title: High impact of macroaggregated albumin-based tumour dose on response and overall survival in hepatocellular carcinoma patients treated with90Y-loaded glass microsphere radioembolization.
abstract: Efficacy of radioembolization is derived from radioinduced damage, whereas tumour dosimetry is not considered as yet in prospective clinical trials.
  
  
  
  This study evaluates the impact of tumour dose (TD), based on99mTc macroaggregated albumin (MAA) quantification, on response and overall survival (OS).
  
  
  
  We consecutively included 85 patients with hepatocellular carcinoma treated with90Y-loaded glass microspheres. TD was calculated using a quantitative analysis of the MAA SPECT/CT. Responses were assessed after 3 months using the European Association for the Study of the Liver criteria. OS was assessed using Kaplan-Meier tests.
  
  
  
  Response rate was 80.3% on lesion-based analysis (n=132), and 77.5% on patient-based analysis. The response rate was only 9.1% for patients with TD <205 Gy against 89.7% for those with TD ≥205 Gy (P<10-7). Non-portal vein thrombosis (PVT) patients exhibited a median OS of 11.75 m (95% CI: 3-30.7 m) for TD <205 Gy, and 25 m (95% CI: 15-34.7 m) for TD ≥205 Gy (P=.0391). PVT patients exhibited a 4.35 m median OS (95% CI: 2-8 m) for TD<205 Gy, and 15.7 m (95% CI: 9.5-25.5 m) for TD ≥205 Gy, (P=.0004), with HR of 6.99. PVT patients exhibited a median OS of 3.6 m (95% CI: 2-8 m) when PVT MAA targeting was poor or with TD <205 Gy (poor candidate), vs 17.5 m (95% CI: 11-26.5 m) for the others identified as good candidates (P<.0001), with HR of 12.85.
  
  
  
  This study confirms the highly predictive value of MAA-based TD evaluation for response and OS. TD evaluation and PVT MAA targeting should be further evaluated in ongoing trials, whereas personalized dosimetry should be implemented in new trial designs.
authors: Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes, France.|University of Rennes 1, Rennes, France.|Liver Metabolisms and Cancer, INSERM, U-991, Rennes, France.
authors: Etienne
authors: E
authors: Garin
authors: Department of Medical Imaging, Cancer Institute Eugène Marquis, Rennes, France.|INSERM LTSI, Rennes, France.
authors: Yan
authors: Y
authors: Rolland
authors: Department of Medical Oncology, Cancer Institute Eugène Marquis, Rennes, France.
authors: Marc
authors: M
authors: Pracht
authors: Department of Medical Oncology, Cancer Institute Eugène Marquis, Rennes, France.
authors: Samuel
authors: S
authors: Le Sourd
authors: Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes, France.
authors: Sophie
authors: S
authors: Laffont
authors: Department of Medical IT, Cancer Institute Eugène Marquis, Rennes, France.
authors: Habiba
authors: H
authors: Mesbah
authors: Department of Medical IT, Cancer Institute Eugène Marquis, Rennes, France.
authors: Laure-Anne
authors: LA
authors: Haumont
authors: Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes, France.
authors: Laurence
authors: L
authors: Lenoir
authors: University of Rennes 1, Rennes, France.
authors: Tanguy
authors: T
authors: Rohou
authors: Department of Medical Imaging, Centre Hospitalier et Universitaire Pontchaillou, Rennes, France.
authors: Vanessa
authors: V
authors: Brun
authors: University of Rennes 1, Rennes, France.|Liver Metabolisms and Cancer, INSERM, U-991, Rennes, France.|Department of Medical Oncology, Cancer Institute Eugène Marquis, Rennes, France.
authors: Julien
authors: 0000-0002-8289-7741
authors: J
authors: Edeline
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein / Q000473:pathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D013668:Technetium Tc 99m Aggregated Albumin / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000473:pathology / Q000628:therapy*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes
keywords: overall survival; predictive dosimetry; radioembolization; response