Results in Hepatocellular Carcinoma

Iñarrairaegui, Mercedes; Sangro, Bruno

doi:10.1007/174_2013_920

Cited by 3 publications

(2 citation statements)

References 72 publications

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“…In general, tolerance criteria are based on D mean . In clinical practice at HEGP, after considering toxicities reported in the literature for SIRT (22,23), mean absorbed dose limits for the lungs and NTL were set to 30 Gy (D mean,NTL # 30 Gy and D mean,Lungs # 30 Gy). Those values were thus considered for that retrospective study.…”

Section: Mia Calculationsmentioning

confidence: 99%

Three-Dimensional Personalized Monte Carlo Dosimetry in ⁹⁰Y Resin Microspheres Therapy of Hepatic Metastases: Nontumoral Liver and Lungs Radiation Protection Considerations and Treatment Planning Optimization

et al. 2014

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In the last decades, selective internal radiation therapy (SIRT) has become a real alternative in the treatment of unresectable hepatic cancers. In practice, the activity prescription is limited by the irradiation of organs at risk (OAR), such as the lungs and nontumoral liver (NTL). Its clinical implementation is therefore highly dependent on dosimetry. In that context, a 3-dimensional personalized dosimetry technique-personalized Monte Carlo dosimetry (PMCD)-based on patient-specific data and Monte Carlo calculations was developed and evaluated retrospectively on clinical data. Methods: The PMCD method was evaluated with data from technetium human albumin macroaggregates ( 99m Tc-MAA) evaluations of 10 patients treated for hepatic metastases. Region-of-interest outlines were drawn on CT images to create patient-specific voxel phantoms using the OEDIPE software. Normalized 3-dimensional matrices of cumulated activity were generated from 99m Tc-SPECT data. Absorbed doses at the voxel scale were then obtained with the MCNPX Monte Carlo code. The maximum-injectable activity (MIA) for tolerance criteria based on either OAR mean absorbed doses (D mean ) or OAR dose-volume histograms (DVHs) was determined using OEDIPE. Those MIAs were compared with the one recommended by the partition model (PM) with D mean tolerance criteria. Finally, OEDIPE was used to evaluate the absorbed doses delivered if those activities were injected to the patient and to generate the corresponding isodose curves and DVHs. Results: The MIA recommended using D mean tolerance criteria is, in average, 27% higher with the PMCD method than with the PM. If tolerance criteria based on DVHs are used along with the PMCD, an increase of at least 40% of the MIA is conceivable, compared with the PM. For MIAs calculated with the PMCD, D mean delivered to tumoral liver (TL) ranged from 19.5 to 118 Gy for D mean tolerance criteria whereas they ranged from 26.6 to 918 Gy with DVH tolerance criteria. Thus, using the PMCD method, which accounts for fixation heterogeneities, higher doses can be delivered to TL. Finally, absorbed doses to the lungs are not the limiting criterion for activity prescription. However, D mean to the lungs can reach 15.0 Gy. Conclusion: Besides its feasibility and applicability in clinical routine, the interest for treatment optimization of a personalized Monte Carlo dosimetry in the context of SIRT was confirmed in this study.

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Section: Mia Calculationsmentioning

confidence: 99%

Three-Dimensional Personalized Monte Carlo Dosimetry in ⁹⁰Y Resin Microspheres Therapy of Hepatic Metastases: Nontumoral Liver and Lungs Radiation Protection Considerations and Treatment Planning Optimization

et al. 2014

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“…Quality depends on the presence of an underlying liver damage (hepatitis or cirrhosis for HCC, chemotherapy-induced liver damage for lmCRC), while quantity depends on the size and location of tumor lesions. RE was initially considered only as rescue therapy for patients that had exhausted all possible therapies, including advanced stage HCC with vascular invasion or highburden intermediate stage HCC unlikely to benefit from chemoembolization [2], and chemorefractory CRC liver metastasis treated as third line or beyond [3]. In fact, surgeons in multidisciplinary team discussions were usually not in favor of considering RE for patients with potentially resectable liver tumors.…”

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confidence: 99%

Radioembolization as an adjunct therapy to the resection of liver tumors

Iñarrairaegui

Sangro

2015

Hepat. Oncol.

