Dose delivery estimated by bremsstrahlung imaging and partition model correlated with response following intra-arterial radioembolization with 32P-glass microspheres for the treatment of hepatocellular carcinoma.
BACKGROUND
The objective of this study was to retrospectively evaluate the efficacy of a combination of (32)P-glass microsphere-mediated intra-arterial internal radiation and chemoembolization for the treatment of hepatocellular carcinoma.


METHODS
Twenty-five consecutive patients with primary hepatocellular carcinoma referred for radiation therapy were treated with intra-arterial infusion of (32)P-glass microspheres followed by chemoembolization. beta-bremsstrahlung imaging was performed to monitor microsphere distribution. A partition model and a radiation dose equation were used for determination of radiation exposure in various tissues. Clinical response was evaluated using computed axial tomography scans.


RESULTS
The mean estimated absorption dose in tumor tissue was 137.42 +/- 56.69 Gy. A receiver operating characteristic curve was used to establish 90.65 Gy as the cutoff absorption dose with the best sensitivity and specificity for predicting response. The overall tumor response rate was 92%, while response in patients with radiation doses >90.65 Gy was 100%. Overall median patient survival was 15 months.


CONCLUSIONS
beta-bremsstrahlung imaging following intra-arterial infusion of (32)P-glass microspheres and chemoembolization incorporates effective treatment with convenient dosimetry monitoring and manageable adverse events using a single surgical procedure. This approach is a safe and effective method for ameliorating hepatocellular carcinoma.
Wang
Xiao-Dong
XD
Laboratory of Carcinogenesis and Translational Research Ministry of Education, Department of interventional therapy, Beijing Cancer Hospital and Institute, Peking University Oncology School, Beijing 100142, China.
Yang
Ren-Jie
RJ
Cao
Xi-Cai
XC
Tan
Jian
J
Li
Bin
B
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000379:methods; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000401:mortality; D009367:Neoplasm Staging; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use*; D015641:Radiography, Interventional; D011877:Radionuclide Imaging / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
D010761:Phosphorus Radioisotopes