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
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
EJNMMI Research
Published in: EJNMMI Research 1/2021

01-12-2021 | Computed Tomography | Original research

Impact of contouring methods on pre-treatment and post-treatment dosimetry for the prediction of tumor control and survival in HCC patients treated with selective internal radiation therapy

Authors: Guillaume Nodari, Romain Popoff, Jean Marc Riedinger, Olivier Lopez, Julie Pellegrinelli, Inna Dygai-Cochet, Claire Tabouret-Viaud, Benoit Presles, Olivier Chevallier, Sophie Gehin, Matthieu Gallet, Marianne Latournerie, Sylvain Manfredi, Romaric Loffroy, Jean Marc Vrigneaud, Alexandre Cochet

Published in: EJNMMI Research | Issue 1/2021

Login to get access

Abstract

Introduction

The aim of this study was to evaluate the impact of the contouring methods on dose metrics and their predictive value on tumor control and survival, in both situations of pre-treatment and post-treatment dosimetry, for patients with advanced HCC treated with SIRT.

Methods

Forty-eight patients who underwent SIRT between 2012 and 2020 were retrospectively included in this study. Target volumes were delineated using two methods: MRI-based contours manually drawn by a radiologist and then registered on SPECT/CT and PET/CT via deformable registration (Pre-CMRI and Post-CMRI), 99mTc-MAA-SPECT and 90Y-microspheres-PET 10% threshold contouring (Pre-CSPECT and Post-CPET). The mean absorbed dose (Dm) and the minimal absorbed dose delivered to 70% of the tumor volume (D70) were evaluated with both contouring methods; the tumor-to-normal liver uptake ratio (TNR) was evaluated with MRI-based contours only. Tumor response was assessed using the mRECIST criteria on the follow-up MRIs.

Results

No significant differences were found for Dm and TNR between pre- and post-treatment. TNR evaluated with radiologic contours (Pre-CMRI and Post-CMRI) were predictive of tumor control at 6 months on pre- and post-treatment dosimetry (OR 5.9 and 7.1, respectively; p = 0.02 and 0.01). All dose metrics determined with both methods were predictive of overall survival (OS) on pre-treatment dosimetry, but only Dm with MRI-based contours was predictive of OS on post-treatment images with a median of 23 months for patients with a supramedian Dm versus 14 months for the others (p = 0.04).

