Sarwar Ammar, Kudla Alexei, Weinstein Jeffrey L, Ali Aamir, Malik Raza, Bullock Andrea, Khwaja Khalid O, Curry Michael, Faintuch Salomao, Ahmed Muneeb
Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
Eur Radiol. 2021 Mar;31(3):1316-1324. doi: 10.1007/s00330-020-07231-8. Epub 2020 Sep 8.
To review the technical feasibility of resin microsphere (SIR-Spheres®) yttrium-90 radioembolization prescribed using the medical internal radiation dose (MIRD) model.
All radioembolization procedures for hepatic malignancies using resin microspheres with MIRD model between November 2015 and February 2019 were included in this IRB-approved study (n = 60). Student's T test was used to compare prescribed activity based on MIRD and BSA models. Adverse events were assessed immediately, 30 days, and 6 months post-treatment.
Sixty radioembolizations were performed in 54 patients (age 68 ± 9 years, 48-87 years, 35% female). Mean prescribed activity calculated by the MIRD model (target absorbed dose 120-200 Gy for primary and 80-200 Gy for metastatic liver cancers) was 1.7 GBq (0.3-6.4) compared with 0.6 GBq (0.12-2.1) if BSA had been used (p < 0.0001). The prescribed activity was successfully delivered in 93% (56/60) treatments. Prophylactic embolization and anti-reflux catheters were used in 20% (12/60) and 5% (3/60) treatments, respectively. No immediate post-procedural complications occurred. Abdominal pain was the most common clinical Grade 3 CTCAE in 30 days (10%) and 6 months (12%). Radiation pneumonitis occurred in 3 (5%) patients but no radiation-induced gastric ulcer or radiation-induced liver disease occurred.
MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry with resin microspheres. MIRD prescribed activity with target absorbed doses up to 200 Gy can be successfully administered without prophylactic embolization in selected patients.
•MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry for radioembolization. •MIRD dosimetry can be used for yttrium-90 resin microsphere radioembolization with acceptable safety profile.
回顾使用医学内照射剂量（MIRD）模型来确定树脂微球（SIR-Spheres®）钇-90放射性栓塞治疗的技术可行性。
本项经机构审查委员会批准的研究纳入了2015年11月至2019年2月间所有使用树脂微球并采用MIRD模型进行肝恶性肿瘤放射性栓塞治疗的病例（n = 60）。采用学生t检验比较基于MIRD模型和体表面积（BSA）模型确定的给药活度。在治疗后即刻、30天和6个月时评估不良事件。
对54例患者进行了60次放射性栓塞治疗（年龄68±9岁，48 - 87岁，35%为女性）。由MIRD模型计算得出的平均给药活度（原发性肝癌靶吸收剂量为120 - 200 Gy，转移性肝癌为80 - 200 Gy）为1.7 GBq（0.3 - 6.4），而若采用BSA模型则为0.6 GBq（0.12 - 2.1）（p < 0.0001）。93%（56/60）的治疗成功给予了规定的活度。分别有20%（12/60）和5%（3/60）的治疗使用了预防性栓塞和抗反流导管。治疗后未立即出现并发症。腹痛是30天（10%）和6个月（12%）时最常见的3级美国国立综合癌症网络常见不良反应事件。3例（5%）患者发生放射性肺炎，但未出现放射性胃溃疡或放射性肝病。
与使用树脂微球的BSA剂量测定法相比，MIRD剂量测定法可导致更高的给药活度。对于选定的患者，在靶吸收剂量高达200 Gy的情况下，采用MIRD确定的给药活度可在不进行预防性栓塞的情况下成功给予。
•与用于放射性栓塞的BSA剂量测定法相比，MIRD剂量测定法可导致更高的给药活度。•MIRD剂量测定法可用于钇-90树脂微球放射性栓塞治疗，安全性良好。
