Angewandte Nuklearmedizin 2023; 46(01): 58-64
DOI: 10.1055/a-1802-8658
Dosimetrie
Übersicht

SIRT: Planung, Durchführung, Dosimetrie

SIRT: Planning, Procedure, Dosimetry
David Kästner
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
,
Enrico Michler
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
› Author Affiliations

Zusammenfassung

Die Selektive Interne Radiotherapie (SIRT) ist ein nuklearmedizinisches Therapieverfahren zur Behandlung von Tumoren und Metastasen in der Leber. Dabei werden radioaktiv markierte Mikrosphären gezielt über einen Katheter in die Leberarterie injiziert, welche sich anschließend im Tumorgewebe anreichern. Dieser Übersichtsartikel soll einen Überblick zur allgemeinen Planung und Durchführung der Therapie sowie den derzeitig verfügbaren Mikrosphären geben. Des Weiteren werden die unterschiedlichen Methoden zur Ermittlung der Therapieaktivität unter Berücksichtigung der aktuellen Empfehlungen und Leitlinien der European Association of Nuclear Medicine (EANM) genauer erläutert. Dabei wird der Stellenwert einer personalisierten Dosimetrie diskutiert.

Abstract

Selective Internal Radiotherapy (SIRT) is a nuclear medicine therapy procedure for the treatment of tumours and metastases in the liver. Radioactively-labelled microspheres are injected into the hepatic artery via a catheter, where they subsequently accumulate in the tumour tissue. This review aims to provide an overview of the general treatment planning and therapy procedures as well as currently available microspheres. Furthermore, the different methods for determining the therapy activity are explained in more detail, taking into account the current recommendations and guidelines of the European Association of Nuclear Medicine (EANM). The importance of personalised dosimetry is discussed.