Conclusion

In advanced HCC treated with SIRT, Dm and TNR determined with radiologic contours were predictive of tumor control and OS. This study shows that a rigorous clinical workflow (radiologic contours + registration on scintigraphic images) is feasible and should be prospectively considered for improving therapeutic strategy.
Literature
1.
Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2017;3:524–48.PubMedCentralCrossRef
2.
European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.CrossRef
3.
Sangro B, Salem R, Kennedy A, Coldwell D, Wasan H. Radioembolization for hepatocellular carcinoma: a review of the evidence and treatment recommendations. Am J Clin Oncol. 2011;34:422–31.PubMedCrossRef
4.
Loffroy R, Ronot M, Greget M, Bouvier A, Mastier C, Sengel C, et al. Short-term safety and quality of life outcomes following radioembolization in primary and secondary liver tumours: a multi-centre analysis of 200 patients in France. Cardiovasc Intervent Radiol. 2020;44:36–49.PubMedPubMedCentralCrossRef
5.
Salem R, Lewandowski RJ, Kulik L, Wang E, Riaz A, Ryu RK, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011;140(497–507):e2.
6.
Vilgrain V, Abdel-Rehim M, Sibert A, Ronot M, Lebtahi R, Castéra L, et al. Radioembolisation with yttrium-90 microspheres versus sorafenib for treatment of advanced hepatocellular carcinoma (SARAH): study protocol for a randomised controlled trial. Trials. 2014;15:474.PubMedPubMedCentralCrossRef
7.
Chow PKH, Gandhi M, Tan S-B, Khin MW, Khasbazar A, Ong J, et al. SIRveNIB: selective internal radiation therapy versus sorafenib in Asia-Pacific patients with hepatocellular carcinoma. J Clin Oncol. 2018;36:1913–21.PubMedCrossRef
8.
Venerito M, Pech M, Canbay A, Donghia R, Guerra V, Chatellier G, et al. NEMESIS: non-inferiority, individual patient meta-analysis of selective internal radiation therapy with yttrium-90 resin microspheres versus sorafenib in advanced hepatocellular carcinoma. J Nucl Med. 2020;61(12):1736–42.PubMedCrossRef
9.
Garin E, Lenoir L, Rolland Y, Edeline J, Mesbah H, Laffont S, et al. Dosimetry based on 99mTc-macroaggregated albumin SPECT/CT accurately predicts tumor response and survival in hepatocellular carcinoma patients treated with 90Y-loaded glass microspheres: preliminary results. J Nucl Med. 2012;53:255–63.PubMedCrossRef
10.
Song YS, Paeng JC, Kim H-C, Chung JW, Cheon GJ, Chung J-K, et al. PET/CT-based dosimetry in 90Y-microsphere selective internal radiation therapy: single cohort comparison with pretreatment planning on (99m)Tc-MAA imaging and correlation with treatment efficacy. Medicine (Baltimore). 2015;94:e945.CrossRef
11.
Kafrouni M, Allimant C, Fourcade M, Vauclin S, Delicque J, Ilonca A-D, et al. Retrospective voxel-based dosimetry for assessing the ability of the body-surface-area model to predict delivered dose and radioembolization outcome. J Nucl Med. 2018;59:1289–95.PubMedCrossRef
12.
Kao Y-H, Steinberg JD, Tay Y-S, Lim GK, Yan J, Townsend DW, et al. Post-radioembolization yttrium-90 PET/CT—part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI Res. 2013;3:57.PubMedPubMedCentralCrossRef
13.
Hermann A-L, Dieudonné A, Ronot M, Sanchez M, Pereira H, Chatellier G, et al. Relationship of tumor radiation-absorbed dose to survival and response in hepatocellular carcinoma treated with transarterial radioembolization with 90Y in the SARAH study. Radiology. 2020;296(3):673–84.PubMedCrossRef
14.
Garin E, Tselikas L, Guiu B, Chalaye J, Edeline J, de Baere T, et al. Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial. Lancet Gastroenterol Hepatol. 2021;6:17–29.PubMedCrossRef
15.
Gnesin S, Canetti L, Adib S, Cherbuin N, Silva Monteiro M, Bize P, et al. Partition model-based 99mTc-MAA SPECT/CT predictive dosimetry compared with 90Y TOF PET/CT posttreatment dosimetry in radioembolization of hepatocellular carcinoma: a quantitative agreement comparison. J Nucl Med. 2016;57:1672–8.PubMedCrossRef
16.
