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Determination of Radiation Absorbed Dose to Primary Liver Tumors and Normal Liver Tissue Using Post-Radioembolization (90)Y PET.

Srinivas SM, Natarajan N, Kuroiwa J, Gallagher S, Nasr E, Shah SN, DiFilippo FP, Obuchowski N, Bazerbashi B, Yu N, McLennan G - Front Oncol (2014)

Bottom Line: Normal liver tissue received a mean dose of 67 Gy (mode 60-70 Gy; range 10-120 Gy).There was a statistically significant association between absorbed dose to normal liver and the presence of two or more severe complications (p = 0.036).Collateral dose to normal liver is non-trivial and can have clinical implications.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Cleveland Clinic , Cleveland, OH , USA.

ABSTRACT

Background: Radioembolization with Yttrium-90 ((90) Y) microspheres is becoming a more widely used transcatheter treatment for unresectable hepatocellular carcinoma (HCC). Using post-treatment (90) Y positron emission tomography/computerized tomography (PET/CT) scans, the distribution of microspheres within the liver can be determined and quantitatively assessed. We studied the radiation dose of (90) Y delivered to liver and treated tumors.

Methods: This retrospective study of 56 patients with HCC, including analysis of 98 liver tumors, measured and correlated the dose of radiation delivered to liver tumors and normal liver tissue using glass microspheres (TheraSpheres(®)) to the frequency of complications with modified response evaluation criteria in solid tumors (mRECIST). (90) Y PET/CT and triphasic liver CT scans were used to contour treated tumor and normal liver regions and determine their respective activity concentrations. An absorbed dose factor was used to convert the measured activity concentration (Bq/mL) to an absorbed dose (Gy).

Results: The 98 studied tumors received a mean dose of 169 Gy (mode 90-120 Gy; range 0-570 Gy). Tumor response by mRECIST criteria was performed for 48 tumors that had follow-up scans. There were 21 responders (mean dose 215 Gy) and 27 non-responders (mean dose 167 Gy). The association between mean tumor absorbed dose and response suggests a trend but did not reach statistical significance (p = 0.099). Normal liver tissue received a mean dose of 67 Gy (mode 60-70 Gy; range 10-120 Gy). There was a statistically significant association between absorbed dose to normal liver and the presence of two or more severe complications (p = 0.036).

Conclusion: Our cohort of patients showed a possible dose-response trend for the tumors. Collateral dose to normal liver is non-trivial and can have clinical implications. These methods help us understand whether patient adverse events, treatment success, or treatment failure can be attributed to the dose that the tumor or normal liver received.

No MeSH data available.


Related in: MedlinePlus

The figure above indicates the symptoms experienced after 90Y radioembolization for the 56 cases evaluated in this study. Patients in certain cases had multiple complications. Complications reported were those that had occurred within 2 months of procedure.
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Figure 7: The figure above indicates the symptoms experienced after 90Y radioembolization for the 56 cases evaluated in this study. Patients in certain cases had multiple complications. Complications reported were those that had occurred within 2 months of procedure.

Mentions: An additional analysis of the 56 cases in this study was done to explore a possible correlation between dose of radiation to normal liver tissue and complications suffered within 2 months of 90Y radioembolization (see Figure 7). The graph displays that in 23 of the 56 cases, no complications were observed in the 2 months following procedure. In the remaining 33 cases in which complications were suffered, the most common complication was slight fatigue, experienced in 14 of the cases. Ascites and moderate to severe fatigue were the next most common complications, which were experienced in seven cases and six cases, respectively. Jaundice and severe chest pain were the least common complications, which were each seen in one case. Thirty-seven had mild or no complications (i.e., slight fatigue, slight abdominal pain, and no symptoms), 15 had one severe complication, and 6 had two or more severe complications.


Determination of Radiation Absorbed Dose to Primary Liver Tumors and Normal Liver Tissue Using Post-Radioembolization (90)Y PET.

Srinivas SM, Natarajan N, Kuroiwa J, Gallagher S, Nasr E, Shah SN, DiFilippo FP, Obuchowski N, Bazerbashi B, Yu N, McLennan G - Front Oncol (2014)

The figure above indicates the symptoms experienced after 90Y radioembolization for the 56 cases evaluated in this study. Patients in certain cases had multiple complications. Complications reported were those that had occurred within 2 months of procedure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195277&req=5

Figure 7: The figure above indicates the symptoms experienced after 90Y radioembolization for the 56 cases evaluated in this study. Patients in certain cases had multiple complications. Complications reported were those that had occurred within 2 months of procedure.
Mentions: An additional analysis of the 56 cases in this study was done to explore a possible correlation between dose of radiation to normal liver tissue and complications suffered within 2 months of 90Y radioembolization (see Figure 7). The graph displays that in 23 of the 56 cases, no complications were observed in the 2 months following procedure. In the remaining 33 cases in which complications were suffered, the most common complication was slight fatigue, experienced in 14 of the cases. Ascites and moderate to severe fatigue were the next most common complications, which were experienced in seven cases and six cases, respectively. Jaundice and severe chest pain were the least common complications, which were each seen in one case. Thirty-seven had mild or no complications (i.e., slight fatigue, slight abdominal pain, and no symptoms), 15 had one severe complication, and 6 had two or more severe complications.

Bottom Line: Normal liver tissue received a mean dose of 67 Gy (mode 60-70 Gy; range 10-120 Gy).There was a statistically significant association between absorbed dose to normal liver and the presence of two or more severe complications (p = 0.036).Collateral dose to normal liver is non-trivial and can have clinical implications.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Cleveland Clinic , Cleveland, OH , USA.

ABSTRACT

Background: Radioembolization with Yttrium-90 ((90) Y) microspheres is becoming a more widely used transcatheter treatment for unresectable hepatocellular carcinoma (HCC). Using post-treatment (90) Y positron emission tomography/computerized tomography (PET/CT) scans, the distribution of microspheres within the liver can be determined and quantitatively assessed. We studied the radiation dose of (90) Y delivered to liver and treated tumors.

Methods: This retrospective study of 56 patients with HCC, including analysis of 98 liver tumors, measured and correlated the dose of radiation delivered to liver tumors and normal liver tissue using glass microspheres (TheraSpheres(®)) to the frequency of complications with modified response evaluation criteria in solid tumors (mRECIST). (90) Y PET/CT and triphasic liver CT scans were used to contour treated tumor and normal liver regions and determine their respective activity concentrations. An absorbed dose factor was used to convert the measured activity concentration (Bq/mL) to an absorbed dose (Gy).

Results: The 98 studied tumors received a mean dose of 169 Gy (mode 90-120 Gy; range 0-570 Gy). Tumor response by mRECIST criteria was performed for 48 tumors that had follow-up scans. There were 21 responders (mean dose 215 Gy) and 27 non-responders (mean dose 167 Gy). The association between mean tumor absorbed dose and response suggests a trend but did not reach statistical significance (p = 0.099). Normal liver tissue received a mean dose of 67 Gy (mode 60-70 Gy; range 10-120 Gy). There was a statistically significant association between absorbed dose to normal liver and the presence of two or more severe complications (p = 0.036).

Conclusion: Our cohort of patients showed a possible dose-response trend for the tumors. Collateral dose to normal liver is non-trivial and can have clinical implications. These methods help us understand whether patient adverse events, treatment success, or treatment failure can be attributed to the dose that the tumor or normal liver received.

No MeSH data available.


Related in: MedlinePlus