Fusion dual-tracer SPECT-based hepatic dosimetry predicts outcome after radioembolization for a wide range of tumour cell types

Marnix G.E.H. Lam, Arjun Banerjee, Michael L. Goris, Andrei H. Iagaru, Erik Mittra, John D. Louie, Daniel Y. Sze

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: Fusion dual-tracer SPECT imaging enables physiological rather than morphological voxel-based partitioning and dosimetry for 90Y hepatic radioembolization (RE). We evaluated its prognostic value in a large heterogeneous cohort of patients with extensive hepatic malignancy. Methods: A total of 122 patients with primary or secondary liver malignancy (18 different cell types) underwent SPECT imaging after intraarterial injection of 99mTc macroaggregated albumin (TcMAA) as a simulation of subsequent 90Y microsphere distribution, followed by administration of an excess of intravenous 99mTc-labelled sulphur colloid (TcSC) as a biomarker for functional liver, and a second SPECT scan. TcMAA distribution was used to estimate 90Y radiation absorbed dose in tumour (DT) and in functional liver. Laboratory and clinical follow-up were recorded for 12 weeks after RE, and radiographic responses according to (m)RECIST were evaluated at 3 and 6 months. Dose–response relationships were determined for efficacy and toxicity. Results: Patients were treated with a median of 1.73 GBq activity of resin microspheres (98 patients) or glass microspheres (24 patients), in a whole-liver approach (97 patients) or a lobar approach (25 patients). The objective response rate was 41 % at 3 months and 48 % at 6 months. Response was correlated with DT (P < 0.01). Median overall survival was 10.1 months (95 % confidence interval 7.4 – 12.8 months). Responders lived for 36.0 months compared to 8.7 months for nonresponders (P < 0.01). Stratified for tumour cell type, DT was independently associated with survival (P < 0.01). Absorbed dose in functional liver was correlated with toxicity grade change (P < 0.05) and RE-induced liver disease (P < 0.05). Conclusion: Fusion dual-tracer SPECT imaging offers a physiology-based functional imaging tool to predict efficacy and toxicity of RE. This technique can be refined to define dosing thresholds for specific tumour types and treatments, but appears generally predictive even in a heterogeneous cohort.

Original languageEnglish (US)
Pages (from-to)1192-1201
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume42
Issue number8
DOIs
StatePublished - Jul 26 2015
Externally publishedYes

Fingerprint

Single-Photon Emission-Computed Tomography
Liver
Microspheres
Neoplasms
Intra-Arterial Injections
Survival
Colloids
Sulfur
Intravenous Administration
Glass
Liver Diseases
Albumins
Biomarkers
Confidence Intervals
Radiation

Keywords

  • Functional imaging
  • Partition model
  • Radioembolization
  • SPECT
  • Treatment planning

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Fusion dual-tracer SPECT-based hepatic dosimetry predicts outcome after radioembolization for a wide range of tumour cell types. / Lam, Marnix G.E.H.; Banerjee, Arjun; Goris, Michael L.; Iagaru, Andrei H.; Mittra, Erik; Louie, John D.; Sze, Daniel Y.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 42, No. 8, 26.07.2015, p. 1192-1201.