Jadoul A, Bernard C, Lovinfosse P, Gérard L, Lilet H, Cornet O, et al. Comparative dosimetry between 99mTc-MAA SPECT/CT and 90Y PET/CT in primary and metastatic liver tumors. Eur J Nucl Med Mol Imaging. 2020;47:828–37.PubMedCrossRef
17.
Kafrouni M, Allimant C, Fourcade M, Vauclin S, Guiu B, Mariano-Goulart D, et al. Analysis of differences between 99mTc-MAA SPECT- and 90Y-microsphere PET-based dosimetry for hepatocellular carcinoma selective internal radiation therapy. EJNMMI Res. 2019;9:62.PubMedPubMedCentralCrossRef
18.
Willowson KP, Tapner M, QUEST Investigator Team, Bailey DL. A multicentre comparison of quantitative (90)Y PET/CT for dosimetric purposes after radioembolization with resin microspheres: the QUEST phantom study. Eur J Nucl Med Mol Imaging. 2015;42:1202–22.PubMedPubMedCentralCrossRef
19.
Bernardini M, Thevenet H, Berthold C, Desbrée A, Smadja C, Desiré C, et al. Optimisation of reconstruction, volumetry and dosimetry for 99mTc-SPECT and 90Y-PET images: towards reliable dose-volume histograms for selective internal radiation therapy with 90Y-microspheres. Phys Med PM Int J Devoted Appl Phys Med Biol. 2017;39:147–55.
20.
Garin E, Lenoir L, Rolland Y, Laffont S, Pracht M, Mesbah H, et al. Effectiveness of quantitative MAA SPECT/CT for the definition of vascularized hepatic volume and dosimetric approach: phantom validation and clinical preliminary results in patients with complex hepatic vascularization treated with yttrium-90-labeled microspheres. Nucl Med Commun. 2011;32:1245–55.PubMedCrossRef
21.
Chiesa C, Mira M, Maccauro M, Spreafico C, Romito R, Morosi C, et al. 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;42:1718–38.PubMedCrossRef
22.
Garin E, Rolland Y, Laffont S, Edeline J. Clinical impact of (99m)Tc-MAA SPECT/CT-based dosimetry in the radioembolization of liver malignancies with (90)Y-loaded microspheres. Eur J Nucl Med Mol Imaging. 2016;43:559–75.PubMedCrossRef
23.
Garin E, Rolland Y, Edeline J. 90Y-loaded microsphere SIRT of HCC patients with portal vein thrombosis: high clinical impact of 99mTc-MAA SPECT/CT-based dosimetry. Semin Nucl Med. 2019;49:218–26.PubMedCrossRef
24.
Meyers N, Jadoul A, Bernard C, Delwaide J, Lamproye A, Detry O, et al. Inter-observer variability of 90Y PET/CT dosimetry in hepatocellular carcinoma after glass microspheres transarterial radioembolization. EJNMMI Phys. 2020;7:29.PubMedPubMedCentralCrossRef
25.
Giammarile F, Bodei L, Chiesa C, Flux G, Forrer F, Kraeber-Bodere F, et al. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging. 2011;38:1393–406.PubMedCrossRef
26.
27.
Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30:52–60.PubMedCrossRef
28.
Seyal AR, Gonzalez-Guindalini FD, Arslanoglu A, Harmath CB, Lewandowski RJ, Salem R, et al. Reproducibility of mRECIST in assessing response to transarterial radioembolization therapy in hepatocellular carcinoma. Hepatol Baltim Md. 2015;62:1111–21.CrossRef
29.
Vogel A, Cervantes A, Chau I, Daniele B, Llovet JM, Meyer T, et al. Hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29:iv238–55.PubMedCrossRef
30.
Salem R, Lewandowski RJ, Sato KT, Atassi B, Ryu RK, Ibrahim S, et al. Technical aspects of radioembolization with 90Y microspheres. Tech Vasc Interv Radiol. 2007;10:12–29.PubMedCrossRef
31.
Piper J, Nelson A, Harper J. Deformable image registration in MIM Maestro® evaluation and description, 5.
32.
33.
Pasciak AS, Bourgeois AC, Bradley YC. A comparison of techniques for (90)Y PET/CT image-based dosimetry following radioembolization with resin microspheres. Front Oncol. 2014;4:121.PubMedPubMedCentral
34.
Garin E, Tzelikas L, Guiu B, Chalaye J, Edeline J, De Baere T, et al. Major impact of personalized dosimetry using 90Y loaded glass microspheres SIRT in HCC: final overall survival analysis of a multicenter randomized phase II study (DOSISPHERE-01). J Clin Oncol. 2020;38:516–516.CrossRef
35.
Pacilio M, Ferrari M, Chiesa C, Lorenzon L, Mira M, Botta F, et al. Impact of SPECT corrections on 3D-dosimetry for liver transarterial radioembolization using the patient relative calibration methodology. Med Phys. 2016;43:4053.PubMedCrossRef
