Abstract
Radioembolization is a well-established treatment for primary and metastatic liver
cancer. There is increasing interest in personalized treatment planning supported
by dosimetry, as it provides an opportunity to optimize dose delivery to tumor and
minimize nontarget deposition, which demonstrably increases the efficacy and safety
of this therapy. However, the optimal dosimetry procedure in the radioembolization
setting is still evolving; existing data are limited as few trials have prospectively
tailored dose based on personalized planning and predominantly semi-empirical methods
are used for dose calculation. Since the pretreatment or “scout” procedure forms the
basis of dosimetry calculations, an accurate and reliable technique is essential.
99mTc-MAA SPECT constitutes the current accepted standard for pretreatment imaging; however,
inconsistent patterns in published data raise the question whether this is the optimal
agent. Alternative particles are now being introduced to the market, and early indications
suggest use of an identical scout and treatment particle may be superior to the current
standard. This review will undertake an evaluation of the increasingly refined dosimetric
methods driving radioembolization practices, and a horizon scanning exercise identifying
alternative scout particle solutions. Together these constitute a compelling vision
for future treatment planning methods that prioritize individualized care.
Keywords
radioembolization - Y90 - novel techniques - positron emission tomography - technetium-MAA
- single-photon emission computed tomography
