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3D voxel-based dosimetry to predict contralateral hypertrophy and an adequate future liver remnant after lobar radioembolization

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Abstract

Introduction

Volume changes induced by selective internal radiation therapy (SIRT) may increase the possibility of tumor resection in patients with insufficient future liver remnant (FLR). The aim was to identify dosimetric and clinical parameters associated with contralateral hepatic hypertrophy after lobar/extended lobar SIRT with 90Y-resin microspheres.

Materials and methods

Patients underwent 90Y PET/CT after lobar or extended lobar (right + segment IV) SIRT. 90Y voxel dosimetry was retrospectively performed (PLANET Dose; DOSIsoft SA). Mean absorbed doses to tumoral/non-tumoral-treated volumes (NTL) and dose-volume histograms were extracted. Clinical variables were collected. Patients were stratified by FLR at baseline (T0-FLR): < 30% (would require hypertrophy) and ≥ 30%. Changes in volume of the treated, non-treated liver, and FLR were calculated at < 2 (T1), 2–5 (T2), and 6–12 months (T3) post-SIRT. Univariable and multivariable regression analyses were performed to identify predictors of atrophy, hypertrophy, and increase in FLR. The best cut-off value to predict an increase of FLR to ≥ 40% was defined using ROC analysis.

Results

Fifty-six patients were studied; most had primary liver tumors (71.4%), 40.4% had cirrhosis, and 39.3% had been previously treated with chemotherapy. FLR in patients with T0-FLR < 30% increased progressively (T0: 25.2%; T1: 32.7%; T2: 38.1%; T3: 44.7%). No dosimetric parameter predicted atrophy. Both NTL-Dmean and NTL-V30 (fraction of NTL exposed to ≥ 30 Gy) were predictive of increase in FLR in patients with T0 FLR < 30%, the latter also in the total cohort of patients. Hypertrophy was not significantly associated with tumor dose or tumor size. When ≥ 49% of NTL received ≥ 30 Gy, FLR increased to ≥ 40% (accuracy: 76.4% in all patients and 80.95% in T0-FLR < 30% patients).

Conclusion

NTL-Dmean and NTL exposed to ≥ 30 Gy (NTL-V30) were most significantly associated with increase in FLR (particularly among patients with T0-FLR < 30%). When half of NTL received ≥ 30 Gy, FLR increased to ≥ 40%, with higher accuracy among patients with T0-FLR < 30%.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors gratefully acknowledge the effort and the excellent technical support of the Cyclotron and PET/CT staff.

Code availability

PET-based voxel dosimetry was performed using a dedicated treatment planning system (PLANET Dose; DOSIsoft SA).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Bruno Sangro and Macarena Rodríguez-Fraile contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain

    Fabiana Grisanti, Juan Fernando Bastidas, Pablo Rodrigo & Macarena Rodríguez-Fraile

  2. Department of Medical Physics, Clínica Universidad de Navarra, Pamplona, Spain

    Elena Prieto

  3. Department of Nuclear Medicine, Clínica Universidad de Navarra, Madrid, Spain

    Lidia Sancho

  4. Department of Health, Government of Navarre, Pamplona, Spain

    Carmen Beorlegui

  5. Liver Unit, Clínica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain

    Mercedes Iñarrairaegui & Bruno Sangro

  6. Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain

    José Ignacio Bilbao

Authors
  1. Fabiana Grisanti
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Corresponding author

Correspondence to Fabiana Grisanti.

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Ethics approval

The institutional ethics committee approved the protocol (212/2019) for this retrospective study. Informed consent was waived.

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Conflict of interest

M.R.-F. and M.I. are paid speakers for Sirtex Medical Europe GmbH. B.S. is a paid consultant and speaker for Sirtex Medical and BTG. The authors declare no conflicts of interest.

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Grisanti, F., Prieto, E., Bastidas, J.F. et al. 3D voxel-based dosimetry to predict contralateral hypertrophy and an adequate future liver remnant after lobar radioembolization. Eur J Nucl Med Mol Imaging 48, 3048–3057 (2021). https://doi.org/10.1007/s00259-021-05272-9

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