Personalized Dosimetry with Intensification Using 90Y-Loaded Glass Microsphere Radioembolization Induces Prolonged Overall Survival in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis

Journal of Nuclear Medicine

Habiba Mesbah¹  Eveline Boucher¹  Tanguy Rohou¹  Nicolas Icard¹  Laurent Sulpice¹  Yan Rolland¹  Etienne Garin¹  Julien Edeline¹  Jean-Luc Raoul¹  Bruno Clement¹  Sophie Laffont¹  Karim Boudjema¹  Laurence Lenoir¹  Mathias Breton¹ 

关键词: radioembolization;    hepatocellular carcinoma;    MAA dosimetry;    personalization;   

DOI  :  10.2967/jnumed.114.145177

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

The objective of this study was to evaluate the response rate and survival of hepatocellular carcinoma portal vein thrombosis (PVT) patients treated with 90Y-loaded glass microspheres using a personalized dosimetry and intensification concept. Methods: The microspheres were administered to 41 hepatocellular carcinoma PVT patients (main = 12; lobar/segmental = 29). 99mTc-macroaggregated albumin SPECT/CT quantitative analysis was used to calculate the tumor dose (TD), healthy injected liver dose (HILD), and injected liver dose (ILD). Response was evaluated at 3 mo using the criteria of the European Association for the Study of the Liver, with CT follow-up lasting until disease progression or death. Survival was assessed using the Kaplan–Meier method. Results: The mean injected activity was 3.1 ± 1.5 GBq, and mean ILD was 143 ± 49 Gy. When a TD threshold of 205 Gy was applied, 99mTc-macroaggregated albumin SPECT/CT achieved a 100% sensitivity and 90% overall accuracy (0 false-negatives; 4 false-positives) in response prediction. On the basis of TD and HILD values, 37% of patients received an intensification of the treatment (increased injected activity with the aim of achieving a TD ≥ 205 Gy and HILD < 120 Gy, applying an ILD > 150 Gy). This intensification resulted in a high response rate (85%) without increased liver toxicity of grade 3 or higher (6% vs. 12% in the patients who did not receive treatment intensification; not statistically significant). For the total 41 patients, median overall survival (OS) was 18 mo (95% confidence interval, 11–25 mo). For patients with a TD of less than 205 Gy, median OS was 4.3 mo (3.7–5 mo), versus 18.2 mo (8.5–28.7 mo) for those with a TD of 205 Gy or more (P = 0.005). Median OS was 20.9 mo for patients with a TD of 205 Gy or more and good PVT targeting (n = 36). OS was 12 mo (3 mo to ∞) for patients with main PVT, versus 21.5 mo (12–28.7 mo) for those with segmental or lobar PVT (not statistically significant). For the 5 patients with complete portal vein revascularization who underwent lobar hepatectomy, median OS was not reached yet exceeded 24.5 mo and was significantly higher than that of other patients (P = 0.0493). Conclusion: Using a 99mTc-macroaggregated albumin SPECT/CT personalized dosimetry and intensification concept with 90Y-loaded glass microspheres induced prolonged OS for PVT patients as compared with the standard of care (sorafenib), without increasing liver toxicity. Prospective randomized studies are therefore warranted.

【 授权许可】

Unknown