PMID- 36650357 OWN - NLM STAT- MEDLINE DCOM- 20230424 LR - 20230706 IS - 1619-7089 (Electronic) IS - 1619-7070 (Print) IS - 1619-7070 (Linking) VI - 50 IP - 6 DP - 2023 May TI - Voxel-based dosimetry predicting treatment response and related toxicity in HCC patients treated with resin-based Y90 radioembolization: a prospective, single-arm study. PG - 1743-1752 LID - 10.1007/s00259-023-06111-9 [doi] AB - BACKGROUND: There is an increasing body of evidence indicating Y90 dose thresholds for tumor response and treatment-related toxicity. These thresholds are poorly studied in resin Y90, particularly in hepatocellular carcinoma (HCC). PURPOSE: To evaluate the efficacy of prospective voxel-based dosimetry for predicting treatment response and adverse events (AEs) in patients with HCC undergoing resin-based Y90 radioembolization. MATERIALS AND METHODS: This correlative study was based on a prospective single-arm clinical trial (NCT04172714), which evaluated the efficacy of low/scout (555 MBq) activity of resin-based Y90 for treatment planning. Partition model was used with goal of tumor dose (TD) > 200 Gy and non-tumoral liver dose (NTLD) < 70 Gy for non-segmental therapies. Single compartment dose of 200 Gy was used for segmentectomies. Prescribed Y90 activity minus scout activity was administered for therapeutic Y90 followed by Y90-PET/CT. Sureplan(R) (MIM Software, Cleveland, OH) was used for dosimetry analysis. Treatment response was evaluated at 3 and 6 months. Receiver operating characteristic curve determined TD response threshold for objective response (OR) and complete response (CR) as well as non-tumor liver dose (NTLD) threshold that predicted AEs. RESULTS: N = 30 patients were treated with 33 tumors (19 segmental and 14 non-segmental). One patient died before the first imaging, and clinical follow-up was excluded from this analysis. Overall, 26 (81%) of the tumors had an OR and 23 (72%) had a CR. A mean TD of 253 Gy predicted an OR with 92% sensitivity and 83% specificity (area under the curve (AUC = 0.929, p < 0.001). A mean TD of 337 Gy predicted a CR with 83% sensitivity and 89% specificity (AUC = 0.845, p < 0.001). A mean NTLD of 81 and 87 Gy predicted grade 3 AEs with 100% sensitivity and 100% specificity in the non-segmental cohort at 3- and 6-month post Y90, respectively. CONCLUSION: In patients with HCC undergoing resin-based Y90, there are dose response and dose toxicity thresholds directly affecting outcomes. CLINICAL TRIAL NUMBER: NCT04172714. CI - (c) 2023. The Author(s). FAU - Kokabi, Nima AU - Kokabi N AUID- ORCID: 0000-0002-4569-2720 AD - Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. nkokabi@emory.edu. FAU - Arndt-Webster, Linzi AU - Arndt-Webster L AD - Division of Interventional Radiology, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA. FAU - Chen, Bernard AU - Chen B AD - Division of Interventional Radiology, Department of Radiology, University of Texas at San Antonio, San Antonio, TX, USA. FAU - Brandon, David AU - Brandon D AD - Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. FAU - Sethi, Ila AU - Sethi I AD - Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. FAU - Davarpanahfakhr, Amir AU - Davarpanahfakhr A AD - Division of Abdominal Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. FAU - Galt, James AU - Galt J AD - Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. FAU - Elsayed, Mohammad AU - Elsayed M AD - Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. FAU - Bercu, Zachary AU - Bercu Z AD - Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. FAU - Cristescu, Mircea AU - Cristescu M AD - Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA. FAU - Kappadath, S Cheenu AU - Kappadath SC AD - Division of Interventional Radiology, Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Schuster, David M AU - Schuster DM AD - Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. LA - eng SI - ClinicalTrials.gov/NCT04172714 GR - P30 CA008748/CA/NCI NIH HHS/United States PT - Clinical Trial PT - Journal Article DEP - 20230118 PL - Germany TA - Eur J Nucl Med Mol Imaging JT - European journal of nuclear medicine and molecular imaging JID - 101140988 RN - 0 (Yttrium Radioisotopes) SB - IM MH - Humans MH - *Carcinoma, Hepatocellular/diagnostic imaging/radiotherapy MH - *Embolization, Therapeutic/adverse effects/methods MH - *Liver Neoplasms/diagnostic imaging/radiotherapy/drug therapy MH - Microspheres MH - Positron Emission Tomography Computed Tomography MH - Prospective Studies MH - Treatment Outcome MH - Yttrium Radioisotopes/adverse effects PMC - PMC10119065 OTO - NOTNLM OT - HCC OT - Liver dose toxicity threshold OT - Resin microspheres OT - Tumor dose response threshold OT - Yttrium-90 EDAT- 2023/01/18 06:00 MHDA- 2023/04/24 06:41 PMCR- 2023/01/18 CRDT- 2023/01/17 23:23 PHST- 2022/11/14 00:00 [received] PHST- 2023/01/05 00:00 [accepted] PHST- 2023/04/24 06:41 [medline] PHST- 2023/01/18 06:00 [pubmed] PHST- 2023/01/17 23:23 [entrez] PHST- 2023/01/18 00:00 [pmc-release] AID - 10.1007/s00259-023-06111-9 [pii] AID - 6111 [pii] AID - 10.1007/s00259-023-06111-9 [doi] PST - ppublish SO - Eur J Nucl Med Mol Imaging. 2023 May;50(6):1743-1752. doi: 10.1007/s00259-023-06111-9. Epub 2023 Jan 18.