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Yttrium-90 radioembolization using MIRD dosimetry with resin microspheres

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To review the technical feasibility of resin microsphere (SIR-Spheres®) yttrium-90 radioembolization prescribed using the medical internal radiation dose (MIRD) model.

Methods

All radioembolization procedures for hepatic malignancies using resin microspheres with MIRD model between November 2015 and February 2019 were included in this IRB-approved study (n = 60). Student’s T test was used to compare prescribed activity based on MIRD and BSA models. Adverse events were assessed immediately, 30 days, and 6 months post-treatment.

Results

Sixty radioembolizations were performed in 54 patients (age 68 ± 9 years, 48–87 years, 35% female). Mean prescribed activity calculated by the MIRD model (target absorbed dose 120–200 Gy for primary and 80–200 Gy for metastatic liver cancers) was 1.7 GBq (0.3–6.4) compared with 0.6 GBq (0.12–2.1) if BSA had been used (p < 0.0001). The prescribed activity was successfully delivered in 93% (56/60) treatments. Prophylactic embolization and anti-reflux catheters were used in 20% (12/60) and 5% (3/60) treatments, respectively. No immediate post-procedural complications occurred. Abdominal pain was the most common clinical Grade 3 CTCAE in 30 days (10%) and 6 months (12%). Radiation pneumonitis occurred in 3 (5%) patients but no radiation-induced gastric ulcer or radiation-induced liver disease occurred.

Conclusion

MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry with resin microspheres. MIRD prescribed activity with target absorbed doses up to 200 Gy can be successfully administered without prophylactic embolization in selected patients.

Key Points

•MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry for radioembolization.

•MIRD dosimetry can be used for yttrium-90 resin microsphere radioembolization with acceptable safety profile.

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Abbreviations

3D:

3 Dimensional

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BSA:

Body surface area

CT:

Computed tomography

CTCAE:

Common Terminology Criteria for Adverse Events

ECOG:

Eastern Cooperative Oncology Group Performance Status

HCC:

Hepatocellular carcinoma

MIRD:

Medical Internal Radiation Dose

TACE:

Transarterial chemoembolization

TARE:

Transarterial radioembolization

Tc-99m MAA:

Technetium 99m macroaggregated albumin

Y-90:

Yttrium-90

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Acknowledgments

This study was funded by Sirtex Medical Inc.

Funding

This study was funded by Sirtex Medical Inc. Woburn MA. The funding supported research personnel performing data collection and data analysis for this project. The funding source had no role in the design of the study and no personnel from the funding source had involvement in data collection, analysis, interpretation of the data, or writing of the manuscript.

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Authors and Affiliations

  1. Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA

    Ammar Sarwar, Alexei Kudla, Jeffrey L. Weinstein, Aamir Ali, Salomao Faintuch & Muneeb Ahmed

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA

    Raza Malik & Michael Curry

  3. Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA

    Andrea Bullock

  4. Transplantation Institute, Department of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA

    Khalid O. Khwaja

Authors
  1. Ammar Sarwar
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  2. Alexei Kudla
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  7. Khalid O. Khwaja
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  8. Michael Curry
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  10. Muneeb Ahmed
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Corresponding author

Correspondence to Ammar Sarwar.

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Guarantor

The scientific guarantor of this publication is Ammar Sarwar (Author).

Conflict of interest

Ammar Sarwar (Author) has received research grants from Sirtex Medical Inc. and is a consultant for the company. None of the other authors have a conflict of interest relevant to this publication.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• retrospective

• observational

• performed at one institution

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Sarwar, A., Kudla, A., Weinstein, J.L. et al. Yttrium-90 radioembolization using MIRD dosimetry with resin microspheres. Eur Radiol 31, 1316–1324 (2021). https://doi.org/10.1007/s00330-020-07231-8

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  • DOI: https://doi.org/10.1007/s00330-020-07231-8

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