Radioembolization for the Treatment of Hepatocellular Carcinoma: The Road to Personalized Dosimetry and Ablative Practice

Cynthia De la Garza-Ramos; Beau B. Toskich

doi:10.1055/s-0041-1735571

Seminars in Interventional Radiology, Inhaltsverzeichnis

Semin intervent Radiol 2021; 38(04): 466-471
DOI: 10.1055/s-0041-1735571

Review Article

Radioembolization for the Treatment of Hepatocellular Carcinoma: The Road to Personalized Dosimetry and Ablative Practice

Cynthia De la Garza-Ramos

¹Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida

,

Beau B. Toskich

¹Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida

› Institutsangaben

Abstract

Radioembolization dosimetry for the treatment of hepatocellular carcinoma has evolved alongside our understanding of best practice for this therapy. At the core of advances in dosimetry are personalized and ablative applications of radioembolization, which have generated paradigm shifts in both safety and efficacy. This review provides a summary of fundamental radioembolization dosimetry concepts and narrates how our approach to treating patients has shifted from conventional to tailored and definitive therapy.

Keywords

radioembolization - Y90 - dosimetry - liver cancer - interventional radiology

Volltext

Referenzen

References
1 Oncology Medical Physics. . Yttrium-90. Accessed June 6, 2021 at: https://oncologymedicalphysics.com/yttrium-90/
2 Bierman HR, Byron Jr RL, Kelley KH, Grady A. Studies on the blood supply of tumors in man. III. Vascular patterns of the liver by hepatic arteriography in vivo. J Natl Cancer Inst 1951; 12 (01) 107-131
3 Westcott MA, Coldwell DM, Liu DM, Zikria JF. The development, commercialization, and clinical context of yttrium-90 radiolabeled resin and glass microspheres. Adv Radiat Oncol 2016; 1 (04) 351-364
4 Walrand S, Hesse M, Jamar F, Lhommel R. A hepatic dose-toxicity model opening the way toward individualized radioembolization planning. J Nucl Med 2014; 55 (08) 1317-1322
5 Pasciak AS, Abiola G, Liddell RP. et al. The number of microspheres in Y90 radioembolization directly affects normal tissue radiation exposure. Eur J Nucl Med Mol Imaging 2020; 47 (04) 816-827
6 Cremonesi M, Chiesa C, Strigari L. et al. Radioembolization of hepatic lesions from a radiobiology and dosimetric perspective. Front Oncol 2014; 4: 210
7 Cardarelli-Leite L, Chung J, Klass D. et al. Ablative transarterial radioembolization improves survival in patients with HCC and portal vein tumor thrombus. Cardiovasc Intervent Radiol 2020; 43 (03) 411-422
8 Louie JD, Kothary N, Kuo WT. et al. Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol 2009; 20 (05) 606-613
9 Ilhan H, Goritschan A, Paprottka P. et al. Predictive value of 99mTc-MAA SPECT for 90Y-labeled resin microsphere distribution in radioembolization of primary and secondary hepatic tumors. J Nucl Med 2015; 56 (11) 1654-1660
10 Haste P, Tann M, Persohn S. et al. Correlation of technetium-99m macroaggregated albumin and yttrium-90 glass microsphere biodistribution in hepatocellular carcinoma: a retrospective review of pretreatment single photon emission CT and posttreatment positron emission tomography/CT. J Vasc Interv Radiol 2017; 28 (05) 722-730.e1
11 Garin E. Radioembolization with (90)Y-loaded microspheres: high clinical impact of treatment simulation with MAA-based dosimetry. Eur J Nucl Med Mol Imaging 2015; 42 (08) 1189-1191
12 Garin E, Rolland Y, Pracht M. et al. High impact of macroaggregated albumin-based tumour dose on response and overall survival in hepatocellular carcinoma patients treated with ⁹⁰Y-loaded glass microsphere radioembolization. Liver Int 2017; 37 (01) 101-110
13 Garin E, Tselikas L, Guiu B. et al; DOSISPHERE-01 Study Group. Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial. Lancet Gastroenterol Hepatol 2021; 6 (01) 17-29
14 Ahmadzadehfar H, Sabet A, Brockmann H. et al. Significance of bremsstrahlung scans in patients treated by selective internal radiation therapy (SIRT). J Nucl Med 2008; 49 (Suppl. 01) 344P
15 Lhommel R, van Elmbt L, Goffette P. et al. Feasibility of 90Y TOF PET-based dosimetry in liver metastasis therapy using SIR-Spheres. Eur J Nucl Med Mol Imaging 2010; 37 (09) 1654-1662
16 Yorke ED, Jackson A, Fox RA, Wessels BW, Gray BN. Can current models explain the lack of liver complications in Y-90 microsphere therapy?. Clin Cancer Res 1999; 5 (10, Suppl): 3024s-3030s
17 Riaz A, Gates VL, Atassi B. et al. Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization. Int J Radiat Oncol Biol Phys 2011; 79 (01) 163-171
18 Pasciak AS, Bourgeois AC, Bradley YC. A microdosimetric analysis of absorbed dose to tumor as a function of number of microspheres per unit volume in 90Y Radioembolization. J Nucl Med 2016; 57 (07) 1020-1026
19 Toskich BB, Liu DM. Y90 radioembolization dosimetry: concepts for the interventional radiologist. Tech Vasc Interv Radiol 2019; 22 (02) 100-111
20 Ingold JA, Reed GB, Kaplan HS, Bagshaw MA. Radiation hepatitis. Am J Roentgenol Radium Ther Nucl Med 1965; 93: 200-208