Research output: Contribution to journalArticle

Lam, Marnix G.E.H. ; Banerjee, Arjun ; Goris, Michael L. ; Iagaru, Andrei H. ; Mittra, Erik ; Louie, John D. ; Sze, Daniel Y. / Fusion dual-tracer SPECT-based hepatic dosimetry predicts outcome after radioembolization for a wide range of tumour cell types. In: European Journal of Nuclear Medicine and Molecular Imaging. 2015 ; Vol. 42, No. 8. pp. 1192-1201.
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abstract = "Purpose: Fusion dual-tracer SPECT imaging enables physiological rather than morphological voxel-based partitioning and dosimetry for 90Y hepatic radioembolization (RE). We evaluated its prognostic value in a large heterogeneous cohort of patients with extensive hepatic malignancy. Methods: A total of 122 patients with primary or secondary liver malignancy (18 different cell types) underwent SPECT imaging after intraarterial injection of 99mTc macroaggregated albumin (TcMAA) as a simulation of subsequent 90Y microsphere distribution, followed by administration of an excess of intravenous 99mTc-labelled sulphur colloid (TcSC) as a biomarker for functional liver, and a second SPECT scan. TcMAA distribution was used to estimate 90Y radiation absorbed dose in tumour (DT) and in functional liver. Laboratory and clinical follow-up were recorded for 12 weeks after RE, and radiographic responses according to (m)RECIST were evaluated at 3 and 6 months. Dose–response relationships were determined for efficacy and toxicity. Results: Patients were treated with a median of 1.73 GBq activity of resin microspheres (98 patients) or glass microspheres (24 patients), in a whole-liver approach (97 patients) or a lobar approach (25 patients). The objective response rate was 41 {\%} at 3 months and 48 {\%} at 6 months. Response was correlated with DT (P < 0.01). Median overall survival was 10.1 months (95 {\%} confidence interval 7.4 – 12.8 months). Responders lived for 36.0 months compared to 8.7 months for nonresponders (P < 0.01). Stratified for tumour cell type, DT was independently associated with survival (P < 0.01). Absorbed dose in functional liver was correlated with toxicity grade change (P < 0.05) and RE-induced liver disease (P < 0.05). Conclusion: Fusion dual-tracer SPECT imaging offers a physiology-based functional imaging tool to predict efficacy and toxicity of RE. This technique can be refined to define dosing thresholds for specific tumour types and treatments, but appears generally predictive even in a heterogeneous cohort.",
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AU - Lam, Marnix G.E.H.

AU - Banerjee, Arjun

AU - Goris, Michael L.

AU - Iagaru, Andrei H.

AU - Mittra, Erik

AU - Louie, John D.

AU - Sze, Daniel Y.

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N2 - Purpose: Fusion dual-tracer SPECT imaging enables physiological rather than morphological voxel-based partitioning and dosimetry for 90Y hepatic radioembolization (RE). We evaluated its prognostic value in a large heterogeneous cohort of patients with extensive hepatic malignancy. Methods: A total of 122 patients with primary or secondary liver malignancy (18 different cell types) underwent SPECT imaging after intraarterial injection of 99mTc macroaggregated albumin (TcMAA) as a simulation of subsequent 90Y microsphere distribution, followed by administration of an excess of intravenous 99mTc-labelled sulphur colloid (TcSC) as a biomarker for functional liver, and a second SPECT scan. TcMAA distribution was used to estimate 90Y radiation absorbed dose in tumour (DT) and in functional liver. Laboratory and clinical follow-up were recorded for 12 weeks after RE, and radiographic responses according to (m)RECIST were evaluated at 3 and 6 months. Dose–response relationships were determined for efficacy and toxicity. Results: Patients were treated with a median of 1.73 GBq activity of resin microspheres (98 patients) or glass microspheres (24 patients), in a whole-liver approach (97 patients) or a lobar approach (25 patients). The objective response rate was 41 % at 3 months and 48 % at 6 months. Response was correlated with DT (P < 0.01). Median overall survival was 10.1 months (95 % confidence interval 7.4 – 12.8 months). Responders lived for 36.0 months compared to 8.7 months for nonresponders (P < 0.01). Stratified for tumour cell type, DT was independently associated with survival (P < 0.01). Absorbed dose in functional liver was correlated with toxicity grade change (P < 0.05) and RE-induced liver disease (P < 0.05). Conclusion: Fusion dual-tracer SPECT imaging offers a physiology-based functional imaging tool to predict efficacy and toxicity of RE. This technique can be refined to define dosing thresholds for specific tumour types and treatments, but appears generally predictive even in a heterogeneous cohort.

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KW - Treatment planning

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