RSS-Feed abonnieren

DOI: 10.1055/s-0045-1809343
Theranostic Radioembolization: Radiation Dosimetry-Guided Treatment Planning and Delivery

Abstract
Radioembolizaton of hepatic malignancy is an accepted palliative treatment option in many subjects. The process of working up an individual for a radioembolization procedure permits pretreatment radiation dosimetry to be estimated, which is not possible with many other theranostic pairs of radionuclides. These estimates can then be used to prescribe the desired amount of radionuclide therapy (RNT), in radiation dose units of gray (Gy), to treat the cancer tissues to a desired level as well as permitting the radiation dose to the normal liver compartment to be minimized. As such, radioembolization represents an excellent example of a theranostic approach to treatment where individualization of the therapy can be highly tailored. The necessary tools are now available to implement this approach on a wider scale, which should improve outcomes for the treated individuals. The aim of this review article was to present a contemporary approach to personalized treatment planning for radioembolization and to emphasize the theranostic aspects of the process. A clinical case is presented demonstrating the potential for excellent clinical outcomes using an image-based and informed treatment plan developed by the multidisciplinary team of nuclear physicians, interventional radiologists, medical oncologists, and medical physicists.
Publikationsverlauf
Artikel online veröffentlicht:
23. Mai 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Arnold C. Theranostics could be big business in precision oncology. Nat Med 2022; 28 (04) 606-608
- 2 Ariel IM. Treatment of inoperable primary pancreatic and liver cancer by the intra-arterial administration of radioactive isotopes (Y90 radiating microspheres). Ann Surg 1965; 162 (02) 267-278
- 3 Smits ML, Nijsen JF, van den Bosch MA. et al. Holmium-166 radioembolisation in patients with unresectable, chemorefractory liver metastases (HEPAR trial): a phase 1, dose-escalation study. Lancet Oncol 2012; 13 (10) 1025-1034
- 4 Wondergem M, Smits ML, Elschot M. et al. 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic radioembolization. J Nucl Med 2013; 54 (08) 1294-1301
- 5 Hertz S, Roberts A. Radioactive iodine in the study of thyroid physiology; the use of radioactive iodine therapy in hyperthyroidism. J Am Med Assoc 1946; 131: 81-86
- 6 Ekman M, Fjälling M, Friman S, Carlson S, Volkmann R. Liver uptake function measured by IODIDA clearance rate in liver transplant patients and healthy volunteers. Nucl Med Commun 1996; 17 (03) 235-242
- 7 Abbott EM, Falzone N, Lee BQ. et al. The impact of radiobiologically informed dose prescription on the clinical benefit of 90Y SIRT in colorectal cancer patients. J Nucl Med 2020; 61 (11) 1658-1664
- 8 Brenner DJ, Hlatky LR, Hahnfeldt PJ, Huang Y, Sachs RK. The linear-quadratic model and most other common radiobiological models result in similar predictions of time-dose relationships. Radiat Res 1998; 150 (01) 83-91
- 9 Abbott EM. Optimising Radiotherapy of Liver Tumours: Radiobiology of Yttrium-90 Microsphere Treatment. DPhil thesis. St Cross College Oxford, UK: University of Oxford; 2019
- 10 Gholami YH, Willowson KP, Bailey DL. Towards personalised dosimetry in patients with liver malignancy treated with 90Y-SIRT using in vivo-driven radiobiological parameters. EJNMMI Phys 2022; 9 (01) 49
- 11 Fornace Jr AJ, Lechner JF, Grafstrom RC, Harris CC. DNA repair in human bronchial epithelial cells. Carcinogenesis 1982; 3 (12) 1373-1377
- 12 Dale RG, Hendry JH, Jones B, Robertson AG, Deehan C, Sinclair JA. Practical methods for compensating for missed treatment days in radiotherapy, with particular reference to head and neck schedules. Clin Oncol (R Coll Radiol) 2002; 14 (05) 382-393
- 13 Gholami YH, Willowson KP, Forwood NJ. et al. Comparison of radiobiological parameters for 90Y radionuclide therapy (RNT) and external beam radiotherapy (EBRT) in vitro. EJNMMI Phys 2018; 5 (01) 18
- 14 Lhommel R, Goffette P, Van den Eynde M. et al. Yttrium-90 TOF PET scan demonstrates high-resolution biodistribution after liver SIRT. Eur J Nucl Med Mol Imaging 2009; 36 (10) 1696
