Radioembolization Dosimetry: The Road Ahead
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Methods for calculating the activity to be administered during yttrium-90 radioembolization (RE) are largely based on empirical toxicity and efficacy analyses, rather than dosimetry. At the same time, it is recognized that treatment planning based on proper dosimetry is of vital importance for the optimization of the results of RE. The heterogeneous and often clustered intrahepatic biodistribution of millions of point-source radioactive particles poses a challenge for dosimetry. Several studies found a relationship between absorbed doses and treatment outcome, with regard to both toxicity and efficacy. This should ultimately lead to improved patient selection and individualized treatment planning. New calculation methods and imaging techniques and a new generation of microspheres for image-guided RE will all contribute to these improvements. The aim of this review is to give insight into the latest and most important developments in RE dosimetry and to suggest future directions on patient selection, individualized treatment planning, and study designs.
KeywordsInterventional oncology Radioembolization Liver/hepatic
The work of M. Smits was supported by the Foundation for Image-guided Cancer Treatments (in Dutch: Stichting Beeldgestuurde Behandeling van Kanker) and by the Alexandre Suerman MD/PhD grant of the University Medical Center Utrecht.
Conflict of interest
D. Sze is consultant for W.L. Gore, Inc., Guerbet, Inc., Codman/J&J, Inc., Covidien, Inc., Embolx, Inc., Amgen, Inc., and BTG, Inc., and is member of the scientific/medical advisory board of Surefire Medical, Inc., Koli, Inc., Treus Medical, Inc., RadiAction Medical, Inc., Lunar Design, Inc., and Northwind Medical, Inc. Y. Kao had previously received research funding from Sirtex Medical Singapore. J. Nijsen is co-inventor of 166-holmium PLLA-microspheres and the patents are assigned to University Medical Center Utrecht Holding BV. J. Nijsen is Chief Scientific Officer at Quirem Medical BV. The other authors declare that they have no conflict of interest.
Statement of Human and Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
- 5.Liu D, Cade DN, Worsley D, Klass D, Lim H, et al (2013) Single procedure yttrium-90 (SPY90). Pilot study of consolidated single procedure selective internal radiation therapy (SIRT) utilizing yttrium-90 resin microspheres: preliminary results. CIRSE https://www.webges.com/cslide/presentations/cirse2013/62025/pdf/000001.pptx.pdf. Accessed 1 Feb 2014
- 9.Hung JC, Redfern MG, Mahoney DW, Thorson LM, Wiseman GA (2000) Evaluation of macroaggregated albumin particle sizes for use in pulmonary shunt patient studies. J Am Pharm Assoc 40:46–51Google Scholar
- 15.Sirtex (2014) SIR-Spheres Yttrium-90 Resin Microspheres Package Insert. Available at: http://www.sirtex.com/us/clinicians/package-insert/. Accessed 19 Dec 2014
- 17.BTG (2014) Therasphere yttrium-90 glass microspheres [package insert]. Available at: http://www.therasphere.com/physicians_us/package_insert.asp. Accessed 19 Dec 2014
- 31.Jiang M, Fischman A, Nowakowski FS (2012) Segmental perfusion differences on paired Tc-99m macroaggregated albumin (MAA) hepatic perfusion imaging and yttrium-90 (Y-90) bremsstrahlung imaging studies in SIR-sphere radioembolization: associations with angiography. J Nucl Med Radiat Ther 3Google Scholar
- 32.Ricke J (2010) Predictive Value of 99mTc- Albumin Spheres Before 90Y- SIR Therapy (EXPLOSIVE). Available at: NCT01186263 http://clinicaltrials.gov/ct2/show/NCT01186263?term=explosive+99mtc&rank=1. Accessed 19 Dec 2014
- 51.Li W, Zhang Z, Guo Y, Nicolai J, Reed A, Larson A (2013) SPIO-labeled 90Y microspheres permit accurate quantification of macroscopic intra-hepatic biodistribution. Paper presented at International Society for Magnetic Resonance in Medicine, Salt Lake City, UTGoogle Scholar