Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling for safe and effective 90Y radioembolization

J Nucl Med. 2012 Apr;53(4):559-66. doi: 10.2967/jnumed.111.097469. Epub 2012 Feb 17.

Abstract

Compliance with radiobiologic principles of radionuclide internal dosimetry is fundamental to the success of (90)Y radioembolization. The artery-specific SPECT/CT partition model is an image-guided personalized predictive dosimetric technique developed by our institution, integrating catheter-directed CT hepatic angiography (CTHA), (99m)Tc-macroaggregated albumin SPECT/CT, and partition modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates (99m)Tc-macroaggregated albumin hepatic biodistribution. The partition model is validated for (90)Y resin microspheres based on MIRD macrodosimetry.

Methods: This was a retrospective analysis of our early clinical outcomes for inoperable hepatocellular carcinoma. Mapping hepatic angiography was performed according to standard technique with the addition of catheter-directed CTHA. (99m)Tc-MAA planar scintigraphy was used for liver-to-lung shunt estimation, and SPECT/CT was used for liver dosimetry. Artery-specific SPECT/CT partition modeling was planned by experienced nuclear medicine physicians.

Results: From January to May 2011, 20 arterial territories were treated in 10 hepatocellular carcinoma patients. Median follow-up was 21 wk (95% confidence interval [CI], 12-50 wk). When analyzed strictly as brachytherapy, (90)Y radioembolization planned by predictive dosimetry achieved index tumor regression in 8 of 8 patients, with a median size decrease of 58% (95% CI, 40%-72%). Tumor thrombosis regressed or remained stable in 3 of 4 patients with baseline involvement. The best α-fetoprotein reduction ranged from 32% to 95%. Clinical success was achieved in 7 of 8 patients, including 2 by sublesional dosimetry, in 1 of whom there was radioembolization lobectomy intent. Median predicted mean radiation absorbed doses were 106 Gy (95% CI, 105-146 Gy) to tumor, 27 Gy (95% CI, 22-33 Gy) to nontumorous liver, and 2 Gy (95% CI, 1.3-7.3 Gy) to lungs. Across all patients, tumor, nontumorous liver, and lungs received predicted ≥91 Gy, ≤51 Gy, and ≤16 Gy, respectively, via at least 1 target arterial territory. No patients developed significant toxicities within 3 mo after radioembolization. The median time to best imaging response was 76 d (95% CI, 55-114 d). Median time to progression and overall survival were not reached. SPECT/CT-derived mean tumor-to-normal liver ratios varied widely across all planning target volumes (median, 5.4; 95% CI, 4.1-6.7), even within the same patient.

Conclusion: Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling achieves high clinical success rates for safe and effective (90)Y radioembolization.

MeSH terms

  • Aged
  • Arteries / diagnostic imaging*
  • Carcinoma, Hepatocellular / blood supply
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / therapy
  • Embolization, Therapeutic / adverse effects*
  • Embolization, Therapeutic / methods*
  • Humans
  • Liver Neoplasms / blood supply
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / therapy
  • Male
  • Middle Aged
  • Models, Biological
  • Multimodal Imaging*
  • Organ Specificity
  • Positron-Emission Tomography*
  • Precision Medicine / methods*
  • Radiometry
  • Retrospective Studies
  • Safety*
  • Tomography, X-Ray Computed*
  • Treatment Outcome
  • Yttrium Radioisotopes / adverse effects
  • Yttrium Radioisotopes / therapeutic use

Substances

  • Yttrium Radioisotopes