Publication History

Article published online:
21 March 2023

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  • Literatur

  • 1 Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol 1954; 30: 969-977
  • 2 Vilgrain V, Pereira H, Assenat E. et al. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. The Lancet Oncology 2017; 18: 1624-1636 DOI: 10.1016/S1470-2045(17)30683-6.
  • 3 Wasan HS, Gibbs P, Sharma NK. et al. First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-Global): a combined analysis of three multicentre, randomised, phase 3 trials. The Lancet Oncology 2017; 18: 1159-1171 DOI: 10.1016/S1470-2045(17)30457-6.
  • 4 Hermann A-L, Dieudonné A, Ronot M. et al. Relationship of Tumor Radiation-absorbed Dose to Survival and Response in Hepatocellular Carcinoma Treated with Transarterial Radioembolization with 90Y in the SARAH Study. Radiology 2020; 296: 673-684 DOI: 10.1148/radiol.2020191606.
  • 5 Garin E, Tselikas L, Guiu B. et al. Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial. The Lancet Gastroenterology & Hepatology 2021; 6: 17-29 DOI: 10.1016/S2468-1253(20)30290-9.
  • 6 Lhommel R, Goffette P, van den Eynde M. et al. Yttrium-90 TOF PET scan demonstrates high-resolution biodistribution after liver SIRT. Eur J Nucl Med Mol Imaging 2009; 36: 1696 DOI: 10.1007/s00259-009-1210-1.
  • 7 Gates VL, Esmail AAH, Marshall K. et al. Internal pair production of 90Y permits hepatic localization of microspheres using routine PET: proof of concept. J Nucl Med 2011; 52: 72-76 DOI: 10.2967/jnumed.110.080986.
  • 8 Smits MLJ, Elschot M, van den Bosch MAAJ. et al. In vivo dosimetry based on SPECT and MR imaging of 166Ho-microspheres for treatment of liver malignancies. J Nucl Med 2013; 54: 2093-2100 DOI: 10.2967/jnumed.113.119768.
  • 9 Chiesa C, Sjogreen-Gleisner K, Walrand S. et al. EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres. EJNMMI Phys 2021; 8: 77 DOI: 10.1186/s40658-021-00394-3.
  • 10 Weber M, Lam M, Chiesa C. et al. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 2022; 49: 1682-1699 DOI: 10.1007/s00259-021-05600-z.
  • 11 Braat AJAT, Prince JF, van Rooij R. et al. Safety analysis of holmium-166 microsphere scout dose imaging during radioembolisation work-up: A cohort study. Eur Radiol 2018; 28: 920-928 DOI: 10.1007/s00330-017-4998-2.
  • 12 Grosser OS, Ruf J, Kupitz D. et al. Pharmacokinetics of 99mTc-MAA- and 99mTc-HSA-Microspheres Used in Preradioembolization Dosimetry: Influence on the Liver-Lung Shunt. J Nucl Med 2016; 57: 925-927 DOI: 10.2967/jnumed.115.169987.
  • 13 Lenoir L, Edeline J, Rolland Y. et al. Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization. Eur J Nucl Med Mol Imaging 2012; 39: 872-880 DOI: 10.1007/s00259-011-2033-4.
  • 14 Jafargholi Rangraz E, Tang X, van Laeken C. et al. Quantitative comparison of pre-treatment predictive and post-treatment measured dosimetry for selective internal radiation therapy using cone-beam CT for tumor and liver perfusion territory definition. EJNMMI Res 2020; 10: 94 DOI: 10.1186/s13550-020-00675-5.
  • 15 Jadoul A, Bernard C, Lovinfosse P. et al. Comparative dosimetry between 99mTc-MAA SPECT/CT and 90Y PET/CT in primary and metastatic liver tumors. Eur J Nucl Med Mol Imaging 2020; 47: 828-837 DOI: 10.1007/s00259-019-04465-7.
  • 16 Smits MLJ, Dassen MG, Prince JF. et al. The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases. Eur J Nucl Med Mol Imaging 2020; 47: 798-806 DOI: 10.1007/s00259-019-04460-y.
  • 17 Gill H, Hiller J. Systematic review of lung shunt fraction quantification comparing SPECT/CT and planar scintigraphy for yttrium 90 radioembolization planning. Clin Transl Imaging 2021; 9: 181-188 DOI: 10.1007/s40336-021-00417-0.
  • 18 Elsayed M, Cheng B, Xing M. et al. Comparison of Tc-99m MAA Planar Versus SPECT/CT Imaging for Lung Shunt Fraction Evaluation Prior to Y-90 Radioembolization: Are We Overestimating Lung Shunt Fraction?. Cardiovasc Intervent Radiol 2021; 44: 254-260 DOI: 10.1007/s00270-020-02638-8.
  • 19 Levillain H, Bagni O, Deroose CM. et al. International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres. Eur J Nucl Med Mol Imaging 2021; 48: 1570-1584 DOI: 10.1007/s00259-020-05163-5.
  • 20 Roosen J, Klaassen NJM, Westlund Gotby LEL. et al. To 1000 Gy and back again: a systematic review on dose-response evaluation in selective internal radiation therapy for primary and secondary liver cancer. Eur J Nucl Med Mol Imaging 2021; 48: 3776-3790 DOI: 10.1007/s00259-021-05340-0.
  • 21 Sirtex Medical Ltd. SIR-Spheres Microspheres Package insert: EU-Version (CR2918). 2022
  • 22 Grosser OS, Ulrich G, Furth C. et al. Intrahepatic Activity Distribution in Radioembolization with Yttrium-90-Labeled Resin Microspheres Using the Body Surface Area Method-A Less than Perfect Model. J Vasc Interv Radiol 2015; 26: 1615-1621 DOI: 10.1016/j.jvir.2015.07.021.
  • 23 Lam MGEH, Louie JD, Abdelmaksoud MHK. et al. Limitations of body surface area-based activity calculation for radioembolization of hepatic metastases in colorectal cancer. J Vasc Interv Radiol 2014; 25: 1085-1093 DOI: 10.1016/j.jvir.2013.11.018.
  • 24 Boston Scientific Corp. TheraSphere Yttrium-90 Glass Microspheres - Instructions for Use. 2021
  • 25 Quirem Medical B.V. Instructions for Use – QuiremSpheres Microspheres. 2022
  • 26 Alsultan AA, Braat AJAT, Smits MLJ. et al. Current Status and Future Direction of Hepatic Radioembolisation. Clin Oncol (R Coll Radiol) 2021; 33: 106-116 DOI: 10.1016/j.clon.2020.12.003.
  • 27 Ahmadzadehfar H, Meyer C, Pieper CC. et al. Evaluation of the delivered activity of yttrium-90 resin microspheres using sterile water and 5 % glucose during administration. EJNMMI Res 2015; 5: 54 DOI: 10.1186/s13550-015-0133-z.
  • 28 Pasciak AS, Bourgeois AC, McKinney JM. et al. Radioembolization and the Dynamic Role of (90)Y PET/CT. Front Oncol 2014; 4: 38 DOI: 10.3389/fonc.2014.00038.
  • 29 Kao YH, Tan EH, Ng CE. et al. Yttrium-90 time-of-flight PET/CT is superior to Bremsstrahlung SPECT/CT for postradioembolization imaging of microsphere biodistribution. Clin Nucl Med 2011; 36: e186-e187 DOI: 10.1097/RLU.0b013e31821c9a11.
  • 30 Kokabi N, Cheng B, Arndt L. et al. Abstract No. 25 Accuracy of scout dose Y-90 for prospective personalized selective internal radiation therapy planning. Journal of Vascular and Interventional Radiology 2022; 33: S12-S13 DOI: 10.1016/j.jvir.2022.03.106.