Dose–response relationship after yttrium-90-radioembolization with glass microspheres in patients with neuroendocrine tumor liver metastases

Ebbers, Sander C.; Roekel, Caren van; Braat, Manon N.G.J.A.; Barentsz, Maarten W.; Lam, Marnix G. E. H.; Braat, Arthur J. A. T.

doi:10.1007/s00259-021-05642-3

Cited by 14 publications

(7 citation statements)

References 35 publications

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“…However, due to the limited REILD occurrence within this study (1 case) and low incidence of significant hepatotoxicity (1 case), no correlation was found and no strong conclusion can be drawn on maximum tolerable healthy liver dose. This is in line with previous results by Ebbers et al [ 20 ] in which no significant relationship between absorbed dose in treated healthy liver and biochemical toxicity was found when assessing a NET patient population treated with yttrium-90 glass microspheres. To date, no clear dose–toxicity relationships have been described in radioembolization in general; advised thresholds for healthy liver dose are based on limited evidence and often lack validation [ 21 ].…”

Section: Discussionsupporting

confidence: 93%

Automatic healthy liver segmentation for holmium-166 radioembolization dosimetry

et al. 2023

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Background For safe and effective holmium-166 (166Ho) liver radioembolization, dosimetry is crucial and requires accurate healthy liver definition. The current clinical standard relies on manual segmentation and registration of a separately acquired contrast enhanced CT (CECT), a prone-to-error and time-consuming task. An alternative is offered by simultaneous imaging of 166Ho and technetium-99m stannous–phytate accumulating in healthy liver cells (166Ho–99mTc dual-isotope protocol). This study compares healthy liver segmentation performed with an automatic method using 99mTc images derived from a 166Ho–99mTc dual-isotope acquisition to the manual segmentation, focusing on healthy liver dosimetry and corresponding hepatotoxicity. Data from the prospective HEPAR PLuS study were used. Automatic healthy liver segmentation was obtained by thresholding the 99mTc image (no registration step required). Manual segmentation was performed on CECT and then manually registered to the SPECT/CT and subsequently to the corresponding 166Ho SPECT to compute absorbed dose in healthy liver. Results Thirty-one patients (66 procedures) were assessed. Manual segmentation and registration took a median of 30 min per patient, while automatic segmentation was instantaneous. Mean ± standard deviation of healthy liver absorbed dose was 18 ± 7 Gy and 20 ± 8 Gy for manual and automatic segmentations, respectively. Mean difference ± coefficient of reproducibility between healthy liver absorbed doses using the automatic versus manual segmentation was 2 ± 6 Gy. No correlation was found between mean absorbed dose in the healthy liver and hepatotoxicity. Conclusions 166Ho–99mTc dual-isotope protocol can automatically segment the healthy liver without hampering the 166Ho dosimetry assessment. Trial registration: ClinicalTrials.gov, NCT02067988. Registered 20 February 2014. https://clinicaltrials.gov/ct2/show/NCT02067988

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Section: Discussionsupporting

confidence: 93%

Automatic healthy liver segmentation for holmium-166 radioembolization dosimetry

et al. 2023

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“…A dose–survival relationship could be established (tumor dose >150 Gy); however, when correcting for the intrahepatic tumor burden, this relationship became non-significant. Although this was a small study, it illustrates that patient-personalized treatment based on dosimetric assessment is the way forward, in line with the developments in hepatocellular carcinoma [ 41 ].…”

Section: Concerns Limitations and Future Perspectivesmentioning

confidence: 85%

“…Ebbers et al analyzed 26 patients (128 tumors) treated with 90 Y glass radioembolization in a single center. A clear dose–response relationship, independent of NEN grade, was confirmed [ 41 ]. A minimum tumor-absorbed dose of 150 Gy, and preferably more than 200 Gy, significantly increases the likelihood of receiving an RECIST 1.1-based ORR (>80%).…”

Section: Concerns Limitations and Future Perspectivesmentioning

confidence: 94%

The Evolving Role of Radioembolization in the Treatment of Neuroendocrine Liver Metastases

Ramdhani

Braat

2022

Cancers

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At diagnosis, 21–50% of neuroendocrine tumors already have distant metastases, of which the liver is most commonly affected. Unfortunately, the presence of neuroendocrine liver metastases (NELM) is the most incriminating factor for survival. At NELM diagnosis, 60–70% of patients suffer from bilobar multifocal disease, making them ineligible for surgical resection. With limited systemic options, a clinical need for liver-directed treatments exists. Trans-arterial (bland) embolization, chemoembolization and radioembolization have been increasingly used in the treatment of NELM. In recent years, radioembolization (also known as selective internal radiation therapy) has gained attention due to promising tumor reductive results, limited toxicities and increasing scientific evidence. This review provides basic insights into radioembolization as a technique, a summary of available literature on radioembolization in NELM, and discusses caveats, challenges and new insights when considering radioembolization in NELM.

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“…SIRT is utilized in patients with NET either as a debulking treatment (independent of treatment line) or it is reserved as a salvage treatment following failure of other (systemic) therapies [ 30 , 33 ]. SIRT is most effective when a patient-tailored dosing approach is applied (i.e., prospective dosimetry), as evident dose–response relationships are presented in literature [ 34 , 35 ]. There is a difference to PRRT, where application of prospective dosimetry/patient-tailored dosing is not common.…”

Section: Prrt Combined With Transarterial Radioembolizationmentioning

confidence: 99%

Advances in Radionuclide Therapies for Patients with Neuro-endocrine Tumors

Hoogenkamp,

de Wit–van der Veen,

Huizing

et al. 2024

Curr Oncol Rep

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Purpose of Review To provide insights into the role of peptide receptor radionuclide therapy (PRRT) in patients with advanced neuroendocrine tumors (NET) and an overview of possible strategies to combine PRRT with locoregional and systemic anticancer treatments. Recent Findings Research on combining PRRT with other treatments encompasses a wide variety or treatments, both local (transarterial radioembolization) and systemic therapies, chemotherapy (i.e., capecitabine and temozolomide), targeted therapies (i.e., olaparib, everolimus, and sunitinib), and immunotherapies (e.g., nivolumab and pembrolizumab). Furthermore, PRRT shows promising first results as a treatment prior to surgery. Summary There is great demand to enhance the efficacy of PRRT through combination with other anticancer treatments. While research in this area is currently limited, the field is rapidly evolving with numerous ongoing clinical trials aiming to address this need and explore novel therapeutic combinations.

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Dose–response relationship after yttrium-90-radioembolization with glass microspheres in patients with neuroendocrine tumor liver metastases

Cited by 14 publications

References 35 publications

Automatic healthy liver segmentation for holmium-166 radioembolization dosimetry

Automatic healthy liver segmentation for holmium-166 radioembolization dosimetry

The Evolving Role of Radioembolization in the Treatment of Neuroendocrine Liver Metastases

Advances in Radionuclide Therapies for Patients with Neuro-endocrine Tumors

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