Stereotactic Inverse Dose Planning After Yttrium-90 Selective Internal Radiation Therapy in Hepatocellular Cancer
| Autor: | Andrew S. Kennedy, Kimberly Mitchell, Caroline Hale, Nadia Falzone, Elliot M Abbott, Katherine A. Vallis, Robert Steve Young |
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| Rok vydání: | 2021 |
| Předmět: |
lcsh:Medical physics. Medical radiology. Nuclear medicine
medicine.medical_specialty Combination therapy business.industry Equivalent dose lcsh:R895-920 Selective internal radiation therapy lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens SABR volatility model medicine.disease lcsh:RC254-282 Effective dose (radiation) 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Oncology 030220 oncology & carcinogenesis Hepatocellular carcinoma Absorbed dose Medicine Dosimetry Scientific Article Radiology Nuclear Medicine and imaging Radiology business |
| Zdroj: | Advances in Radiation Oncology Advances in Radiation Oncology, Vol 6, Iss 2, Pp 100617-(2021) |
| ISSN: | 2452-1094 |
| Popis: | Purpose Selective internal radiation therapy (SIRT) is administered to treat tumors of the liver and is generally well tolerated. Although widely adopted for its therapeutic benefits, SIRT is rarely combined with external beam radiation therapy (EBRT) owing to the complexity of the dosimetry resulting from the combination of treatments with distinct radiobiological effects. The purpose of this study was to establish a dosimetric framework for combining SIRT and EBRT using clinical experience derived from representative patients with hepatocellular carcinoma (HCC) who received both therapies. Methods and Materials Treatments from 10 patients with HCC given EBRT either before or after SIRT were analyzed. The dosimetry framework used here considered differences in the radiobiological effects and fractionation schemes of SIRT versus EBRT, making use of the concepts of biological effective dose (BED) and equivalent dose (EQD). Absorbed dose from SIRT was calculated, converted to BED, and summed with BED from EBRT dose plans. Two of these patients were used in a virtual planning exercise to investigate the feasibility of combining stereotactic body radiation therapy and SIRT. Results The combination of EBRT and SIRT in 10 patients with HCC showed no major toxicity. No Child-Pugh scores went above 8 and albumin-bilirubin scores from only 1 patient worsened to grade 3 (> -1.39) from treatment through 3-months follow-up. A framework with radiobiological modeling was developed to manage the combined treatments in terms of their sum BED. The exploratory SIRT plus SABR inverse dose plans for 2 patients, incorporating radiobiologically informed 90Y SIRT dosimetry, achieved dose distributions comparable to SBRT alone. Conclusions Treatment with both EBRT and SIRT can be given safely to patients with HCC. The BED and EQD concepts should be used in combined dosimetry to account for the differing radiobiological effects of EBRT and SIRT. Inverse dose planning of EBRT after SIRT could provide improved dose distributions and flexibility to the clinical workflow. Further research into combination therapy is needed through prospective trials. |
| Databáze: | OpenAIRE |
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