Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group

Salem, Riad; Padia, Siddharth A.; Lam, Marnix G. E. H.; Bell, Jon; Chiesa, Carlo; Fowers, Kirk D.; Hamilton, Bonnie; Herman, Joseph M.; Kappadath, S Cheenu; Leung, TW; Portelance, Lorraine; Sze, Daniel Y.; Garin, Étienne

doi:10.1007/s00259-019-04340-5

Cited by 114 publications

(100 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several technical issues have been described: the spasm occurrence [16,23,26], the proximity of arterial bifurcation [27], the speed of surrogate injection [16], and the catheter repositioning [25,28]. Several recommendations have been drawn to control the blood blow and improve the accuracy of the simulation-based dosimetry [16,23,29]:…”

Section: Specific Angiographic Requirements For a Simulation-based Domentioning

confidence: 99%

Personalised Dosimetry in Radioembolisation for HCC: Impact on Clinical Outcome and on Trial Design

Garin¹,

Palard

Rolland

2020

Cancers

Self Cite

View full text Add to dashboard Cite

Selective internal radiation therapy (SIRT) of hepatocellular carcinoma (HCC) has been used for many years, usually without any specific dosimetry endpoint. Despite good clinical results in early phase studies or in cohort studies, three randomized trials in locally advanced HCC available failed to demonstrate any improvement of overall overall survival (OS) in comparison with sorafenib. In recent years, many studies have evaluated the dosimetry of SIRT using either a simulation-based dosimetry (macroaggregated albumin (MAA)-based) or a post-therapy-based one (90Y-based). The goal of this review is to present the dosimetry concept, tools available, its limitations, and main clinical results described for HCC patients treated with 90Y-loaded resin or glass microspheres. With MAA-based dosimetry, the threshold tumor doses allowing for a response were between 100 and 210 Gy for resin microspheres and between 205 and 257 Gy for glass microspheres. The significant impact of the tumor dose on OS was reported with both devices. The correlation between 90Y-based dosimetry and response was also reported. Regarding the safety, preliminary results are available for both products but with a larger range of normal liver doses values correlated with liver toxicities due to numerous confounding factors. Based on those results, international expert group recommendations for personalized dosimetry have been provided for both devices. The clinical impact of personalized dosimetry has been recently confirmed in a multicenter randomized study demonstrating a doubling of the response rate and an OS of 150% while using personalized dosimetry. Even if technical dosimetry improvements are still under investigation, the use of personalized dosimetry has to be generalized for both clinical practice and trial design.

show abstract

Section: Specific Angiographic Requirements For a Simulation-based Domentioning

confidence: 99%

Personalised Dosimetry in Radioembolisation for HCC: Impact on Clinical Outcome and on Trial Design

Garin¹,

Palard

Rolland

2020

Cancers

Self Cite

View full text Add to dashboard Cite

show abstract

“…The above reported confidence intervals (or range of ratios by Gnesin et al), are unacceptably large for lesions and suboptimal for non tumoral liver, if compared to the thresholds of toxicity and efficacy proposed in literature, which are for resin spheres of 50-70 Gy to liver [20] and 150 Gy to lesions [21], and for glass spheres of about 75 Gy for parenchyma [22,23] or 120 Gy to the injected volume if its fraction is larger than 70% [24], and 205 Gy for lesions [24,25]. Beyond that, since nuclear medicine therapy is a kind of radiotherapy, it could be worth recalling that our colleagues in external beam have a limit of ± 5% on the treatment dosimetric uncertainty [26].…”

mentioning

confidence: 68%

166Ho microsphere scout dose for more accurate radioembolization treatment planning

Chiesa

Maccauro

2019

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

“…15 As was recently conceptualized in an expert statement about SIRT, we should now more clearly distinguish different clinical scenarios in which SIRT is applied. 16 As exemplified in Fig. 1, different clinical scenarios lead to different requirements from MAA-SPECT.…”

Section: See Article Pages 1151-1158mentioning

confidence: 99%

Streamlining TARE or personalizing SIRT? Different philosophies to treat different HCCs with Yttrium-90…

Edeline

Garin

2020

Journal of Hepatology

Self Cite

View full text Add to dashboard Cite

Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group

Cited by 114 publications

References 62 publications

Personalised Dosimetry in Radioembolisation for HCC: Impact on Clinical Outcome and on Trial Design

Personalised Dosimetry in Radioembolisation for HCC: Impact on Clinical Outcome and on Trial Design

166Ho microsphere scout dose for more accurate radioembolization treatment planning

Streamlining TARE or personalizing SIRT? Different philosophies to treat different HCCs with Yttrium-90…

Contact Info

Product

Resources

About