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Title: Post-radioembolization yttrium-90 PET/CT-part 2: Dose-response and tumor predictive dosimetry for resin microspheres
Authors: Kao, Y.-H.
Steinberg, J.D.
Tay, Y.-S.
Lim, G.K.Y.
Yan, J.
Townsend, D.W.
Budgeon, C.
Boucek, J.A.
Francis, R.J.
Cheo, T.S.T.
Burgmans, M.C.
Irani, F.G.
Lo, R.H.G.
Tay, K.-H.
Tan, B.-S.
Chow, P.K.H. 
Satchithanantham, S.
Tan, A.E.H.
Ng, D.C.E.
Goh, A.S.W.
Keywords: Dose-volume histogram
Predictive dosimetry
Selective internal radiation therapy
Voxel dosimetry
Yttrium-90 radioembolization
Issue Date: 2013
Citation: Kao, Y.-H., Steinberg, J.D., Tay, Y.-S., Lim, G.K.Y., Yan, J., Townsend, D.W., Budgeon, C., Boucek, J.A., Francis, R.J., Cheo, T.S.T., Burgmans, M.C., Irani, F.G., Lo, R.H.G., Tay, K.-H., Tan, B.-S., Chow, P.K.H., Satchithanantham, S., Tan, A.E.H., Ng, D.C.E., Goh, A.S.W. (2013). Post-radioembolization yttrium-90 PET/CT-part 2: Dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI Research 3 (1) : 1-27. ScholarBank@NUS Repository.
Abstract: Background Coincidence imaging of low-abundance yttrium-90 (90Y) internal pair production by positron emission tomography with integrated computed tomography (PET/CT) achieves highresolution imaging of post-radioembolization microsphere biodistribution. Part 2 analyzes tumor and non-target tissue dose-response by 90Y PET quantification and evaluates the accuracy of tumor 99mTc macroaggregated albumin (MAA) single-photon emission computed tomography with integrated CT (SPECT/CT) predictive dosimetry. Methods Retrospective dose quantification of 90Y resin microspheres was performed on the same 23-patient data set in part 1. Phantom studies were performed to assure quantitative accuracy of our time-of-flight lutetium-yttrium-oxyorthosilicate system. Dose-responses were analyzed using 90Y dose-volume histograms (DVHs) by PET voxel dosimetry or mean absorbed doses by Medical Internal Radiation Dose macrodosimetry, correlated to follow-up imaging or clinical findings. Intended tumor mean doses by predictive dosimetry were compared to doses by 90Y PET. Results Phantom studies demonstrated near-perfect detector linearity and high tumor quantitative accuracy. For hepatocellular carcinomas, complete responses were generally achieved at D70 > 100 Gy (D70, minimum dose to 70% tumor volume), whereas incomplete responses were generally at D70 < 100 Gy; smaller tumors ( 100 Gy more easily than larger tumors. There was complete response in a cholangiocarcinoma at D70 90 Gy and partial response in an adrenal gastrointestinal stromal tumor metastasis at D70 53 Gy. In two patients, a mean dose of 18 Gy to the stomach was asymptomatic, 49 Gy caused gastritis, 65 Gy caused ulceration, and 53 Gy caused duodenitis. In one patient, a bilateral kidney mean dose of 9 Gy (V20 8%) did not cause clinically relevant nephrotoxicity. Under near-ideal dosimetric conditions, there was excellent correlation between intended tumor mean doses by predictive dosimetry and those by 90Y PET, with a low median relative error of +3.8% (95% confidence interval, -1.2% to +13.2%). Conclusions Tumor and non-target tissue absorbed dose quantification by 90Y PET is accurate and yields radiobiologically meaningful dose-response information to guide adjuvant or mitigative action. Tumor 99mTc MAA SPECT/CT predictive dosimetry is feasible. 90Y DVHs may guide future techniques in predictive dosimetry. © 2013 Kao et al.
Source Title: EJNMMI Research
ISSN: 2191219X
DOI: 10.1186/2191-219X-3-57
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