Radioembolization with 90 Y glass microspheres for hepatocellular carcinoma: significance of pretreatment 11 C-acetate and 18 F-FDG PET/CT and posttreatment 90 Y PET/CT in individualized dose prescription.

Autor: Ho CL; Department of Nuclear Medicine & PET, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, Hong Kong. garrettho@hksh.com., Chen S; Department of Nuclear Medicine & PET, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, Hong Kong.; Medical Physics & Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, Hong Kong., Cheung SK; Department of Nuclear Medicine & PET, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, Hong Kong., Leung YL; Department of Nuclear Medicine & PET, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, Hong Kong., Cheng KC; Department of Nuclear Medicine & PET, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, Hong Kong., Wong KN; Department of Nuclear Medicine & PET, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, Hong Kong., Wong YH; Department of Nuclear Medicine & PET, Hong Kong Sanatorium & Hospital, 2 Village Road, Happy Valley, Hong Kong, Hong Kong., Leung TWT; Comprehensive Oncology Center, Hong Kong Sanatorium & Hospital, Hong Kong, Hong Kong.
Jazyk: angličtina
Zdroj: European journal of nuclear medicine and molecular imaging [Eur J Nucl Med Mol Imaging] 2018 Nov; Vol. 45 (12), pp. 2110-2121. Date of Electronic Publication: 2018 Jun 11.
DOI: 10.1007/s00259-018-4064-6
Abstrakt: Purpose: The aim of this study was to establish an algorithm for the prescription of 90 Y glass microsphere radioembolization ( 90 Y-GMRE) of HCC in individual patients based on the relationship between tumour dose (TD) and response validated by 90 Y PET/CT dosimetry and dual-tracer PET/CT metabolic parameters.
Methods: The study group comprised 62 HCC patients prospectively recruited for 90 Y-GMRE who underwent pretreatment dual-tracer ( 11 C-acetate and 18 F-FDG) PET/CT as surrogate markers of HCC cellular differentiation. Pretreatment tumour-to-nontumour ratio on 99m Tc-MAA SPECT/CT (T/NT MAA ) was correlated with posttreatment 90 Y PET/CT T/NT 90Y after quantification validation. The TD-response relationship for HCC of different tracer groups was assessed on follow-up PET/CT 2 months after treatment.
Results: 90 Y PET/CT was accurate in the measurement of recovery of injected 90 Y activity (81.9-99.9%, median 94.8%). Pretreatment SPECT/CT T/NT MAA was strongly correlated with posttreatment 90 Y PET/CT T/NT 90Y (5.6 ± 3.2 versus 5.9 ± 3.5, T/NT 90Y 1.01 × T/NT MAA  + 0.161, r = 0.918, P < 0.05). The response rates were 72.4% (21/29), 70.6% (12/17) and 25% (4/16) for well, moderately and poorly differentiated HCC, respectively. The cut-off TD for a good response was significantly different between poorly differentiated and well/moderately differentiated HCC (262 Gy versus 152/174 Gy) with 89.2% sensitivity and 88% specificity. At a limiting tolerated liver dose of 70 Gy, the T/NT MAA thresholds for predicting a good response in poorly differentiated and well/moderately differentiated HCC were 3.5 and 2.0/2.3. Disregarding HCC cellular differentiation, the cut-off TD became 170 Gy, with lower sensitivity (70.3%) and specificity (76%).
Conclusion: 90 Y PET/CT can provide accurate dosimetry for 90 Y-GMRE. Pretreatment T/NT MAA predicts posttreatment T/NT 90Y . The TD thresholds for a good response are tracer-dependent, with a strong correlation between HCC radiosensitivity and cellular differentiation and other PET-based parameters. These cytokinetic factors improve treatment efficacy while minimizing organ damage for the prescription of personalized 90 Y-GMRE.
Databáze: MEDLINE
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