Comparison of Dosimetry Results Before 90Y Microembolization Treatment with 99mTc MAA and After 90Y PET/CT Treatment
Abstract
Radioembolization with Yttrium-90 (90Y) microspheres stands as an effective treatment option for liver tumors. The suitability of a patient for this treatment is routinely determined through dosimetry based on Technetium-99m Macro Aggregated Albumin (99mTc MAA) SPECT/CT images. This study aims to compare pre-treatment (pre) dosimetry results with 99mTc MAA and post-treatment (post) dosimetry results after 90Y microsphere therapy in patients seeking liver tumor treatment. Eleven patients undergoing liver tumor treatment were randomly included in the study. In 99mTc-MAA dosimetry, the calculated treatment activity was 1.3-6.2 GBq (mean 3.2±1.4), tumor dose was 125.1-527.5 Gy (mean 264.7±139.4), and liver dose was 19.4-38.8 Gy (mean 31.9±5.8). Post-dosimetry using PET/CT images after 90Y microsphere therapy revealed a tumor dose of 156.2-480.4 Gy (mean 266.5±102.9) and a liver dose of 20.6-37.4 Gy (mean 29.1±5.2). The doses exhibited good conformity for both tumor and normal liver tissue (p=0.85716 and p=0.53526, respectively). In conclusion, PET/CT-based post-dosimetry with 90Y microspheres proved to be an effective method in determining liver parenchymal tissue and tumor doses.
Ethical Statement
The study was approved by the Local Ethics Committee of Cerrahpasa Faculty of Medicine/Istanbul University-Cerrahpasa in accordance with the Helsinki Declaration (Approval No: 83045809-604.01.02-). Informed consent was obtained from all participating patients.
References
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- Bozkurt M. F. Personalized Treatment and Protection from Side Effects. Nuclear Medicine Seminars 2019;5(2),:122-31.
- Villalobos A, Soliman MM, Majdalany BS, et al. Yttrium-90 radioembolization dosimetry: what trainees need to know. In Seminars in Interventional Radiology 2020, 37(05): 543-54. DOI: 10.1055/s-0040-1720954
- Tong A K, Kao Y H, Too CW, Chin K F, Ng DC, Chow P K. Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry. The British Journal of Radiology 2016;89(1062), 20150943.
- Tafti BA, Padia SA. Dosimetry of Y-90 Microspheres Utilizing Tc-99m SPECT and Y-90 PET. Semin Nucl Med. 2019;49(3):211-17.
- Richetta E, Pasquino M, Poli M, et al. PET-CT post therapy dosimetry in radioembolization with resin 90Y microspheres: comparison with pre-treatment SPECT-CT 99mTc-MAA results. Physica Medica 2019;64:16-23.DOI: 10.1016/j.ejmp.2019.05.025
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- Selcuk NA, Toklu T, Karaaslan SI. Radionuclide Treatment and Dosimetric Approaches. In Nuclear Medicine Seminars 2015;1(3):158-71.
- Lam M, Garin E, Maccauro Kappadath SC, Sze D, Turkmen C, Salem R. A global evaluation of advanced dosimetry in transarterial radioembolization of hepatocellular carcinoma with Yttrium-90: the TARGET study. European Journal of Nuclear Medicine and Molecular Imaging, 2022;49(10);3340-52. DOI: 10.1007/s00259-022-05774-0
- Martin M, Hocquelet A, Debordeaux F, et al. Comparison of perfused volume segmentation between cone-beam CT and 99mTc-MAA SPECT/CT for treatment dosimetry before selective internal radiation therapy using 90Y-glass microspheres. Diagnostic and Interventional Imaging, 2021;102(1), 45-52. DOI: 10.1016/j.diii.2020.09.003
- Riveira-Martin M, Akhavanallaf A, Mansouri Z, et al. Predictive value of 99mTc-MAA-based dosimetry in personalized 90Y-SIRT planning for liver malignancies. EJNMMI research, 2023;13(1): 63. DOI: 10.1186/s13550-023-01011-3
- Knesaurek K, DaCosta M, Ghesani M. Comparison of predictive, pre-therapy MAA SPECT/CT dosimetry vs. post-therapy Y-90 PET/CT dosimetry. Journal of Nuclear Medicine 2023;64 (supplement 1):P44.
- Song Y S, Paeng J C, Kim HC, Chung JW, Cheon GJ, Kang KW. PET/CT-based dosimetry in 90Y-microsphere selective internal radiation therapy: Single cohort comparison with pretreatment planning on 99mTc-MAA imaging and correlation with treatment efficacy. Medicine, 2015;94(23), e945. DOI: 10.1097/MD.0000000000000945
- Kao Y H, Steinberg J D, Tay YS, et al. Post-radioembolization yttrium-90 PET/CT-part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI research, 2013;3:1-12.