- 15 Willowson K, Forwood N, Jakoby BW, Smith AM, Bailey DL. Quantitative (90)Y image reconstruction in PET. Med Phys 2012; 39 (11) 7153-7159
- 16 Linder PM, Lan W, Trautwein NF. et al. Optimization of Y-90 radioembolization imaging for post-treatment dosimetry on a long axial field-of-view PET/CT scanner. Diagnostics (Basel) 2023; 13 (22) 3418
- 17 Willowson KP, Eslick EM, Bailey DL. Individualised dosimetry and safety of SIRT for intrahepatic cholangiocarcinoma. EJNMMI Phys 2021; 8 (01) 65
- 18 Lescure C, Estrade F, Pedrono M. et al. ALBI score is a strong predictor of toxicity following SIRT for hepatocellular carcinoma. Cancers (Basel) 2021; 13 (15) 13
- 19 Schaefer N, Grözinger G, Pech M. et al; CIRT Principal Investigators. Prognostic factors for effectiveness outcomes after transarterial radioembolization in metastatic colorectal cancer: results from the multicentre observational study CIRT. Clin Colorectal Cancer 2022; 21 (04) 285-296
- 20 Shah RM, Sheikh S, Shah J. et al. Prognostic factors of unresectable hepatocellular carcinoma treated with yttrium-90 radioembolization: results from a large cohort over 13 years at a single center. J Gastrointest Oncol 2021; 12 (04) 1718-1731
- 21 Mejait A, Roux C, Soret M. et al. Enhanced therapeutic outcomes with atezolizumab-bevacizumab and SIRT combination compared to SIRT alone in unresectable HCC: a promising approach for improved survival. Clin Res Hepatol Gastroenterol 2024; 48 (02) 102282
- 22 Ramdhani K, Smits MLJ, Lam MGEH, Braat AJAT. Combining selective internal radiation therapy with immunotherapy in treating hepatocellular carcinoma and hepatic colorectal metastases: a systematic review. Cancer Biother Radiopharm 2023; 38 (04) 216-224
- 23 Haugen BR, Alexander EK, Bible KC. et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26 (01) 1-133
- 24 Gray BN, Anderson JE, Burton MA. et al. Regression of liver metastases following treatment with yttrium-90 microspheres. Aust N Z J Surg 1992; 62 (02) 105-110
- 25 Kim SP, Cohalan C, Kopek N, Enger SA. A guide to 90Y radioembolization and its dosimetry. Phys Med 2019; 68: 132-145
- 26 Dezarn WA, Cessna JT, DeWerd LA. et al; American Association of Physicists in Medicine. Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys 2011; 38 (08) 4824-4845
- 27 Levillain H, Bagni O, Deroose CM. et al. International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres. Eur J Nucl Med Mol Imag 2021; 48: 1570-1584
- 28 Sirtex. SIR-Spheres Y90 Resin Package Insert. IFU-006-ROW Rev. 1. Sirtex Medical Pvt Ltd, Sydney, Australia
- 29 Ho S, Lau WY, Leung TW. et al. Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours. Eur J Nucl Med 1996; 23 (08) 947-952
- 30 Kao YH, Tan EH, Ng CE, Goh SW. Clinical implications of the body surface area method versus partition model dosimetry for yttrium-90 radioembolization using resin microspheres: a technical review. Ann Nucl Med 2011; 25 (07) 455-461
- 31 Pasciak AS, Bourgeois AC, Bradley YC. A comparison of techniques for (90)Y PET/CT image-based dosimetry following radioembolization with resin microspheres. Front Oncol 2014; 4: 121
- 32 Garin E, Tselikas L, Guiu B. et al; DOSISPHERE-01 Study Group. Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial. Lancet Gastroenterol Hepatol 2021; 6 (01) 17-29
- 33 Rognoni C, Barcellona MR, Bargellini I. et al. Cost-effectiveness analysis of personalised versus standard dosimetry for selective internal radiation therapy with TheraSphere in patients with hepatocellular carcinoma. Front Oncol 2022; 12: 920073
- 34 Marquis H, Ocampo Ramos JC, Carter LM. et al. MIRD Pamphlet No. 29: MIRDy90-A 90Y research microsphere dosimetry tool. J Nucl Med 2024; 65 (05) 794-802
- 35 Willowson KP, Hayes AR, Chan DLH. et al. Clinical and imaging-based prognostic factors in radioembolisation of liver metastases from colorectal cancer: a retrospective exploratory analysis. EJNMMI Res 2017; 7 (01) 46
- 36 Kokabi N, Arndt-Webster L, Chen B. et al. Voxel-based dosimetry predicting treatment response and related toxicity in HCC patients treated with resin-based Y90 radioembolization: a prospective, single-arm study. Eur J Nucl Med Mol Imaging 2023; 50 (06) 1743-1752
- 37 Chiesa C, Sjogreen-Gleisner K, Walrand S. et al. EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres. EJNMMI Phys 2021; 8 (01) 77