Abstract

Background

The aim of this study was to investigate the safety and efficacy of selective internal radiation therapy (SIRT) with 90Y resin microspheres for the treatment of Intrahepatic Cholangiocarcinoma (ICC). A total of 23 SIRT procedures from 18 ICC subjects were analysed to determine a lesion-based dose/response relationship with absorbed dose measures from 90Y PET and metabolic response as measured on [18F]FDG PET. Average absorbed dose (Davg), minimum dose to 70% of the volume (D70), volume receiving at least 50 Gy (V50), biological effective dose (BED) and equivalent uniform dose (EUD), were compared to changes in metabolic volume, maximum standardised uptake value (SUVmax) and total lesion glycolysis (TLG). Dose to normal liver was assessed with changes in liver uptake rate as measured with [99mTc]mebrofenin scintigraphy for a cohort of 20 subjects with primary liver malignancy (12 ICC, 8 hepatocellular carcinoma (HCC)).

Results

Thirty-four lesions were included in the analysis. A relationship was found between metabolic response and both Davg and EUD similar to that seen previously in metastatic colorectal cancer (mCRC), albeit trending towards a lower response plateau. Both dose and SUV coefficient of variation within the lesion (CoVdose and CoVSUV), baseline TLG and EUD were found to be mildly significant predictors of response. No strong correlation was seen between normal liver dose and change in [99mTc]mebrofenin liver uptake rate; low baseline uptake rate was not indicative of declining function following SIRT, and no subjects dropped into the ‘poor liver function’ category.

Conclusions

ICC lesions follow a similar dose–response trend as mCRC, however, despite high lesion doses a full metabolic response was rarely seen. The CoV of lesion dose may have a significant bearing on response, and EUD correlated more tightly with metabolic response compared to Davg. SIRT in primary liver malignancy appears safe in terms of not inducing a clinically significant decline in liver function, and poor baseline uptake rate is not predictive of a reduction in function post SIRT.

Details

Title
Individualised dosimetry and safety of SIRT for intrahepatic cholangiocarcinoma
Author
Willowson, Kathy P 1   VIAFID ORCID Logo  ; Eslick, Enid M 2 ; Bailey, Dale L 3 

1  Royal North Shore Hospital, Department of Nuclear Medicine, Acute Services Building, St Leonards, Australia (GRID:grid.412703.3) (ISNI:0000 0004 0587 9093); The University of Sydney, Institute of Medical Physics, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X) 
2  Royal North Shore Hospital, Department of Nuclear Medicine, Acute Services Building, St Leonards, Australia (GRID:grid.412703.3) (ISNI:0000 0004 0587 9093) 
3  Royal North Shore Hospital, Department of Nuclear Medicine, Acute Services Building, St Leonards, Australia (GRID:grid.412703.3) (ISNI:0000 0004 0587 9093); The University of Sydney, Faculty of Medicine and Health, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X) 
Publication year
2021
Publication date
Dec 2021
Publisher
Springer Nature B.V.
e-ISSN
21977364
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s40658-021-00406-2
ProQuest document ID
2572354717
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.