21 Simon N, Warner RR, Baron MG, Rudavsky AZ. Intra-arterial irradiation of carcinoid tumors of the liver. Am J Roentgenol Radium Ther Nucl Med 1968; 102 (03) 552-561
22 Mantravadi RVP, Spigos DG, Tan WS, Felix EL. Intraarterial yttrium 90 in the treatment of hepatic malignancy. Radiology 1982; 142 (03) 783-786
23 Houle S, Yip TK, Shepherd FA. et al. Hepatocellular carcinoma: pilot trial of treatment with Y-90 microspheres. Radiology 1989; 172 (03) 857-860
24 Andrews JC, Walker SC, Ackermann RJ, Cotton LA, Ensminger WD, Shapiro B. Hepatic radioembolization with yttrium-90 containing glass microspheres: preliminary results and clinical follow-up. J Nucl Med 1994; 35 (10) 1637-1644
25 Lau W-Y, Leung W-T, Ho S. et al. Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study. Br J Cancer 1994; 70 (05) 994-999
26 Ho S, Lau WY, Leung TWT, Chan M, Johnson PJ, Li AKC. Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med 1997; 24 (03) 293-298
27 Mazzaferro V, Sposito C, Bhoori S. et al. Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: a phase 2 study. Hepatology 2013; 57 (05) 1826-1837
28 Vilgrain V, Pereira H, Assenat E. et al; SARAH Trial Group. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet Oncol 2017; 18 (12) 1624-1636
29 Garin E, Lenoir L, Rolland Y. et al. Dosimetry based on 99mTc-macroaggregated albumin SPECT/CT accurately predicts tumor response and survival in hepatocellular carcinoma patients treated with 90Y-loaded glass microspheres: preliminary results. J Nucl Med 2012; 53 (02) 255-263
30 Garin E, Lenoir L, Edeline J. et al. Boosted selective internal radiation therapy with 90Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept. Eur J Nucl Med Mol Imaging 2013; 40 (07) 1057-1068
31 Garin E, Rolland Y, Edeline J. et al. Personalized dosimetry with intensification using 90Y-loaded glass microsphere radioembolization induces prolonged overall survival in hepatocellular carcinoma patients with portal vein thrombosis. J Nucl Med 2015; 56 (03) 339-346
32 Garin E, Rolland Y, Edeline J. ⁹⁰Y-loaded microsphere SIRT of HCC patients with portal vein thrombosis: high clinical impact of 99mTc-MAA SPECT/CT-based dosimetry. Semin Nucl Med 2019; 49 (03) 218-226
33 Hermann AL, Dieudonné A, Ronot M. et al; SARAH Trial Group. Relationship of tumor radiation–absorbed dose to survival and response in hepatocellular carcinoma treated with transarterial radioembolization with 90Y in the SARAH study. Radiology 2020; 296 (03) 673-684
34 Lau WY, Kennedy AS, Kim YH. et al. Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres. Int J Radiat Oncol Biol Phys 2012; 82 (01) 401-407
35 Spreafico C, Morosi C, Maccauro M. et al. Intrahepatic flow redistribution in patients treated with radioembolization. Cardiovasc Intervent Radiol 2015; 38 (02) 322-328
36 Core JM, Frey GT, Sharma A. et al. Increasing yttrium-90 dose conformality using proximal radioembolization enabled by distal angiosomal truncation for the treatment of hepatic malignancy. J Vasc Interv Radiol 2020; 31 (06) 934-942
37 Vouche M, Habib A, Ward TJ. et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy. Hepatology 2014; 60 (01) 192-201
38 Lewandowski RJ, Gabr A, Abouchaleh N. et al. Radiation segmentectomy: potential curative therapy for early hepatocellular carcinoma. Radiology 2018; 287 (03) 1050-1058
39 Gabr A, Riaz A, Johnson GE. et al. Correlation of Y90-absorbed radiation dose to pathological necrosis in hepatocellular carcinoma: confirmatory multicenter analysis in 45 explants. Eur J Nucl Med Mol Imaging 2021; 48 (02) 580-583
40 Toskich B, Vidal LL, Olson MT. et al. Pathologic response of hepatocellular carcinoma treated with yttrium-90 glass microsphere radiation segmentectomy prior to liver transplantation: a validation study. J Vasc Interv Radiol 2021; 32 (04) 518-526.e1
41 Salem R, Johnson GE, Kim E. et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable hepatocellular carcinoma: the LEGACY study. Hepatology 2021; 0–2
42 Gaba RC, Lewandowski RJ, Kulik LM. et al. Radiation lobectomy: preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization. Ann Surg Oncol 2009; 16 (06) 1587-1596
43 Lewandowski RJ, Donahue L, Chokechanachaisakul A. et al. (90) Y radiation lobectomy: outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes. J Surg Oncol 2016; 114 (01) 99-105
44 Vouche M, Lewandowski RJ, Atassi R. et al. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol 2013; 59 (05) 1029-1036
45 Palard X, Edeline J, Rolland Y. et al. Dosimetric parameters predicting contralateral liver hypertrophy after unilobar radioembolization of hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2018; 45 (03) 392-401
46 Liou H, Mody K, Boyle AW. et al. Neoadjuvant radiation lobectomy and immunotherapy for angioinvasive HCC resulting in complete pathologic response. Hepatology 2021; 74 (01) 525-527
47 Li X, Montazeri SA, Paz-Fumagalli R. et al. Prognostic significance of neutrophil to lymphocyte ratio dynamics in patients with hepatocellular carcinoma treated with radioembolization using glass microspheres. Eur J Nucl Med Mol Imaging 2021; 48 (08) 2624-2634