Dosimetrie bei der Selektiven Internen Radiotherapie (SIRT)

Oliver S. Großer; Philipp Genseke; Michael C. Kreißl

doi:10.1055/s-0043-120731

Der Nuklearmediziner, Table of Contents

Der Nuklearmediziner 2018; 41(01): 81-88
DOI: 10.1055/s-0043-120731

Dosimetrie

Dosimetrie bei der Selektiven Internen Radiotherapie (SIRT)

Dosimetry in Selective Internal Radiotherapy (SIRT)

Oliver S. Großer

Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R, Magdeburg, Deutschland

,

Philipp Genseke

Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R, Magdeburg, Deutschland

,

Michael C. Kreißl

Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R, Magdeburg, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Für die Berechnung der Therapieaktivität im Rahmen der Selektiven Internen Radiotherapie (SIRT oder auch Radioembolisation) existieren unterschiedlich elaborierte Berechnungsmodelle. Diese besitzen empirischen Charakter bzw. basieren auf makroskopischen Ansätzen unter der Annahme einer Gleichverteilung der Mikrosphären und damit der akkumulierten Dosis (MIRD-basierter Modellansatz). Eine Inhomogenität in der Anreicherung des Radioembolisats, welche regulär durch die post-therapeutische Bildgebung beobachtet wird, findet in den Dosierungskonzepten keine Berücksichtigung. Für die weitere Entwicklung wäre es hier wünschenswert, radiobiologische Konzepte stärker zu integrieren und eine Dosierung der Therapieaktivität unter Berücksichtigung der (limitierenden) gewebsspezifischen Toleranzen durchzuführen.

Generell sind die Bewertung der Effektivität und der Nebenwirkungen sowie die damit verbundene Definition von Toleranzdosen/Zieldosen schwierig. Die verfügbaren Daten weisen aufgrund der Heterogenität der untersuchten Endpunkte, unterschiedlicher basaler Leberfunktion und individueller Erkrankungshistorien (Vortherapie) eine große Streuung und eine damit verbundene große Unsicherheit auf.

Abstract

Models with different levels of elaboration are available for calculating treatment activity in Selective Internal Radiotherapy (SIRT or radioembolization). These either have empiric character or are based on macroscopic approaches assuming a uniform distribution of microspheres and therefore of accumulated dose (MIRD based modelling approach). The inhomogeneous accumulation of the radioembolizate, regularly observed by post-therapeutic imaging, is not taken into consideration by current dose concepts.

In the future, it would be preferable to integrate radiobiological concepts and to estimate therapeutic activity considering (limiting) tissue specific tolerances.

In general, assessment of therapeutic outcome and side effects including the definition of corresponding tolerance doses/target doses is challenging. Due to the heterogeneity of examined endpoints, different basic liver function and individual medical history (previous therapies), the available data exhibit a high spread and uncertainty.

Schlüsselwörter

SIRT - Radioembolisation - Dosimetrie - ⁹⁰Y

Keywords

SIRT - Radioembolization - Dosimetry - ⁹⁰Y

Full Text

References

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