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Semin intervent Radiol 2021; 38(05): 542-553
DOI: 10.1055/s-0041-1736660
Review Article

Beyond the MAA-Y90 Paradigm: The Evolution of Radioembolization Dosimetry Approaches and Scout Particles

Grace Keane
1   Nuclear Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
,
Marnix Lam
1   Nuclear Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
,
Hugo de Jong
1   Nuclear Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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Abstract

Radioembolization is a well-established treatment for primary and metastatic liver cancer. There is increasing interest in personalized treatment planning supported by dosimetry, as it provides an opportunity to optimize dose delivery to tumor and minimize nontarget deposition, which demonstrably increases the efficacy and safety of this therapy. However, the optimal dosimetry procedure in the radioembolization setting is still evolving; existing data are limited as few trials have prospectively tailored dose based on personalized planning and predominantly semi-empirical methods are used for dose calculation. Since the pretreatment or “scout” procedure forms the basis of dosimetry calculations, an accurate and reliable technique is essential. 99mTc-MAA SPECT constitutes the current accepted standard for pretreatment imaging; however, inconsistent patterns in published data raise the question whether this is the optimal agent. Alternative particles are now being introduced to the market, and early indications suggest use of an identical scout and treatment particle may be superior to the current standard. This review will undertake an evaluation of the increasingly refined dosimetric methods driving radioembolization practices, and a horizon scanning exercise identifying alternative scout particle solutions. Together these constitute a compelling vision for future treatment planning methods that prioritize individualized care.

Keywords

radioembolization - Y90 - novel techniques - positron emission tomography - technetium-MAA - single-photon emission computed tomography


Publikationsverlauf

Artikel online veröffentlicht:
24. November 2021

© 2021. Thieme. All rights reserved.

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