Stereotactic body radiation therapy (SBRT) following Yttrium-90 (90Y) selective internal radiation therapy (SIRT): a feasibility planning study using 90Y delivered dose

被引:8
作者
Mee, Stephen F. [1 ,2 ]
Polan, Daniel F. [3 ]
Dewaraja, Yuni K. [1 ]
Cuneo, Kyle C. [3 ]
Gemmete, Joseph J. [1 ]
Evans, Joseph R. [3 ]
Lawrence, Theodore S. [3 ]
Dow, Janell S. [3 ]
Mikell, Justin K. [3 ]
机构
[1] Univ Michigan, Dept Radiol, Ann Arbor, MI USA
[2] Wayne State Univ, Sch Med, Detroit, MI USA
[3] Univ Michigan, Dept Radiat Oncol, Ann Arbor, MI 48108 USA
基金
美国国家卫生研究院;
关键词
hepatocellular carcinoma; Yttrium-90; radioembolization; SBRT; SIRT; Y-90; radiation therapy; HEPATOCELLULAR-CARCINOMA; LIVER METASTASES; CANCER;
D O I
10.1088/1361-6560/acbbb5
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
Objective. Y-90 selective internal radiation therapy (SIRT) treatment of hepatocellular carcinoma (HCC) can potentially underdose lesions, as identified on post-therapy PET/CT imaging. This study introduces a methodology and explores the feasibility for selectively treating SIRT-underdosed HCC lesions, or lesion subvolumes, with stereotactic body radiation therapy (SBRT) following post-SIRT dosimetry. Approach. We retrospectively analyzed post-treatment PET/CT images of 20 HCC patients after Y-90 SIRT. Predicted tumor response from SIRT was quantified based on personalized post-therapy dosimetry and corresponding response models. Predicted non-responding tumor regions were then targeted with a hypothetical SBRT boost plan using a framework for selecting eligible tumors and tumor subregions. SBRT boost plans were compared to SBRT plans targeting all tumors irrespective of SIRT dose with the same prescription and organ-at-risk (OAR) objectives. The potential benefit of SIRT followed by a SBRT was evaluated based on OAR dose and predicted toxicity compared to the independent SBRT treatment. Main results. Following SIRT, 14/20 patients had at least one predicted non-responding tumor considered eligible for a SBRT boost. When comparing SBRT plans, 10/14 (71%) SBRTboost and 12/20 (60%) SBRTalone plans were within OAR dose constraints. For three patients, SBRTboost plans were within OAR constraints while SBRTalone plans were not. Across the 14 eligible patients, SBRTboost plans had significantly less dose to the healthy liver (decrease in mean dose was on average +/- standard deviation, 2.09 Gy +/- 1.99 Gy, ) and reduced the overall targeted PTV volume (39% +/- 21%) compared with SBRTalone. Significance. A clinical methodology for treating HCC using a synergized SIRT and SBRT approach is presented, demonstrating that it could reduce normal tissue toxicity risk in a majority of our retrospectively evaluated cases. Selectively targeting SIRT underdosed HCC lesions, or lesion subvolumes, with SBRT could improve tumor control and patient outcomes post-SIRT and allow SIRT to function as a target debulking tool for cases when SBRT is not independently feasible.
引用
收藏
页数:9
相关论文
共 50 条
[31]   Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases:: Single-centre experience with 100 patients [J].
Stubbs, Richard S. ;
O'Brien, Inga ;
Correia, Mauro M. .
ANZ JOURNAL OF SURGERY, 2006, 76 (08) :696-703
[32]   A retrospective analysis of selective internal radiation therapy (SIRT) with yttrium-90 microspheres in patients with unresectable hepatic malignancies [J].
Omed, A. ;
Lawrance, J. A. L. ;
Murphy, G. ;
Laasch, H. -U. ;
Wilson, G. ;
Illidge, T. ;
Tipping, J. ;
Zivanovic, M. ;
Jeans, S. .
CLINICAL RADIOLOGY, 2010, 65 (09) :720-728
[33]   Outcomes and Predictors of Toxicity after selective internal radiation Therapy Using Yttrium-90 resin Microspheres for Unresectable hepatocellular carcinoma [J].
Gabrielson, Andrew ;
Miller, Akemi ;
Banovac, Filip ;
Kim, Alexander ;
He, Aiwu Ruth ;
Unger, Keith .
FRONTIERS IN ONCOLOGY, 2015, 5
[34]   Effects of Yttrium-90 selective internal radiation therapy on non-conventional liver tumors [J].
Andrew Kuei ;
Sammy Saab ;
Sung-Ki Cho ;
Stephen T Kee ;
Edward Wolfgang Lee .
World Journal of Gastroenterology, 2015, 21 (27) :8271-8283
[35]   Selective intraarterial radionuclide therapy with Yttrium-90 (Y-90) microspheres for unresectable primary and metastatic liver tumors [J].
Kucuk, Ozlem N. ;
Soydal, Cigdem ;
Lacin, Seda ;
Ozkan, Elgin ;
Bilgic, Sadik .
WORLD JOURNAL OF SURGICAL ONCOLOGY, 2011, 9
[36]   Selective internal radiation therapy by yttrium-90 microspheres for hepatocellular carcinoma after renal transplantation [J].
Szeto, CC ;
Wong, TYH ;
Leung, CB ;
Leung, TWT ;
Wang, AYM ;
Lui, SF ;
Li, PKT .
CLINICAL TRANSPLANTATION, 2001, 15 (04) :284-288
[37]   Efficacy and safety of selective internal radiation therapy with yttrium-90 for the treatment of unresectable hepatocellular carcinoma [J].
Nguyen Van Thai ;
Nguyen Tien Thinh ;
Thai Doan Ky ;
Mai Hong Bang ;
Dinh Truong Giang ;
Le Ngoc Ha ;
Mai Hong Son ;
Dao Duc Tien ;
Hyun Woong Lee .
BMC Gastroenterology, 21
[38]   High quality imaging and dosimetry for yttrium-90 (90Y) liver radioembolization using a SiPM-based PET/CT scanner [J].
Duan, Heying ;
Khalaf, Mohamed H. ;
Ferri, Valentina ;
Baratto, Lucia ;
Srinivas, Shyam M. ;
Sze, Daniel Y. ;
Iagaru, Andrei .
EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, 2021, 48 (08) :2426-2436
[39]   High quality imaging and dosimetry for yttrium-90 (90Y) liver radioembolization using a SiPM-based PET/CT scanner [J].
Heying Duan ;
Mohamed H. Khalaf ;
Valentina Ferri ;
Lucia Baratto ;
Shyam M. Srinivas ;
Daniel Y. Sze ;
Andrei Iagaru .
European Journal of Nuclear Medicine and Molecular Imaging, 2021, 48 :2426-2436
[40]   Technical note: simultaneous 90Y and 99mTc-MAA injection for two-stage selective internal radiation therapy (SIRT) of liver metastases [J].
Eftekhari, Arash ;
Worsley, Daniel ;
Klass, Darren ;
Liu, David M. .
TRANSLATIONAL CANCER RESEARCH, 2014, 3 (02) :138-145