36.
Brosch J, Gosewisch A, Kaiser L, Seidensticker M, Ricke J, Zellmer J, et al. 3D image-based dosimetry for Yttrium-90 radioembolization of hepatocellular carcinoma: impact of imaging method on absorbed dose estimates. Phys Med PM Int J Devoted Appl Phys Med Biol. 2020;80:317–26.
37.
Carlier T, Eugène T, Bodet-Milin C, Garin E, Ansquer C, Rousseau C, et al. Assessment of acquisition protocols for routine imaging of Y-90 using PET/CT. EJNMMI Res. 2013;3:11.PubMedPubMedCentralCrossRef
38.
Siman W, Mawlawi OR, Mourtada F, Kappadath SC. Systematic and random errors of PET-based 90 Y 3D dose quantification. Med Phys. 2020;47:2441–9.PubMedCrossRef
39.
Ho S, Lau WY, Leung TW, Chan M, Johnson PJ, Li AK. Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med. 1997;24:293–8.PubMed
40.
Wondergem M, Smits MLJ, Elschot M, de Jong HWAM, Verkooijen HM, van den Bosch MAAJ, et al. 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic radioembolization. J Nucl Med. 2013;54:1294–301.PubMedCrossRef
41.
Knesaurek K, Machac J, Muzinic M, DaCosta M, Zhang Z, Heiba S. Quantitative comparison of yttrium-90 (90Y)-microspheres and technetium-99m (99mTc)-macroaggregated albumin SPECT images for planning 90Y therapy of liver cancer. Technol Cancer Res Treat. 2010;9:253–62.PubMedCrossRef
42.
Mikell JK, Majdalany BS, Owen D, Paradis KC, Dewaraja YK. Assessing spatial concordance between theranostic pairs using phantom and patient-specific acceptance criteria: application to 99mTc-MAA SPECT/90Y-microsphere PET. Int J Radiat Oncol Biol Phys. 2019;104:1133–40.PubMedCrossRefPubMedCentral
43.
Lassmann M, Eberlein U, Tran-Gia J. Multicentre trials on standardised quantitative imaging and dosimetry for radionuclide therapies. Clin Oncol R Coll Radiol G B. 2020;33:125–30.CrossRef
44.
Garin E, Palard X, Rolland Y. Personalised dosimetry in radioembolisation for HCC: impact on clinical outcome and on trial design. Cancers. 2020;12:1557.PubMedCentralCrossRef
45.
Chan KT, Alessio AM, Johnson GE, Vaidya S, Kwan SW, Monsky W, et al. Prospective trial using internal pair-production positron emission tomography to establish the yttrium-90 radioembolization dose required for response of hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2018;101:358–65.PubMedCrossRef
46.
Cremonesi M, Chiesa C, Strigari L, Ferrari M, Botta F, Guerriero F, et al. Radioembolization of hepatic lesions from a radiobiology and dosimetric perspective. Front Oncol. 2014;4:210.PubMedPubMedCentralCrossRef
Metadata
Title
Impact of contouring methods on pre-treatment and post-treatment dosimetry for the prediction of tumor control and survival in HCC patients treated with selective internal radiation therapy
Authors
Guillaume Nodari
Romain Popoff
Jean Marc Riedinger
Olivier Lopez
Julie Pellegrinelli
Inna Dygai-Cochet
Claire Tabouret-Viaud
Benoit Presles
Olivier Chevallier
Sophie Gehin
Matthieu Gallet
Marianne Latournerie
Sylvain Manfredi
Romaric Loffroy
Jean Marc Vrigneaud
Alexandre Cochet
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2021
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/s13550-021-00766-x

Other articles of this Issue 1/2021

EJNMMI Research 1/2021 Go to the issue

Original research

Prognostic superiority of International Prognostic Index over [18F]FDG PET/CT volumetric parameters in post-transplant lymphoproliferative disorder

Original research

The effect of eating on the uptake of PSMA ligands in the salivary glands

Original research

A physiologically based pharmacokinetic (PBPK) model to describe organ distribution of 68Ga-DOTATATE in patients without neuroendocrine tumors

Original research

Risk factors for nonvisualization of the sentinel lymph node on lymphoscintigraphy in breast cancer patients

Review

Imaging modalities for diagnosis and monitoring of cancer cachexia

Original research

GMP-compliant fully automated radiosynthesis of [18F]FEPPA for PET/MRI imaging of regional brain TSPO expression