International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

• Type of Material: Article
• Authors: Hugo Levillain, Univ Libre Bruxelles; Oreste Bagni, Santa Maria Goretti Hospital; Christopher M Deroose, Katholieke University Leuven; Arnaud Dieudonne, Hôpital Beaujon; Silvano Gnesin, Lausanne University Hospital; Oliver S Grosser, University Hospital Magdeburg; Cheenu S Kappadath, University of Texas MD Anderson Cancer Center; Andrew Kennedy, Sarah Cannon Research Institute; Nima Kokabi, Emory University; David M Liu, University of British Columbia; David C Madoff, Yale School of Medicine; Armeen Mahvash, University of Texas MD Anderson Cancer Center; Antonio Martinez de la Cuesta, Clinica Universidad de Navarra-IDISNA; David CE Ng, Singapore General Hospital; Philipp M Paprottka, Technical University of Munich; Cinzia Pettinato, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Macarena Rodriguez-Fraile, Clinica Universidad de Navarra-IDISNA; Riad Salem, Northwestern University; Bruno Sangro, Clinica Universidad de Navarra-IDISNA; Lidia Strigari, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Daniel Y Sze, Stanford University; Berlinda J de Wit van der Veen, Netherlands Cancer Institute; Patrick Flamen, Université Libre de Bruxelles
• Language: English
• Date: 2021-01-12
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s00259-020-05163-5
• Title of Journal or Parent Work: EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
• Volume: 48
• Issue: 5
• Start Page: 1570
• End Page: 1584
• Grant/Funding Information: Funding of honoraria to attend meetings, and logistical and editorial support for this investigator-initiated venture was provided by an independent study grant from Sirtex Medical.
• Keywords: CANCER; Radiology, Nuclear Medicine & Medical Imaging; DOSIMETRY; RADIOTHERAPY; INTRAHEPATIC CHOLANGIOCARCINOMA; DOSE-RESPONSE; SIRT; Recommendations; HEPATOCELLULAR-CARCINOMA; Science & Technology; Dosimetry; RADIOEMBOLIZATION; PARTITION MODEL; Life Sciences & Biomedicine; Liver tumours; TC-99M-MAA; CONE-BEAM CT
• Research Categories: Health Sciences, Radiology; Health Sciences, Pathology

Abstract

Purpose: A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-resin microspheres. Methods: A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results: Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99mTc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion: Practitioners are encouraged to work towards adoption of these recommendations.