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Utility of pre-procedural [99mTc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of 90Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [99mTc]TcMAA-based Segmentation

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Title: Utility of pre-procedural [99mTc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of 90Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [99mTc]TcMAA-based Segmentation
Authors: Lam, Marnix, Garin, Etienne, Haste, Paul, Denys, Alban, Geller, Brian, Kappadath, S Cheenu, Turkmen, Cuneyt, Sze, Daniel Y., Alsuhaibani, Hamad Saleh, Herrmann, Ken, Maccauro, Marco, Cantasdemir, Murat, Dreher, Matthew, Fowers, Kirk D, Gates, Vanessa, Salem, Riad
Contributors: Researchgr. Nucleaire Geneeskunde, Cancer, Jonchère, Laurent, Radiology and Imaging Sciences, School of Medicine
Source: Eur J Nucl Med Mol Imaging
European journal of nuclear medicine and molecular imaging, vol. 52, no. 2, pp. 744-755
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: [SDV] Life Sciences [q-bio], Yttrium-90, Segmentation, Hepatocellular carcinoma, Radiology Nuclear Medicine and imaging, Dosimetry, Glass/chemistry [MeSH], Aged, 80 and over [MeSH], Aged [MeSH], Radiometry [MeSH], Yttrium Radioisotopes/therapeutic use [MeSH], Original Article, Microspheres [MeSH], Liver Neoplasms/pathology [MeSH], Male [MeSH], Single Photon Emission Computed Tomography Computed Tomography [MeSH], Carcinoma, Hepatocellular/radiotherapy [MeSH], Female [MeSH], Liver Neoplasms/diagnostic imaging [MeSH], Adult [MeSH], Albumins [MeSH], Humans [MeSH], Carcinoma, Hepatocellular/pathology [MeSH], Retrospective Studies [MeSH], Technetium Tc 99m Aggregated Albumin [MeSH], Middle Aged [MeSH], Radioembolization, Radiotherapy Planning, Computer-Assisted/methods [MeSH], Carcinoma, Hepatocellular/diagnostic imaging [MeSH], Liver Neoplasms/radiotherapy [MeSH], Humans, Liver Neoplasms/diagnostic imaging, Liver Neoplasms/radiotherapy, Carcinoma, Hepatocellular/diagnostic imaging, Carcinoma, Hepatocellular/radiotherapy, Microspheres, Male, Female, Single Photon Emission Computed Tomography Computed Tomography, Aged, Middle Aged, Yttrium Radioisotopes/therapeutic use, Yttrium Radioisotopes/chemistry, Radiotherapy Planning, Computer-Assisted/methods, Radiometry, Retrospective Studies, Glass/chemistry, Technetium Tc 99m Aggregated Albumin, Aged, 80 and over, Radiopharmaceuticals/therapeutic use
Description: Purpose Pre-treatment [99mTc]TcMAA-based radioembolization treatment planning using multicompartment dosimetry involves the definition of the tumor and normal tissue compartments and calculation of the prescribed absorbed doses. The aim was to compare the real-world utility of anatomic and [99mTc]TcMAA-based segmentation of tumor and normal tissue compartments. Materials and methods Included patients had HCC treated by glass [90Y]yttrium microspheres, ≥ 1 tumor, ≥ 3 cm diameter and [99mTc]TcMAA SPECT/CT imaging before treatment. Segmentation was performed retrospectively using dedicated dosimetry software: (1) anatomic (diagnostic CT/MRI-based), and (2) [99mTc]TcMAA threshold-based (i.e., using an activity-isocontour threshold). CT/MRI was co-registered with [99mTc]TcMAA SPECT/CT. Logistic regression and Cox regression, respectively, were used to evaluate relationships between total perfused tumor absorbed dose (TAD) and objective response rate (ORR) and overall survival (OS). In a subset-analysis pre- and post-treatment dosimetry were compared using Bland-Altman analysis and Pearson’s correlation coefficient. Results A total of 209 patients were enrolled. Total perfused tumor and normal tissue volumes were larger when using anatomic versus [99mTc]TcMAA threshold segmentation, resulting in lower absorbed doses. mRECIST ORR was higher with increasing total perfused TAD (odds ratio per 100 Gy TAD increase was 1.22 (95% CI: 1.01–1.49; p = 0.044) for anatomic and 1.19 (95% CI: 1.04–1.37; p = 0.012) for [99mTc]TcMAA threshold segmentation. Higher total perfused TAD was associated with improved OS (hazard ratio per 100 Gy TAD increase was 0.826 (95% CI: 0.714–0.954; p = 0.009) and 0.847 (95% CI: 0.765–0.936; p = 0.001) for anatomic and [99mTc]TcMAA threshold segmentation, respectively). For pre- vs. post-treatment dosimetry comparison, the average bias for total perfused TAD was + 11.5 Gy (95% limits of agreement: -227.0 to 250.0) with a strong positive correlation (Pearson’s correlation coefficient = 0.80). Conclusion Real-world data support [99mTc]TcMAA imaging to estimate absorbed doses prior to treatment of HCC with glass [90Y]yttrium microspheres. Both anatomic and [99mTc]TcMAA threshold methods were suitable for treatment planning. Trial registration number NCT03295006.
