Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres.
OBJECTIVE
Selective internal radiotherapy (SIRT) with yttrium-90 ((90)Y) resin microspheres can improve the clinical outcomes for selected patients with inoperable liver cancer. This technique involves intra-arterial delivery of β-emitting microspheres into hepatocellular carcinomas or liver metastases while sparing uninvolved structures. Its unique mode of action, including both (90)Y brachytherapy and embolization of neoplastic microvasculature, necessitates activity planning methods specific to SIRT.


METHODS
A panel of clinicians experienced in (90)Y resin microsphere SIRT was convened to integrate clinical experience with the published data to propose an activity planning pathway for radioembolization.


RESULTS
Accurate planning is essential to minimize potentially fatal sequelae such as radiation-induced liver disease while delivering tumoricidal (90)Y activity. Planning methods have included empiric dosing according to degree of tumor involvement, empiric dosing adjusted for the body surface area, and partition model calculations using Medical Internal Radiation Dose principles. It has been recommended that at least two of these methods be compared when calculating the microsphere activity for each patient.


CONCLUSIONS
Many factors inform (90)Y resin microsphere SIRT activity planning, including the therapeutic intent, tissue and vasculature imaging, tumor and uninvolved liver characteristics, previous therapies, and localization of the microsphere infusion. The influence of each of these factors has been discussed.
Lau
Wan-Yee
WY
Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Kennedy
Andrew S
AS
Kim
Yun Hwan
YH
Lai
Hee Kit
HK
Lee
Rheun-Chuan
RC
Leung
Thomas W T
TW
Liu
Ching-Sheng
CS
Salem
Riad
R
Sangro
Bruno
B
Shuter
Borys
B
Wang
Shih-Chang
SC
D000465:Algorithms; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D032921:Consensus; D004621:Embolization, Therapeutic / Q000379:methods*; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary; D008863:Microspheres; D055806:Microvessels; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D013438:Sulfhydryl Compounds; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D013438:Sulfhydryl Compounds; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes; C082426:technetium Tc99m-mercaptoacetyl albumin