90Y Mikroembolizasyon Tedavisinde 99mTc MAA ile Tedavi Öncesi ve 90Y PET/BT Tedavi sonrası Dozimetri Sonuçlarının Karşılaştırılması
Abstract
Karaciğer tümörleri tedavisinde Yitriyum 90 (90Y) mikroküreler ile yapılan radyoembolizasyon etkili bir tedavi seçeneğidir. Hastanın tedaviye uygunluğu rutinde 99mTc Makro Albümin Agregat (MAA) SPECT/BT görüntüleri üzerinden yapılan dozimetri ile belirlenir. Bu çalışmada, karaciğer tümör tedavisi için başvuran hastalarda 99mTc MAA tedavi öncesi (pre) dozimetri sonuçları ile 90Y mikroküre tedavi sonrası (post) dozimetri yapılarak sonuçlarının karşılaştırılması amaçlandı. Çalışmamıza karaciğer tümör tedavisi için başvuran ve rastgele seçilmiş 11 hasta dahil edildi. 99mTc-MAA dozimetrisinde,99mTc-MAA dozimetri ile hesaplanan tedavi aktivitesi 1.3-6.2 GBq (ortalama 3.2±1.4), tümör dozu 125.1-527.5 Gy (ortalama 264.7±139.4) ve karaciğer dozu 19.4-38.8 Gy (ortalama 31.9±5.8) bulundu. 90Y mikroküre tedavisinden sonra çekilen PET/BT görüntülerinden yapılan dozimetride tümör dozu 156.2-480.4 Gy (ortalama 266.5±102.9), karaciğer dozu 20.6-37.4 Gy (ortalama 29.1±5.2) bulundu. Dozlar, tümör ve normal karaciğer dokusu için iyi bir uyum gösterdi (p=0.85716 ve p=0.53526, sırasıyla). Sonuçta 90Y mikroküreler ile PET/BT’ye dayanan post dozimetrinin karaciğer parankim doku dozunu ve tümör dozunu belirlemede etkili bir yöntem olduğu belirlendi.
References
- Vente MA, Hobbelink MG, van Het Schip AD, Zonnenberg BA, Nijsen JF. Radionuclide liver cancer therapies: from concept to current clinical status. Anticancer Agents Med Chem. 2007;7(4):441-59. DOI: 10.2174/187152007781058569
- Bozkurt M. F. Personalized Treatment and Protection from Side Effects. Nuclear Medicine Seminars 2019;5(2),:122-31.
- Villalobos A, Soliman MM, Majdalany BS, et al. Yttrium-90 radioembolization dosimetry: what trainees need to know. In Seminars in Interventional Radiology 2020, 37(05): 543-54. DOI: 10.1055/s-0040-1720954
- Tong A K, Kao Y H, Too CW, Chin K F, Ng DC, Chow P K. Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry. The British Journal of Radiology 2016;89(1062), 20150943.
- Tafti BA, Padia SA. Dosimetry of Y-90 Microspheres Utilizing Tc-99m SPECT and Y-90 PET. Semin Nucl Med. 2019;49(3):211-17.
- Richetta E, Pasquino M, Poli M, et al. PET-CT post therapy dosimetry in radioembolization with resin 90Y microspheres: comparison with pre-treatment SPECT-CT 99mTc-MAA results. Physica Medica 2019;64:16-23.DOI: 10.1016/j.ejmp.2019.05.025
- Türkmen C, Demirci E, Selçuk NA, et al. Karaciğer Tümörlerinde Y-90 Radyomikroküre Tedavisi Uygulama Kılavuzu. Nucl Med Semin. 2020;6:416-22. DOI:10.4274/nts.galenos.2020.0034
- Selcuk NA, Toklu T, Karaaslan SI. Radionuclide Treatment and Dosimetric Approaches. In Nuclear Medicine Seminars 2015;1(3):158-71.
- Lam M, Garin E, Maccauro Kappadath SC, Sze D, Turkmen C, Salem R. A global evaluation of advanced dosimetry in transarterial radioembolization of hepatocellular carcinoma with Yttrium-90: the TARGET study. European Journal of Nuclear Medicine and Molecular Imaging, 2022;49(10);3340-52. DOI: 10.1007/s00259-022-05774-0
- Martin M, Hocquelet A, Debordeaux F, et al. Comparison of perfused volume segmentation between cone-beam CT and 99mTc-MAA SPECT/CT for treatment dosimetry before selective internal radiation therapy using 90Y-glass microspheres. Diagnostic and Interventional Imaging, 2021;102(1), 45-52. DOI: 10.1016/j.diii.2020.09.003
- Riveira-Martin M, Akhavanallaf A, Mansouri Z, et al. Predictive value of 99mTc-MAA-based dosimetry in personalized 90Y-SIRT planning for liver malignancies. EJNMMI research, 2023;13(1): 63. DOI: 10.1186/s13550-023-01011-3
- Knesaurek K, DaCosta M, Ghesani M. Comparison of predictive, pre-therapy MAA SPECT/CT dosimetry vs. post-therapy Y-90 PET/CT dosimetry. Journal of Nuclear Medicine 2023;64 (supplement 1):P44.
- Song Y S, Paeng J C, Kim HC, Chung JW, Cheon GJ, Kang KW. PET/CT-based dosimetry in 90Y-microsphere selective internal radiation therapy: Single cohort comparison with pretreatment planning on 99mTc-MAA imaging and correlation with treatment efficacy. Medicine, 2015;94(23), e945. DOI: 10.1097/MD.0000000000000945
- Kao Y H, Steinberg J D, Tay YS, et al. Post-radioembolization yttrium-90 PET/CT-part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI research, 2013;3:1-12.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Physics |
| Journal Section | Research Article |
| Authors | |
| Publication Date | June 29, 2024 |
| Submission Date | February 6, 2024 |
| Acceptance Date | April 2, 2024 |
| Published in Issue | Year 2024Volume: 46 Issue: 2 |
