’h C, Steinling M, Comar D (1986) Stable labelling of serum albumin microspheres with gallium-68. Int J Radiat Appl Instrum A 37:360–361CrossRef
36.
Schiller E, Bergmann R, Pietzsch J, Noll B, Sterger A et al (2008) Yttrium-86-labelled human serum albumin microspheres: relation of surface structure with in vivo stability. Nucl Med Biol 35:227–232CrossRefPubMed
37.
Smits ML, Nijsen JF, van den Bosch MA, Lam MG, Vente MA et al (2012) Holmium-166 radioembolisation in patients with unresectable, chemorefractory liver metastases (HEPAR trial): a phase 1, dose-escalation study. Lancet Oncol 13:1025–1034CrossRefPubMed
38.
Elschot M, Smits ML, Nijsen JF, Lam MG, Zonnenberg BA et al (2013) Quantitative Monte Carlo-based holmium-166 SPECT reconstruction. Med Phys 40:112502CrossRefPubMed
39.
van de Maat GH, Seevinck PR, Elschot M, Smits ML, de Leeuw H et al (2012) MRI-based biodistribution assessment of holmium-166 poly(l-lactic acid) microspheres after radioembolisation. Eur Radiol 23:827–835CrossRefPubMedCentralPubMed
40.
Lhommel R, van Elmbt L, Goffette P, Van den Eynde M, Jamar F et al (2010) Feasibility of 90Y TOF PET-based dosimetry in liver metastasis therapy using SIR-Spheres. Eur J Nucl Med Mol Imaging 37:1654–1662CrossRefPubMed
41.
Kao YH, Tan EH, Teo TK, Ng CE, Goh SW (2011) Imaging discordance between hepatic angiography versus Tc-99m-MAA SPECT/CT: a case series, technical discussion and clinical implications. Ann Nucl Med 25:669–676CrossRefPubMed
42.
Chang TT, Bourgeois AC, Balius AM, Pasciak AS (2013) Treatment modification of yttrium-90 radioembolization based on quantitative positron emission tomography/CT imaging. J Vasc Interv Radiol 24:333–337CrossRefPubMed
43.
Lam MG, Louie JD, Iagaru AH, Goris ML, Sze DY (2013) Safety of repeated yttrium-90 radioembolization. Cardiovasc Intervent Radiol 36:1320–1328CrossRefPubMed
44.
Elschot M, Vermolen BJ, Lam MG, de Keizer B, van den Bosch MA et al (2013) Quantitative comparison of PET and Bremsstrahlung SPECT for imaging the in vivo yttrium-90 microsphere distribution after liver radioembolization. PLoS ONE 8:e55742CrossRefPubMedCentralPubMed
45.
Elschot M, Nijsen JF, Dam AJ, de Jong HW (2011) Quantitative evaluation of scintillation camera imaging characteristics of isotopes used in liver radioembolization. PLoS ONE 6:e26174CrossRefPubMedCentralPubMed
46.
Rong X, Du Y, Ljungberg M, Rault E, Vandenberghe S et al (2012) Development and evaluation of an improved quantitative (90)Y bremsstrahlung SPECT method. Med Phys 39:2346–2358CrossRefPubMedCentralPubMed
47.
Elschot M, Lam MG, van den Bosch MA, Viergever MA, de Jong HW (2013) Quantitative Monte Carlo-based 90Y SPECT reconstruction. J Nucl Med 54:1557–1563CrossRefPubMed
48.
49.
Carlier T, Eugene T, Bodet-Milin C, Garin E, Ansquer C et al (2013) Assessment of acquisition protocols for routine imaging of Y-90 using PET/CT. EJNMMI Res 3:11CrossRefPubMedCentralPubMed
50.
Gupta T, Virmani S, Neidt TM, Szolc-Kowalska B, Sato KT et al (2008) MR tracking of iron-labeled glass radioembolization microspheres during transcatheter delivery to rabbit VX2 liver tumors: feasibility study. Radiology 249:845–854CrossRefPubMed
51.
Li W, Zhang Z, Guo Y, Nicolai J, Reed A, Larson A (2013) SPIO-labeled 90Y microspheres permit accurate quantification of macroscopic intra-hepatic biodistribution. Paper presented at International Society for Magnetic Resonance in Medicine, Salt Lake City, UT
52.
Smits ML, Elschot M, van den Bosch MA, van de Maat GH, van Het Schip AD et al (2013) In vivo dosimetry based on SPECT and MR imaging of 166Ho-microspheres for treatment of liver malignancies. J Nucl Med 54:2093–2100CrossRefPubMed
53.
Seppenwoolde JH, Bartels LW, van der Weide R, Nijsen JF, van het Schip AD et al (2006) Fully MR-guided hepatic artery catheterization for selective drug delivery: a feasibility study in pigs. J Magn Reson Imaging 23:123–129CrossRefPubMed
54.
Kos S, Huegli R, Bongartz GM, Jacob AL, Bilecen D (2008) MR-guided endovascular interventions: a comprehensive review on techniques and applications. Eur Radiol 18:645–657CrossRefPubMed
Metadata
Title
Radioembolization Dosimetry: The Road Ahead
Authors
Maarten L. J. Smits
Mattijs Elschot
Daniel Y. Sze
Yung H. Kao
Johannes F. W. Nijsen
Andre H. Iagaru
Hugo W. A. M. de Jong
Maurice A. A. J. van den Bosch
Marnix G. E. H. Lam
Publication date
01-04-2015
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 2/2015
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-014-1042-7

Other articles of this Issue 2/2015

CardioVascular and Interventional Radiology 2/2015 Go to the issue

Case Report

Spontaneous Solitaire™ AB Thrombectomy Stent Detachment During Stroke Treatment

Case Report

Microwave Ablation (MWA) for the Treatment of a Solitary, Chemorefractory Testicular Cancer Liver Metastasis

Clinical Investigation

Irreversible Electroporation (IRE) Fails to Demonstrate Efficacy in a Prospective Multicenter Phase II Trial on Lung Malignancies: The ALICE Trial

Clinical Investigation

Diagnostic Accuracy of MRI-guided Percutaneous Transthoracic Needle Biopsy of Solitary Pulmonary Nodules

Letter to the Editor

Bailout Alternative Use of Re-entry Device to Achieve a Chronically Occluded Superficial Artery Recanalization without Detectable Origin

Technical Note

Radiation Protection Methods for the Interventionalist’s Hands: Use of an Extension Tube