Tumor Targeting and Three-Dimensional Voxel-Based Dosimetry to Predict Tumor Response, Toxicity, and Survival after Yttrium-90 Resin Microsphere Radioembolization in Hepatocellular Carcinoma

Allimant, Carole; Kafrouni, Marilyne; Delicque, Julien; Ilonca, D.; Cassinotto, Christophe; Assenat, Éric; Ursic‐Bedoya, José; Pageaux, Georges‐Philippe; Mariano‐Goulart, Denis; Aho, Serge; Guiu, Boris

doi:10.1016/j.jvir.2018.07.006

Cited by 51 publications

(36 citation statements)

References 28 publications

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“…Allimant et al [45] evaluated 90 Y PET dosimetry using the MIRD approach and the area under the dose-volume histogram as a TD parameter in 37 patients and 42 procedures [45]. The area under the tumor dose volume histograms (AUDVHs) of ≥61 Gy were predictive of tumor control with a 76.5% sensitivity and a 75% specificity.…”

Section: Resin Microspheresmentioning

confidence: 99%

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

Garin¹,

Palard

Rolland

2020

Cancers

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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.

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Section: Resin Microspheresmentioning

confidence: 99%

“…Allimant et al [45] evaluated the AUDVH as a TD parameter in 38 patients ( 90 Y PET dosimetry, MIRD approach). The AUDVH for the NPL was significantly higher for patients with liver toxicity than for those without liver toxicity (78.91 versus 53.84 Gy; p = 0.04).…”

Section: Resin Microspheresmentioning

confidence: 99%

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

Garin¹,

Palard

Rolland

2020

Cancers

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“…These results, if validated in larger cohorts, could help to guide radiation lobectomy planning. More recently, three-dimensional voxel-based dosimetry for patients undergoing radioembolization with resin microspheres has also been described and shown to be an independent factor associated with tumor control and clinical outcomes [56]. Collectively, these advances have the potential to personalize dosimetry and improve clinical outcomes for patients treated with radioembolization.…”

Section: Variations In Y90 Radioembolization Techniquementioning

confidence: 99%

History and Evolution of Yttrium-90 Radioembolization for Hepatocellular Carcinoma

Saini

Wallace

Alzubaidi

et al. 2019

JCM

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Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and affects millions worldwide. Due to the lack of effective systemic therapies for HCC, researchers have been investigating the use of locoregional tumor control with Yttrium-90 (Y90) radioembolization since the 1960s. Following the development of glass and resin Y90 microspheres in the early 1990s, Y90 radioembolization has been shown to be a safe and efficacious treatment for patients with HCC across Barcelona Clinic Liver Cancer (BCLC) stages. By demonstrating durable local control, good long term outcomes, and equivalent if not superior tumor responses and tolerability when compared to alternative therapies including transarterial chemoembolization (TACE) and sorafenib, Y90 radioembolization is being increasingly used in HCC treatment. More recently, investigations into variations in Y90 radioembolization technique including radiation segmentectomy and radiation lobectomy have further expanded its clinical utility. Here, we discuss the history and evolution of Y90 use in HCC. We outline key clinical trials that have established the safety and efficacy of Y90 radioembolization, and also summarize trials comparing its efficacy to existing HCC treatments. We conclude by reviewing the techniques of radiation segmentectomy and lobectomy, and by discussing dosimetry.

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“…A pragmatic approach could be followed, as done for instance by Allimant et al . who reported after a multivariate analysis that the coverage of a lesion in TARE is by far much more important for response than the mean absorbed dose, with an odds ratio of 37 versus 1.027. Coverage is not accounted for by mean dose evaluation.…”

Section: Rebuttal: Carlo Chiesa Phdmentioning

confidence: 99%

Voxel‐based dosimetry is superior to mean absorbed dose approach for establishing dose‐effect relationship in targeted radionuclide therapy

Chiesa

Bardiès

Zaidi³

2019

Medical Physics

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Tumor Targeting and Three-Dimensional Voxel-Based Dosimetry to Predict Tumor Response, Toxicity, and Survival after Yttrium-90 Resin Microsphere Radioembolization in Hepatocellular Carcinoma

Cited by 51 publications

References 28 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

History and Evolution of Yttrium-90 Radioembolization for Hepatocellular Carcinoma

Voxel‐based dosimetry is superior to mean absorbed dose approach for establishing dose‐effect relationship in targeted radionuclide therapy

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