SBIR PHASE I TOPIC 392: TARGETED RADIONUCLIDE THERAPY OF METASTATIC LIVER CANCER: PATIENT SPECIFIC OPTIMIZATION

在透视引导下，将Y-90微球送入肝动脉进行放射栓塞治疗，可以减缓转移性结直肠癌（mCRC）患者肝脏肿瘤的进展。治疗计划基于对传递到治疗体积的平均吸收剂量（AD）的简单估计；因此，肿瘤剂量取决于肿瘤负荷和肿瘤与背景比，导致一些患者剂量不足。根据更严格的、患者特异性的AD对正常肝脏的剂量，可以安全地增加给药活性，可能改善肿瘤反应，而不会增加毒性。

Radioembolization using Y-90 microspheres delivered into the hepatic artery under fluoroscopy guidance has slowed tumor progression in the liver for patients diagnosed with metastatic colorectal cancer (mCRC). Treatment planning is based on a simple estimate of the average absorbed dose (AD) delivered to the treated volume; tumor dose thus depends on tumor burden and tumor-to-background ratio, resulting in under-dosing in some patients. Dosing based on more rigorous, patient-specific AD to normal liver would allow safely increasing administered activity, likely improving tumor response, without an increased toxicity. The goal of this work is to improve the outcome of patients with mCRC by implementing a cloud-based treatment planning software service using rigorous quantitative imaging and dosimetry methods. We will perform a pilot study involving 3 patients to demonstrate feasibility of recruiting, imaging, and performing the treatment planning, validate the reproducibility catheter placement, add and verify quantitative Tc-99m MAA SPECT/CT reconstruction capability, verify that AD to normal treated liver estimated from Tc-99m MAA predicts the normal liver AD measured using quantitative Y-90 bremsstrahlung SPECT, validate automated segmentation of liver in Tc-99m MAA SPECT/CT images, develop and validate a proof-of-principle cloud-based software service; and obtain approval for the Phase II project’s dose escalation trial.