A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Abstract

Yttrium-90 radioembolization ( 90 Y-RE) is a well-established therapy for the treatment of hepatocellular carcinoma (HCC) and also of metastatic liver deposits from other malignancies. Nuclear Medicine and Cath Lab diagnostic imaging takes a pivotal role in the success of the treatment, and in order to fully exploit the efficacy of the technique and provide reliable quantitative dosimetry that are related to clinical endpoints in the era of personalized medicine, technical challenges in imaging need to be overcome. In this paper, the extensive literature of current 90 Y-RE techniques and challenges facing it in terms of quantification and dosimetry are reviewed, with a focus on the current generation of 3D dosimetry techniques. Finally, new emerging techniques are reviewed which seek to overcome these challenges, such as highresolution imaging, novel surgical procedures and the use of other radiopharmaceuticals for therapy and pre-therapeutic planning.

Impact of respiratory motion and acquisition settings on SPECT liver dosimetry for radioembolization

“…These SPECT/CT images can be used for lung dose estimations and detection of potential extra‐hepatic depositions . But they may also be used to predict the tumor dose and the dose to the healthy liver parenchyma by the subsequent administration of 90 Y microspheres, which enables a more patient‐specific treatment planning . This requires the quantitative reconstruction of pretherapy 99m Tc safety scans.…”

Integration of Systemic and Liver-Directed Therapies for Locally Advanced Hepatocellular Cancer: Harnessing Potential Synergy for New Therapeutic Horizons

“…5,12 Improved modeling and targeting of the radiation dose delivered to the tumor by TARE may further enhance disease control. 13 TARE with resin beads has been compared with sorafenib in 2 phase III trials in BCLC stage B and C HCC without distant metastases. Both of these trials included some patients with portal vein thrombus.…”

Editorial Review 2015 – Nuclear Medicine, Diagnostic Imaging and Therapy

“…The article, 'A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90 Y microsphere therapy', by Jim O'Doherty [6]. This therapy which involves yttrium-90 radioembolization ( 90 Y-RE) is used in the treatment of hepatocellular carcinoma and other disease states.…”