Comparison of absorbed doses to the tumoral and non-tumoral liver in HCC patients undergoing Tc-MAA and Y-microspheres radioembolization.

Dec 25, 2023

Experts: Nut Noipinit,Chanan Sukprakun,Punnarai Siricharoen,Kitiwat Khamwan

This study aimed to determine the absorbed doses in the tumoral-liver and non-tumoral liver of hepatocellular carcinoma (HCC) patients undergoing radioembolization with Yttrium-90 (Y) resin microspheres, and compared with those derived from Tc-MAA using the partition model.
A total of 42 HCC patients (28 males and 14 females, mean age 65 ± 11.51 years) who received 45 treatment sessions with Y-microspheres between 2016 and 2021 were included. Pre-treatment Tc-MAA and post-treatment Y-bremsstrahlung SPECT/CT were acquired for each patient. Semi-automated segmentation of regions of interest (ROIs) was performed using MIM Encore software to determine the tumor-liver ratio (TLR) encompassing the liver volume, tumoral-liver, and lungs, and verified by both nuclear medicine physician and interventional radiologist. A partition dosimetry model was used to estimate the administered activity of Y-microspheres and the absorbed doses to the tumoral-liver and non-tumoral liver. The student’s paired t test and Bland-Altman plot were used for the statistical analysis.
The mean TLR values obtained from Tc-MAA SPECT/CT and Y-bremsstrahlung SPECT/CT were 4.78 ± 3.51 and 2.73 ± 1.18, respectively. The mean planning administered activity of Y-microspheres based on Tc-MAA SPECT/CT was 1.56 ± 0.80 GBq, while the implanted administered activity was 2.53 ± 1.23 GBq (p value < 0.001). The mean absorbed doses in the tumoral-liver estimated from Tc-MAA and Y-bremsstrahlung SPECT/CT were 127.44 ± 4.36 Gy and 135.98 ± 6.30 Gy, respectively. The corresponding mean absorbed doses in the non-tumoral liver were 34.61 ± 13.93 Gy and 55.04 ± 16.36 Gy.
This study provides evidence that the administered activity of Y-microspheres, as estimated from Y-bremsstrahlung SPECT/CT, was significantly higher than that estimated from Tc-MAA SPECT/CT resulted in increased absorbed doses in both the tumoral-liver and non-tumoral liver. However, Tc-MAA SPECT/CT remains a valuable planning tool for predicting the distribution of Y-microspheres in liver cancer treatment.

© 2023. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.

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ABOUT THE EXPERTS

Nut Noipinit,Chanan Sukprakun,Punnarai Siricharoen,Kitiwat Khamwan

Nut Noipinit

Medical Physics Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Division of Nuclear Medicine, Department of Radiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.

Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Chanan Sukprakun

Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Punnarai Siricharoen

Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.

Kitiwat Khamwan

Medical Physics Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. kitiwat.k@chula.ac.th.

Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. kitiwat.k@chula.ac.th.

Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. kitiwat.k@chula.ac.th.