A simple method for estimating dose delivered to hepatocellular carcinoma after yttrium-90 glass-based radioembolization therapy: preliminary results of a proof of concept study.
OBJECTIVE
To investigate a simple semiquantitative method to estimate yttrium-90 ((90)Y) dose delivered with radioembolization to infiltrative hepatocellular carcinoma (HCC).


METHODS
In a prospective study, patients with infiltrative HCC and portal vein thrombosis (PVT) underwent glass-based (90)Y radioembolization including technetium-99m macroaggregated albumin ((99m)Tc-MAA) hepatopulmonary shunt study before therapy and bremsstrahlung single photon emission computed tomography (SPECT)/computed tomography (CT) after (90)Y radioembolization. Baseline magnetic resonance imaging was coregistered with (99m)Tc-MAA and bremsstrahlung SPECT/CT imaging separately. Unit tumor activity ((90)Y radioactivity delivered to each cubic centimeter of tumor) was estimated based on a lobar infusion approach. Correlation between proportions of (99m)Tc-MAA and (90)Y delivered to the tumor was investigated. Survival analysis was performed using Kaplan-Meier estimations.


RESULTS
(90)Y therapy was administered in 18 consecutive patients (median age, 55.3 y; mean tumor volume, 588 cm(3)). Higher intratumoral (90)Y dose predicted prolonged survival, with 13.2-month median survival in patients with HCC and mean (90)Y dose of ≥ 100 Gy versus 4.6-month median survival for other patients (P < .001). Of administered (90)Y dose, 51.9% was delivered to the targeted tumors compared with 74.1% of (99m)Tc-MAA with linear correlation between biodistribution of (99m)Tc-MAA and (90)Y observed (Pearson r = 0.774, P < .001).


CONCLUSIONS
The findings in this study suggest that approximately 50% of administered (90)Y dose is taken up by targeted infiltrative HCC with PVT. Intratumoral (90)Y dose ≥ 100 Gy in unresectable infiltrative HCC via a lobar intraarterial approach is a positive prognostic factor for survival.
Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia.
Nima
N
Kokabi
Nuclear Medicine and Molecular Imaging, Emory University School of Medicine, Atlanta, Georgia.
James R
JR
Galt
Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia.
Minzhi
M
Xing
Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia.
Juan C
JC
Camacho
Nuclear Medicine and Molecular Imaging, Emory University School of Medicine, Atlanta, Georgia.
Bruce J
BJ
Barron
Nuclear Medicine and Molecular Imaging, Emory University School of Medicine, Atlanta, Georgia.
David M
DM
Schuster
Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: kimk7@upmc.edu.
Hyun S
HS
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005898:Glass; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D064847:Multimodal Imaging; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011169:Portal Vein / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011829:Radiation Dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D013668:Technetium Tc 99m Aggregated Albumin; D014018:Tissue Distribution; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D020246:Venous Thrombosis / Q000000981:diagnostic imaging; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes
(90)Y; (99m)Tc-MAA; BCLC; Barcelona Clinic Liver Cancer; HCC; LSF; PVT; ROI; SPECT; TD; hepatocellular carcinoma; lung shunt fraction; portal vein thrombosis; region of interest; single photon emission computed tomography; technetium-99m macroaggregated albumin; tumor dose; yttrium-90