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Treatment of Hepatocellular Carcinoma by Radioembolization Using <sup>90</sup>Y Microspheres

Sangro¹,

Bilbao²,

Iñarrairaegui³

et al. 2009

Dig Dis

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The use of external beam radiation therapy for primary treatment of hepatocellular carcinoma (HCC) has been limited by the low radiation tolerance of the non-tumoral liver. However, technical advances allowing partial liver volume external irradiation have resulted in consistently high response rates. Internal radiation therapy, also called ⁹⁰Y radioembolization (⁹⁰Y-RE), consists in delivering implantable microspheres labeled with ⁹⁰Y into the arteries that feed liver tumors in order to provide a high dose of radiation to tumor nodules irrespective of their number, size and location, while preserving the non-tumoral liver tissue from receiving a harmful level of radiation. Among patients with HCC, ⁹⁰Y-RE is used for those that have a preserved liver function and unresectable tumors that cannot be treated with percutaneous ablation. Although ⁹⁰Y-RE is by and large well tolerated, it may produce relevant toxic effects as a result of radiation of non-target organs including cholecystitis, gastrointestinal ulceration, pneumonitis, and most importantly, liver toxicity. A significant effect on tumor growth in the treated lesions is consistently observed with disease control rates in excess of 80%. Also, ⁹⁰Y-RE may allow downstaging large or multiple lesions to radical treatments with curative intent. When compared with the survival of HCC patients in advanced stage either not treated or treated with ineffective systemic agents, survival after ⁹⁰Y-RE is encouraging and warrants future clinical trials. Clinical research in combining the cytotoxic effect of ⁹⁰Y with the cytostatic mechanism of targeted therapies is currently in progress and will provide valuable safety and toxicity data that may translate into improved clinical outcome and overall survival.

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Results in Hepatocellular Carcinoma

Cited by 3 publications

References 72 publications

Three-Dimensional Personalized Monte Carlo Dosimetry in ⁹⁰Y Resin Microspheres Therapy of Hepatic Metastases: Nontumoral Liver and Lungs Radiation Protection Considerations and Treatment Planning Optimization

Three-Dimensional Personalized Monte Carlo Dosimetry in ⁹⁰Y Resin Microspheres Therapy of Hepatic Metastases: Nontumoral Liver and Lungs Radiation Protection Considerations and Treatment Planning Optimization

Radioembolization as an adjunct therapy to the resection of liver tumors

Treatment of Hepatocellular Carcinoma by Radioembolization Using <sup>90</sup>Y Microspheres

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Results in Hepatocellular Carcinoma

Cited by 3 publications

References 72 publications

Three-Dimensional Personalized Monte Carlo Dosimetry in 90Y Resin Microspheres Therapy of Hepatic Metastases: Nontumoral Liver and Lungs Radiation Protection Considerations and Treatment Planning Optimization

Three-Dimensional Personalized Monte Carlo Dosimetry in 90Y Resin Microspheres Therapy of Hepatic Metastases: Nontumoral Liver and Lungs Radiation Protection Considerations and Treatment Planning Optimization

Radioembolization as an adjunct therapy to the resection of liver tumors

Treatment of Hepatocellular Carcinoma by Radioembolization Using <sup>90</sup>Y Microspheres

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Product

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Three-Dimensional Personalized Monte Carlo Dosimetry in ⁹⁰Y Resin Microspheres Therapy of Hepatic Metastases: Nontumoral Liver and Lungs Radiation Protection Considerations and Treatment Planning Optimization

Three-Dimensional Personalized Monte Carlo Dosimetry in ⁹⁰Y Resin Microspheres Therapy of Hepatic Metastases: Nontumoral Liver and Lungs Radiation Protection Considerations and Treatment Planning Optimization