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 1619-7089
1619-7070
DOI: 10.1007/s00259-024-06920-6
Access URL: https://pubmed.ncbi.nlm.nih.gov/39331131
https://dspace.library.uu.nl/handle/1874/458476
http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_FBAD8255BF995
https://serval.unil.ch/resource/serval:BIB_FBAD8255BF99.P001/REF.pdf
https://serval.unil.ch/notice/serval:BIB_FBAD8255BF99
https://repository.publisso.de/resource/frl:6508186
Rights: CC BY
Accession Number: edsair.doi.dedup.....b83ef70a5b9371c0f7ddcc4586fe7d8e
Database: OpenAIRE
Description
Abstract:Purpose Pre-treatment [99mTc]TcMAA-based radioembolization treatment planning using multicompartment dosimetry involves the definition of the tumor and normal tissue compartments and calculation of the prescribed absorbed doses. The aim was to compare the real-world utility of anatomic and [99mTc]TcMAA-based segmentation of tumor and normal tissue compartments. Materials and methods Included patients had HCC treated by glass [90Y]yttrium microspheres, ≥ 1 tumor, ≥ 3 cm diameter and [99mTc]TcMAA SPECT/CT imaging before treatment. Segmentation was performed retrospectively using dedicated dosimetry software: (1) anatomic (diagnostic CT/MRI-based), and (2) [99mTc]TcMAA threshold-based (i.e., using an activity-isocontour threshold). CT/MRI was co-registered with [99mTc]TcMAA SPECT/CT. Logistic regression and Cox regression, respectively, were used to evaluate relationships between total perfused tumor absorbed dose (TAD) and objective response rate (ORR) and overall survival (OS). In a subset-analysis pre- and post-treatment dosimetry were compared using Bland-Altman analysis and Pearson’s correlation coefficient. Results A total of 209 patients were enrolled. Total perfused tumor and normal tissue volumes were larger when using anatomic versus [99mTc]TcMAA threshold segmentation, resulting in lower absorbed doses. mRECIST ORR was higher with increasing total perfused TAD (odds ratio per 100 Gy TAD increase was 1.22 (95% CI: 1.01–1.49; p = 0.044) for anatomic and 1.19 (95% CI: 1.04–1.37; p = 0.012) for [99mTc]TcMAA threshold segmentation. Higher total perfused TAD was associated with improved OS (hazard ratio per 100 Gy TAD increase was 0.826 (95% CI: 0.714–0.954; p = 0.009) and 0.847 (95% CI: 0.765–0.936; p = 0.001) for anatomic and [99mTc]TcMAA threshold segmentation, respectively). For pre- vs. post-treatment dosimetry comparison, the average bias for total perfused TAD was + 11.5 Gy (95% limits of agreement: -227.0 to 250.0) with a strong positive correlation (Pearson’s correlation coefficient = 0.80). Conclusion Real-world data support [99mTc]TcMAA imaging to estimate absorbed doses prior to treatment of HCC with glass [90Y]yttrium microspheres. Both anatomic and [99mTc]TcMAA threshold methods were suitable for treatment planning. Trial registration number NCT03295006.
ISSN:16197089
16197070
DOI:10.1007/s00259-024-06920-6