Utility of pre-procedural [99mTc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of 90Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [99mTc]TcMAA-based Segmentation.
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Serval ID
serval:BIB_FBAD8255BF99
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Utility of pre-procedural [99mTc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of 90Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [99mTc]TcMAA-based Segmentation.
Journal
European journal of nuclear medicine and molecular imaging
ISSN
1619-7089 (Electronic)
ISSN-L
1619-7070
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Publication Status: aheadofprint
Abstract
Pre-treatment [ <sup>99m</sup> Tc]TcMAA-based radioembolization treatment planning using multicompartment dosimetry involves the definition of the tumor and normal tissue compartments and calculation of the prescribed absorbed doses. The aim was to compare the real-world utility of anatomic and [ <sup>99m</sup> Tc]TcMAA-based segmentation of tumor and normal tissue compartments.
Included patients had HCC treated by glass [ <sup>90</sup> Y]yttrium microspheres, ≥ 1 tumor, ≥ 3 cm diameter and [ <sup>99m</sup> Tc]TcMAA SPECT/CT imaging before treatment. Segmentation was performed retrospectively using dedicated dosimetry software: (1) anatomic (diagnostic CT/MRI-based), and (2) [ <sup>99m</sup> Tc]TcMAA threshold-based (i.e., using an activity-isocontour threshold). CT/MRI was co-registered with [ <sup>99m</sup> Tc]TcMAA SPECT/CT. Logistic regression and Cox regression, respectively, were used to evaluate relationships between total perfused tumor absorbed dose (TAD) and objective response rate (ORR) and overall survival (OS). In a subset-analysis pre- and post-treatment dosimetry were compared using Bland-Altman analysis and Pearson's correlation coefficient.
A total of 209 patients were enrolled. Total perfused tumor and normal tissue volumes were larger when using anatomic versus [ <sup>99m</sup> Tc]TcMAA threshold segmentation, resulting in lower absorbed doses. mRECIST ORR was higher with increasing total perfused TAD (odds ratio per 100 Gy TAD increase was 1.22 (95% CI: 1.01-1.49; p = 0.044) for anatomic and 1.19 (95% CI: 1.04-1.37; p = 0.012) for [ <sup>99m</sup> Tc]TcMAA threshold segmentation. Higher total perfused TAD was associated with improved OS (hazard ratio per 100 Gy TAD increase was 0.826 (95% CI: 0.714-0.954; p = 0.009) and 0.847 (95% CI: 0.765-0.936; p = 0.001) for anatomic and [ <sup>99m</sup> Tc]TcMAA threshold segmentation, respectively). For pre- vs. post-treatment dosimetry comparison, the average bias for total perfused TAD was + 11.5 Gy (95% limits of agreement: -227.0 to 250.0) with a strong positive correlation (Pearson's correlation coefficient = 0.80).
Real-world data support [ <sup>99m</sup> Tc]TcMAA imaging to estimate absorbed doses prior to treatment of HCC with glass [ <sup>90</sup> Y]yttrium microspheres. Both anatomic and [ <sup>99m</sup> Tc]TcMAA threshold methods were suitable for treatment planning.
NCT03295006.
Included patients had HCC treated by glass [ <sup>90</sup> Y]yttrium microspheres, ≥ 1 tumor, ≥ 3 cm diameter and [ <sup>99m</sup> Tc]TcMAA SPECT/CT imaging before treatment. Segmentation was performed retrospectively using dedicated dosimetry software: (1) anatomic (diagnostic CT/MRI-based), and (2) [ <sup>99m</sup> Tc]TcMAA threshold-based (i.e., using an activity-isocontour threshold). CT/MRI was co-registered with [ <sup>99m</sup> Tc]TcMAA SPECT/CT. Logistic regression and Cox regression, respectively, were used to evaluate relationships between total perfused tumor absorbed dose (TAD) and objective response rate (ORR) and overall survival (OS). In a subset-analysis pre- and post-treatment dosimetry were compared using Bland-Altman analysis and Pearson's correlation coefficient.
A total of 209 patients were enrolled. Total perfused tumor and normal tissue volumes were larger when using anatomic versus [ <sup>99m</sup> Tc]TcMAA threshold segmentation, resulting in lower absorbed doses. mRECIST ORR was higher with increasing total perfused TAD (odds ratio per 100 Gy TAD increase was 1.22 (95% CI: 1.01-1.49; p = 0.044) for anatomic and 1.19 (95% CI: 1.04-1.37; p = 0.012) for [ <sup>99m</sup> Tc]TcMAA threshold segmentation. Higher total perfused TAD was associated with improved OS (hazard ratio per 100 Gy TAD increase was 0.826 (95% CI: 0.714-0.954; p = 0.009) and 0.847 (95% CI: 0.765-0.936; p = 0.001) for anatomic and [ <sup>99m</sup> Tc]TcMAA threshold segmentation, respectively). For pre- vs. post-treatment dosimetry comparison, the average bias for total perfused TAD was + 11.5 Gy (95% limits of agreement: -227.0 to 250.0) with a strong positive correlation (Pearson's correlation coefficient = 0.80).
Real-world data support [ <sup>99m</sup> Tc]TcMAA imaging to estimate absorbed doses prior to treatment of HCC with glass [ <sup>90</sup> Y]yttrium microspheres. Both anatomic and [ <sup>99m</sup> Tc]TcMAA threshold methods were suitable for treatment planning.
NCT03295006.
Keywords
Dosimetry, Hepatocellular carcinoma, Radioembolization, Segmentation, Yttrium-90
Pubmed
Open Access
Yes
Create date
30/09/2024 14:42
Last modification date
01/10/2024 6:09
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