Dosimetry Based on 99mTc-Macroaggregated Albumin SPECT/CT Accurately Predicts Tumor Response and Survival in Hepatocellular Carcinoma Patients Treated with 90Y-Loaded Glass Microspheres: Preliminary Results
Dosimetry Based on 99mTc-Macroaggregated Albumin SPECT/CT Accurately Predicts Tumor Response and Survival in Hepatocellular Carcinoma Patients Treated with 90Y-Loaded Glass Microspheres: Preliminary Results
复制标题
DOI：
10.2967/jnumed.111.094235
复制
发表时间：
2012-02-01
影响因子：
9.3
通讯作者：
Boucher, E.
中科院分区：
文献类型：
--
作者：
Garin, Etienne;Lenoir, Laurence;Boucher, E.
使用Y-90装载微球的肝癌放射性栓塞正在经历更广泛的使用。然而，很少有数据是关于输送到肿瘤和健康肝脏的剂量。本回顾性研究旨在计算接受Y-90载药玻璃微球治疗的患者的肿瘤剂量（计划肿瘤剂量[T-plan D]）和非肿瘤剂量，并确定肿瘤剂量是否可以预测缓解和生存。研究方法：应用载Y-99玻璃微球治疗36例肝细胞癌（HOC）患者，其中16例合并门静脉血栓形成（PVT）。使用定量分析的Tc-99 m-MAA（Tc-99 m-MAA）SPECT/CT检查计算T计划D和输送到注射的健康肝脏的剂量。3个月后，使用欧洲肝脏研究协会的标准评估反应。使用Kaplan-Meier检验评价无进展生存期（PFS）和总生存期（OS）。结果：总人群的有效率为69%，PVT患者的有效率为75%。递送至肿瘤的剂量是与多变量分析的反应相关的唯一参数（P = 0.019）。阈值T计划D值为205戈伊可预测反应，灵敏度为100%，准确度为91%。定量Tc-99 m-MAA SPECT/CT使我们能够增加4例大病灶患者的注射活性。当T计划D小于205戈伊时，PFS仅为5.2个月，OS为9个月，而T计划D为205戈伊或更高时，PFS分别为14个月（P = 0.0003）和18个月（P = 0.0322）。结论：定量Tc-99 m-MAA SPECT/CT可预测反应、PFS和OS。基于Tc-99 m-MAA SPECT/CT的剂量测定可用于选择患者和调整治疗计划，特别是在选定的患者中（特别是在大肿瘤的情况下）。这些结果还证实了Y-90负载的微球在治疗HOC中的有效性和安全性，即使在PVT存在的情况下（并且特别是当在PVT内观察到Tc-99 m-MAA摄取时）。
Radioembolization of liver cancers using Y-90-loaded microspheres is experiencing more widespread use. However, few data are available concerning the doses delivered to the tumors and the healthy liver. This retrospective study was conducted to calculate the tumor dosimetry (planned tumor dose [T-plan D]) and nontumor dosimetry in patients treated by Y-90-loaded glass microspheres and determine whether tumor dosimetry could predict response and survival. Methods: Thirty-six patients with hepatocellular carcinoma (HOC), including 16 with portal vein thrombosis (PVT), were treated with Y-99-loaded glass microspheres. The T-plan D and the dose delivered to the injected healthy liver were calculated using a quantitative analysis of the Tc-99m-macroaggregated albumin (Tc-99m-MAA) SPECT/CT exam. Responses were assessed after 3 mo, using the criteria of the European Association for the Study of the Liver. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier tests. Results: The response rate was 69% for the overall population and 75% for the PVT patients. The dose delivered to the tumor was the only parameter associated with response with multivariate analysis (P = 0.019). A threshold T-plan D value of 205 Gy was predictive of response, with a sensitivity of 100% and an accuracy of 91%. Quantitative Tc-99m-MAA SPECT/CT allowed us to increase the injected activity for 4 patients with large lesions. PFS was only 5.2 mo and OS 9 mo when using a T-plan D of less than 205 Gy versus 14 mo (P = 0.0003) and 18 mo (P = 0.0322), respectively, with a T-plan D of 205 Gy or more. Conclusion: Quantitative Tc-99m-MAA SPECT/CT is predictive of response, PFS, and OS. Dosimetry based on Tc-99m-MAA SPECT/CT can be used for the selection of patients and for an adaptation of treatment planning, especially in selected patients (particularly in the case of large tumors). These results also confirm the efficacy and safety of Y-90-loaded microspheres in treating HOC, even in the presence of PVT (and especially when Tc-99m-MAA uptake is seen inside the PVT).