Veenstra Emile B, Ruiter Simeon J S, de Haas Robbert J, Bokkers Reinoud P H, de Jong Koert P, Noordzij Walter
Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
EJNMMI Res. 2022 Feb 4;12(1):9. doi: 10.1186/s13550-022-00879-x.
Post-therapy [Y] PET/CT-based dosimetry is currently recommended to validate treatment planning as [Tc] MAA SPECT/CT is often a poor predictor of subsequent actual [Y] absorbed dose. Treatment planning software became available allowing 3D voxel dosimetry offering tumour-absorbed dose distributions and dose-volume histograms (DVH). We aim to assess dose-response effects in post-therapy [Y] PET/CT dosimetry in SIRT-treated HCC patients for predicting overall and progression-free survival (OS and PFS) and four-month follow-up tumour response (mRECIST). Tumour-absorbed dose and mean percentage of the tumour volume (V) receiving ≥ 100, 150, 200, or 250 Gy and mean minimum absorbed dose (D) delivered to 30%, 50%, 70%, and 90% of tumour volume were calculated from DVH's. Depending on the mean tumour -absorbed dose, treated lesions were assigned to a < 120 Gy or ≥ 120 Gy group.
Thirty patients received 36 SIRT treatments, totalling 43 lesions. Median tumour-absorbed dose was significantly different between the ≥ 120 Gy (n = 28, 207 Gy, IQR 154-311 Gy) and < 120 Gy group (n = 15, 62 Gy, IQR 49-97 Gy, p <0 .01). Disease control (DC) was found more frequently in the ≥ 120 Gy group (79%) compared to < 120 Gy (53%). Mean tumour-absorbed dose optimal cut-off predicting DC was 131 Gy. Tumour control probability was 54% (95% CI 52-54%) for a mean tumour-absorbed dose of 120 Gy and 90% (95% CI 87-92%) for 284 Gy. Only D30 was significantly different between DC and progressive disease (p = 0.04). For the ≥ 120 Gy group, median OS and PFS were longer (median OS 33 months, [range 8-33 months] and median PFS 23 months [range 4-33 months]) than the < 120 Gy group (median OS 17 months, [range 5-33 months] and median PFS 13 months [range 1-33 months]) (p < 0.01 and p = 0.03, respectively).
Higher 3D voxel-based tumour-absorbed dose in patients with HCC is associated with four-month DC and longer OS and PFS. DVHs in [Y] SIRT could play a role in evaluative dosimetry.
目前推荐基于治疗后[钇]PET/CT的剂量测定法来验证治疗计划，因为[锝]MAA SPECT/CT常常不能很好地预测后续实际的[钇]吸收剂量。治疗计划软件已可使用，它能进行三维体素剂量测定，提供肿瘤吸收剂量分布和剂量体积直方图（DVH）。我们旨在评估经选择性内放射治疗（SIRT）的肝细胞癌（HCC）患者治疗后[钇]PET/CT剂量测定中的剂量反应效应，以预测总生存期和无进展生存期（OS和PFS）以及四个月的随访肿瘤反应（mRECIST）。根据DVH计算肿瘤吸收剂量以及接受≥100、150、200或250 Gy的肿瘤体积（V）的平均百分比，以及输送至30%、50%、70%和90%肿瘤体积的平均最小吸收剂量（D）。根据平均肿瘤吸收剂量，将治疗的病灶分为<120 Gy组或≥120 Gy组。
30例患者接受了36次SIRT治疗，共43个病灶。≥120 Gy组（n = 28，207 Gy，四分位间距154 - 311 Gy）和<120 Gy组（n = 15，62 Gy，四分位间距49 - 97 Gy，p <0.01）的中位肿瘤吸收剂量有显著差异。与<120 Gy组（53%）相比，≥120 Gy组（79%）疾病控制（DC）更常见。预测DC的平均肿瘤吸收剂量最佳截断值为131 Gy。平均肿瘤吸收剂量为120 Gy时，肿瘤控制概率为54%（95%可信区间52 - 54%），为284 Gy时为90%（95%可信区间87 - 92%）。仅D30在DC和疾病进展之间有显著差异（p = 0.04）。对于≥120 Gy组，中位OS和PFS比<120 Gy组更长（中位OS 33个月，[范围8 - 33个月]，中位PFS 23个月[范围4 - 33个月]）（<120 Gy组中位OS 17个月，[范围5 - 33个月]，中位PFS 13个月[范围1 - 33个月]）（分别为p <0.01和p = 0.03）。
HCC患者中基于三维体素的更高肿瘤吸收剂量与四个月的DC以及更长的OS和PFS相关。[钇]SIRT中的DVH可能在评估剂量测定中发挥作用。
