Boosted selective internal radiation therapy with super(90)Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept

Purpose: To evaluate the impact of dosimetry based on MAA SPECT/CT for the prediction of response, toxicity and survival, and for treatment planning in patients with hepatocellular carcinoma (HCC) treated with super(90)Y-loaded glass microspheres (TheraSphere registered ). Methods: TheraSphere regis...

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Published in:European journal of nuclear medicine and molecular imaging 2013-07, Vol.40 (7), p.1057-1068
Main Authors: Garin, E, Lenoir, L, Edeline, J, Laffont, S, Mesbah, H, Poree, P, Sulpice, L, Boudjema, K, Mesbah, M, Guillygomarc'h, A, Quehen, E, Pracht, M, Raoul, J L, Clement, B, Rolland, Y, Boucher, E
Format: Article
Language:English
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Summary:Purpose: To evaluate the impact of dosimetry based on MAA SPECT/CT for the prediction of response, toxicity and survival, and for treatment planning in patients with hepatocellular carcinoma (HCC) treated with super(90)Y-loaded glass microspheres (TheraSphere registered ). Methods: TheraSphere registered was administered to 71 patients with inoperable HCC. MAA SPECT/CT quantitative analysis was used for the calculation of the tumour dose (TD), healthy injected liver dose (HILD), and total injected liver dose. Response was evaluated at 3 months using EASL criteria. Time to progression (TTP) and overall survival (OS) were evaluated using the Kaplan-Meier method. Factors potentially associated with liver toxicity were combined to construct a liver toxicity score (LTS). Results: The response rate was 78.8 %. Median TD were 342 Gy for responding lesions and 191 Gy for nonresponding lesions (p205 Gy and good PVT targeting on MAA SPECT/CT. The LTS was able to detect severe liver toxicity (n=6) with a sensitivity of 83 % and overall accuracy of 97 %. Conclusion: Dosimetry based on MAA SPECT/CT was able to accurately predict response and survival in patients treated with glass microspheres. This method can be used to adapt the injected activity without increasing liver toxicity, thus defining a new concept of boosted selective internal radiation therapy (B-SIRT). This new concept and LTS enable fully personalized treatment planning with glass microspheres to be achieved.
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-013-2395-x