Voxel-based dosimetry predicting treatment response and related toxicity in HCC patients treated with resin-based Y90 radioembolization: a prospective, single-arm study

• Type of Material: Article
• Authors: Nima Kokabi, Emory University; Linzi Arndt-Webster, Mt Sinai School of Medicine; Bernard Chen, University of Texas San Antonio; David Brandon, Emory University; Ila Sethi, Emory University; Amir Davarpanah, Emory University; James Galt, Emory University; Mohammad Elsayed, Memorial Sloan Kettering Cancer Center; Zachary Bercu, Emory University; Mircea Cristescu, Medical College of Wisconsin; S. Cheenu Kappadath, University of Texas MD Anderson Cancer Center; David Schuster, Emory University
• Language: English
• Date: 2023-01-18
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s00259-023-06111-9
• Title of Journal or Parent Work: EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
• Volume: 50
• Issue: 6
• Start Page: 1743
• End Page: 1752
• Grant/Funding Information: The funding for the study was provided by RSNA Research Scholar Grant and Sirtex Medical Ltd., with X as the primary investigator.
• Keywords: Yttrium-90; Liver dose toxicity threshold; SPECT/CT; THERAPY; HCC; PET/CT; Tumor dose response threshold; Radiology, Nuclear Medicine & Medical Imaging; Science & Technology; NEED; Life Sciences & Biomedicine; Resin microspheres
• Research Categories: Health Sciences, Radiology; Health Sciences, Toxicology; Health Sciences, Medicine and Surgery

Abstract

Background: There is an increasing body of evidence indicating Y90 dose thresholds for tumor response and treatment-related toxicity. These thresholds are poorly studied in resin Y90, particularly in hepatocellular carcinoma (HCC). Purpose: To evaluate the efficacy of prospective voxel-based dosimetry for predicting treatment response and adverse events (AEs) in patients with HCC undergoing resin-based Y90 radioembolization. Materials and methods: This correlative study was based on a prospective single-arm clinical trial (NCT04172714), which evaluated the efficacy of low/scout (555 MBq) activity of resin-based Y90 for treatment planning. Partition model was used with goal of tumor dose (TD) > 200 Gy and non-tumoral liver dose (NTLD) < 70 Gy for non-segmental therapies. Single compartment dose of 200 Gy was used for segmentectomies. Prescribed Y90 activity minus scout activity was administered for therapeutic Y90 followed by Y90-PET/CT. Sureplan® (MIM Software, Cleveland, OH) was used for dosimetry analysis. Treatment response was evaluated at 3 and 6 months. Receiver operating characteristic curve determined TD response threshold for objective response (OR) and complete response (CR) as well as non-tumor liver dose (NTLD) threshold that predicted AEs. Results: N = 30 patients were treated with 33 tumors (19 segmental and 14 non-segmental). One patient died before the first imaging, and clinical follow-up was excluded from this analysis. Overall, 26 (81%) of the tumors had an OR and 23 (72%) had a CR. A mean TD of 253 Gy predicted an OR with 92% sensitivity and 83% specificity (area under the curve (AUC = 0.929, p < 0.001). A mean TD of 337 Gy predicted a CR with 83% sensitivity and 89% specificity (AUC = 0.845, p < 0.001). A mean NTLD of 81 and 87 Gy predicted grade 3 AEs with 100% sensitivity and 100% specificity in the non-segmental cohort at 3- and 6-month post Y90, respectively. Conclusion: In patients with HCC undergoing resin-based Y90, there are dose response and dose toxicity thresholds directly affecting outcomes. Clinical trial number: NCT04172714.