Clinical impact of 99mTc-MAA SPECT/CT-based personalized predictive dosimetry in selective internal radiotherapy: a real-life single-center experience in unresectable HCC patients
Tóm tắt
Recent data demonstrated that personalized dosimetry-based selective internal radiotherapy (SIRT) is associated with better outcome for unresectable hepatocellular carcinoma (HCC).
We aim to evaluate the contribution of personalized predictive dosimetry (performed with Simplicity90® software) in our population of HCC patients by comparing them to our historical cohort whose activity was determined by standard dosimetry. This is a retrospective, single-center study conducted between February 2016 and December 2020 that included patients with HCC who received SIRT after simulation based on either standard dosimetry (group A) or, as of December 2017, on personalized dosimetry (group B). Primary endpoints were best overall response (BOR) and objective response rate (ORR) evaluated by mRECIST at 3 months. Safety and toxicity profiles were evaluated at 1- and 3-months post-treatment. For group A we compared the activity to be administered determined a posteriori using Simplicit90Y® and the activity actually administered determined by the standard approach. Between February 2016 and December 2020, 66 patients received 69 simulations leading to 40 treatments. The median follow-up time was equal for both groups, 21 months (range 3–55) in group A and 21 months (range 4–39) in group B. The per patient analysis revealed a significant benefit of personalized predictive dosimetry in terms of better overall response at 3 months (80% vs. 33.3%, p = 0.007) and at 6 months (77.8% vs. 22.2%, p = 0.06). This trend was found in the analysis by nodule with a response rate according to mRECIST of 87.5% for personalized dosimetry versus 68.4% for standard dosimetry at 3 months, p = 0.24. Only one grade 3 biological toxicity (hyperbilirubinemia) was noted in group A. The comparison between the administered activity and the recommended activity recalculated a posteriori using Simplicit90Y® showed that the vast majority of patients who progressed (83.33%) received less activity than that recommended by the personalized approach or an inadequate distribution of the administered activity. Our study aligns to recent literature and confirms that the use of personalized dosimetry allows a better selection of HCC patients who can benefit from SIRT, and consequently, improves the effectiveness of this treatment.
Tài liệu tham khảo
Chow PKH et al (2018) SIRveNIB: selective internal radiation therapy versus sorafenib in Asia-Pacific patients with hepatocellular carcinoma. J Clin Oncol. https://doi.org/10.1200/JCO.2017.76.0892
Dezarn WA et al (2011) 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. https://doi.org/10.1118/1.3608909
Finn RS et al (2020) Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. https://doi.org/10.1056/nejmoa1915745
Garin E, Rolland Y, Laffont S, Edeline J (2016) Clinical impact of 99mTc-MAA SPECT/CT-based dosimetry in the radioembolization of liver malignancies with 90Y-loaded microspheres. Eur J Nucl Med Mol Imaging. https://doi.org/10.1007/s00259-015-3157-8
Garin E et al (2017) High impact of macroaggregated albumin-based tumour dose on response and overall survival in hepatocellular carcinoma patients treated with 90Y-loaded glass microsphere radioembolization. Liver Int. https://doi.org/10.1111/liv.13220
Garin E et al (2021) 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. https://doi.org/10.1016/S2468-1253(20)30290-9
Gnesin S et al (2016) Partition model-based 99mTc-MAA SPECT/CT predictive dosimetry compared with 90Y TOF PET/CT posttreatment dosimetry in radioembolization of hepatocellular carcinoma: A quantitative agreement comparison. J Nucl Med. https://doi.org/10.2967/jnumed.116.173104
Grosser OS et al (2015) Intrahepatic activity distribution in radioembolization with yttrium-90-labeled resin microspheres using the body surface area method—a less than perfect model. J Vasc Interv Radiol. https://doi.org/10.1016/j.jvir.2015.07.021
Hermann AL et al (2020) Relationship of tumor radiation–absorbed dose to survival and response in hepatocellular carcinoma treated with transarterial radioembolization with 90Y in the SARAH study. Radiology. https://doi.org/10.1148/radiol.2020191606
Ho S et al (1997a) Tumour-to-normal uptake ratio of 90Y microspheres in hepatic cancer assessed with 99Tcm macroaggregated albumin. Br J Radiol. https://doi.org/10.1259/bjr.70.836.9486047
Ho S et al (1997b) Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med. https://doi.org/10.1007/s002590050055
Ilhan H et al (2015) Predictive value of 99mTc-labelled MAA scintigraphy for 90Y-microspheres distribution in radioembolization treatment with resin microspheres in primary and secondary hepatic tumors. J Nucl Med 2015;56:1654–1660
Kadalayil L et al (2013) A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer. Ann Oncol. https://doi.org/10.1093/annonc/mdt247
Lencioni R, Llovet JM (2010) Modified recist (mRECIST) assessment for hepatocellular carcinoma. Seminars in Liver Disease Preprint at. https://doi.org/10.1055/s-0030-1247132
Levillain H et al (2021) International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres. Eur J Nucl Med Mol Imaging. https://doi.org/10.1007/s00259-020-05163-5
Nijsen JFW et al (1999) Holmium-166 poly lactic acid microspheres applicable for intra-arterial radionuclide therapy of hepatic malignancies: Effects of preparation and neutron activation techniques. Eur J Nucl Med. https://doi.org/10.1007/s002590050440
Nijsen JFW et al (2001) Characterization of poly(L-lactic acid) microspheres loaded with holmium acetylacetonate. Biomaterials. https://doi.org/10.1016/S0142-9612(01)00055-2
Reig M et al (2021) BCLC strategy for prognosis prediction and treatment recommendation Barcelona Clinic Liver Cancer (BCLC) staging system. The 2022 update. J Hepatol. https://doi.org/10.1016/j.jhep.2021.11.018
Ricke J et al (2018) The impact of combining Selective Internal Radiation Therapy (SIRT) with sorafenib on overall survival in patients with advanced hepatocellular carcinoma: The SORAMIC trial palliative cohort. Ann Oncol. https://doi.org/10.1093/annonc/mdy149.028
Salem R et al (2019) Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging. https://doi.org/10.1007/s00259-019-04340-5
Salem R et al (2021) Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY Study. Hepatology. https://doi.org/10.1002/hep.31819
Smits MLJ et al (2020) The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases. Eur J Nucl Med Mol Imaging. https://doi.org/10.1007/s00259-019-04460-y
Trotta N et al (2022) Comparison of PMT-based TF64 and SiPM-based Vereos PET/CT systems for 90Y imaging and dosimetry optimization: A quantitative study. Med Phys 49:7567–7582
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (2017) Common terminology criteria for adverse events (CTCAE).v.5.0. Cancer Therapy Evaluation Program (CTEP)
Ulrich G et al (2013) Predictive value of intratumoral 99mTc-macroaggregated albumin uptake in patients with colorectal liver metastases scheduled for radioembolization with 90Y-microspheres. J Nucl Med. https://doi.org/10.2967/jnumed.112.112508
Vilgrain V et al (2017) Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(17)30683-6
Weber M et al (2022) EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging. https://doi.org/10.1007/s00259-021-05600-z
Wondergem M et al (2013) 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic radioembolization. J Nucl Med. https://doi.org/10.2967/jnumed.112.117614