Stereotactic Inverse Dose Planning After Yttrium-90 Selective Internal Radiation Therapy in Hepatocellular Cancer

Abbott, Elliot; Young, Robert Steve; Hale, Caroline; Mitchell, Kimberly J.; Falzone, Nadia; Vallis, Katherine A.; Kennedy, Andrew S.

doi:10.1016/j.adro.2020.11.002

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…2,3 The possibility of using combined therapies has also been recommended in the literature. 4,5 There is a large body of prospective and retrospective literature demonstrating both safety and efficacy of radioembolization for the management of primary 2,[6][7][8] and metastatic 3,9,10 liver cancers. The literature for colorectal liver metastases, especially patients with liver only, or liver dominant disease, is particularly extensive.…”

Section: Clinical Indications and Patient Selectionmentioning

confidence: 99%

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AAPM Medical Physics Practice Guideline 14.a: Yttrium‐90 microsphere radioembolization

Busse,

Al‐Ghazi,

Abi‐Jaoudeh

et al. 2023

J Applied Clin Med Phys

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Radioembolization using Yttrium‐90 (90Y) microspheres is widely used to treat primary and metastatic liver tumors. The present work provides minimum practice guidelines for establishing and supporting such a program. Medical physicists play a key role in patient and staff safety during these procedures. Products currently available are identified and their properties and suppliers summarized. Appropriateness for use is the domain of the treating physician. Patient work up starts with pre‐treatment imaging. First, a mapping study using Technetium‐99m (Tc‐99m) is carried out to quantify the lung shunt fraction (LSF) and to characterize the vascular supply of the liver. An MRI, CT, or a PET‐CT scan is used to obtain information on the tumor burden. The tumor volume, LSF, tumor histology, and other pertinent patient characteristics are used to decide the type and quantity of 90Y to be ordered. On the day of treatment, the appropriate dose is assayed using a dose calibrator with a calibration traceable to a national standard. In the treatment suite, the care team led by an interventional radiologist delivers the dose using real‐time image guidance. The treatment suite is posted as a radioactive area during the procedure and staff wear radiation dosimeters. The treatment room, patient, and staff are surveyed post‐procedure. The dose delivered to the patient is determined from the ratio of pre‐treatment and residual waste exposure rate measurements. Establishing such a treatment modality is a major undertaking requiring an institutional radioactive materials license amendment complying with appropriate federal and state radiation regulations and appropriate staff training commensurate with their respective role and function in the planning and delivery of the procedure. Training, documentation, and areas for potential failure modes are identified and guidance is provided to ameliorate them.

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Section: Clinical Indications and Patient Selectionmentioning

confidence: 99%

“…The therapeutic ratio effectively improves intrahepatic tumor control while minimizing the relative risk of radioembolization‐induced liver disease (REILD) even for patients with extensive tumor burden 2,3 . The possibility of using combined therapies has also been recommended in the literature 4,5 …”

Section: Introductionmentioning

confidence: 99%

AAPM Medical Physics Practice Guideline 14.a: Yttrium‐90 microsphere radioembolization

Busse,

Al‐Ghazi,

Abi‐Jaoudeh

et al. 2023

J Applied Clin Med Phys

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“…This approach was shown to be technically feasible in the treatment of hepatocellular cancer (HCC), where multiple intrahepatic tumours were targeted using yttrium-90 selective internal radiation therapy ([ 90 Y]Y-SIRT), which involves the administration of radiolabelled microspheres into the hepatic artery, combined with EBRT to bulk lesions. Two studies demonstrated methods for combining the absorbed dose from [ 90 Y]Y-SIRT with that of EBRT [12,13]. Using the biological effective dose (BED) which is a quantitative measure of the biological effect of a radiotherapy treatment taking into account dose per fraction or dose rate and total dose, it was possible to compute the combined dose from both sources (Figure 1).…”

Section: Spatial Co-operationmentioning

confidence: 99%

“…Liver is contoured in blue and tumour in magenta. Reproduced with permission from [12]. and rate of efflux from the tumour or normal organs.…”

Section: Radiobiological Considerationsmentioning

confidence: 99%

Combining External Beam Radiation and Radionuclide Therapies: Rationale, Radiobiology, Results and Roadblocks

et al. 2021

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The emergence of effective radionuclide therapeutics, such as radium-223 dichloride, [ 177 Lu]Lu-DOTA-TATE and [ 177 Lu]Lu-PSMA ligands, over the last 10 years is driving a rapid expansion in molecular radiotherapy (MRT) research. Clinical trials that are underway will help to define optimal dosing protocols and identify groups of patients who are likely to benefit from this form of treatment. Clinical investigations are also being conducted to combine new MRT agents with other anticancer drugs, with particular emphasis on DNA repair inhibitors and immunotherapeutics. In this review, the case is presented for combining MRT with external beam radiotherapy (EBRT). The technical and dosimetric challenges of combining two radiotherapeutic modalities have impeded progress in the past. However, the need for research into the specific radiobiological effects of radionuclide therapy, which has lagged behind that for EBRT, has been recognised. This, together with innovations in imaging technology, MRT dosimetry tools and EBRT hardware, will facilitate the future use of this important combination of treatments.

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“…This information can be used to determine undertreated areas of tumor which may require additional therapy, such as a more selective TARE, SBRT, or other locoregional therapies. A recent study combining EBRT and SIRT utilizing y-90based dosimetry in 10 HCC patients appeared safe [66]. Further studies are needed regarding the safety and efficacy of TARE using these more advanced dosimetry methodologies.…”

Section: Sirt For Clmsmentioning

confidence: 99%

The Role of Ablative Radiotherapy to Liver Oligometastases from Colorectal Cancer

Yeakel

Gan

et al. 2021

Curr Colorectal Cancer Rep

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Purpose of Review This review describes recent data supporting locoregional ablative radiation in the treatment of oligometastatic colorectal cancer liver metastases. Recent Findings Stereotactic body radiotherapy (SBRT) demonstrates high rates of local control in colorectal cancer liver metastases when a biologically equivalent dose of > 100 Gy is delivered. Future innovations to improve the efficacy of SBRT include MRI-guided radiotherapy (MRgRT) to enhance target accuracy, systemic immune activation to treat extrahepatic disease, and genomic customization. Selective internal radiotherapy (SIRT) with y-90 is an intra-arterial therapy that delivers high doses to liver metastases internally which has shown to increase liver disease control in phase 3 trials. Advancements in transarterial radioembolization (TARE) dosimetry could improve local control and decrease toxicity. Summary SBRT and SIRT are both promising options in treating unresectable metastatic colorectal cancer liver metastases. Identification of oligometastatic patients who receive long-term disease control from either therapy is essential. Future advancements focusing on improving radiation design and customization could further improve efficacy and toxicity.

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Stereotactic Inverse Dose Planning After Yttrium-90 Selective Internal Radiation Therapy in Hepatocellular Cancer

Cited by 7 publications

References 18 publications

AAPM Medical Physics Practice Guideline 14.a: Yttrium‐90 microsphere radioembolization

AAPM Medical Physics Practice Guideline 14.a: Yttrium‐90 microsphere radioembolization

Combining External Beam Radiation and Radionuclide Therapies: Rationale, Radiobiology, Results and Roadblocks

The Role of Ablative Radiotherapy to Liver Oligometastases from Colorectal Cancer

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