Lam Marnix, Garin Etienne, Haste Paul, Denys Alban, Geller Brian, Kappadath S Cheenu, Turkmen Cuneyt, Sze Daniel Y, Alsuhaibani Hamad Saleh, Herrmann Ken, Maccauro Marco, Cantasdemir Murat, Dreher Matthew, Fowers Kirk D, Gates Vanessa, Salem Riad
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Huispostnummer E01.132. Postbus 85500, Utrecht, 3508 GA, The Netherlands.
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
Eur J Nucl Med Mol Imaging. 2025 Jan;52(2):744-755. doi: 10.1007/s00259-024-06920-6. Epub 2024 Sep 27.
Pre-treatment [Tc]TcMAA-based radioembolization treatment planning using multicompartment dosimetry involves the definition of the tumor and normal tissue compartments and calculation of the prescribed absorbed doses. The aim was to compare the real-world utility of anatomic and [Tc]TcMAA-based segmentation of tumor and normal tissue compartments.
Included patients had HCC treated by glass [Y]yttrium microspheres, ≥ 1 tumor, ≥ 3 cm diameter and [Tc]TcMAA SPECT/CT imaging before treatment. Segmentation was performed retrospectively using dedicated dosimetry software: (1) anatomic (diagnostic CT/MRI-based), and (2) [Tc]TcMAA threshold-based (i.e., using an activity-isocontour threshold). CT/MRI was co-registered with [Tc]TcMAA SPECT/CT. Logistic regression and Cox regression, respectively, were used to evaluate relationships between total perfused tumor absorbed dose (TAD) and objective response rate (ORR) and overall survival (OS). In a subset-analysis pre- and post-treatment dosimetry were compared using Bland-Altman analysis and Pearson's correlation coefficient.
A total of 209 patients were enrolled. Total perfused tumor and normal tissue volumes were larger when using anatomic versus [Tc]TcMAA threshold segmentation, resulting in lower absorbed doses. mRECIST ORR was higher with increasing total perfused TAD (odds ratio per 100 Gy TAD increase was 1.22 (95% CI: 1.01-1.49; p = 0.044) for anatomic and 1.19 (95% CI: 1.04-1.37; p = 0.012) for [Tc]TcMAA threshold segmentation. Higher total perfused TAD was associated with improved OS (hazard ratio per 100 Gy TAD increase was 0.826 (95% CI: 0.714-0.954; p = 0.009) and 0.847 (95% CI: 0.765-0.936; p = 0.001) for anatomic and [Tc]TcMAA threshold segmentation, respectively). For pre- vs. post-treatment dosimetry comparison, the average bias for total perfused TAD was + 11.5 Gy (95% limits of agreement: -227.0 to 250.0) with a strong positive correlation (Pearson's correlation coefficient = 0.80).
Real-world data support [Tc]TcMAA imaging to estimate absorbed doses prior to treatment of HCC with glass [Y]yttrium microspheres. Both anatomic and [Tc]TcMAA threshold methods were suitable for treatment planning.
NCT03295006.
使用多室剂量测定法进行基于[锝-99m]大颗粒聚合白蛋白（[Tc]TcMAA）的栓塞前放射治疗计划，涉及肿瘤和正常组织室的定义以及规定吸收剂量的计算。目的是比较基于解剖学和基于[Tc]TcMAA的肿瘤和正常组织室分割在实际应用中的效用。
纳入的患者患有肝细胞癌（HCC），接受玻璃[钇-90]微球治疗，肿瘤≥1个，直径≥3 cm，且在治疗前进行了[Tc]TcMAA单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）成像。使用专用剂量测定软件进行回顾性分割：（1）基于解剖学（基于诊断性CT/MRI），以及（2）基于[Tc]TcMAA阈值（即使用活性等剂量线阈值）。CT/MRI与[Tc]TcMAA SPECT/CT进行了配准。分别使用逻辑回归和Cox回归来评估总灌注肿瘤吸收剂量（TAD）与客观缓解率（ORR）以及总生存期（OS）之间的关系。在亚组分析中，使用Bland-Altman分析和Pearson相关系数比较治疗前和治疗后的剂量测定。
共纳入209例患者。与基于[Tc]TcMAA阈值分割相比，使用解剖学分割时，总灌注肿瘤和正常组织体积更大，导致吸收剂量更低。随着总灌注TAD的增加，改良实体瘤疗效评价标准（mRECIST）ORR更高（解剖学分割每增加100 Gy TAD的优势比为1.22（95%置信区间：1.01-1.49；p = 0.044），[Tc]TcMAA阈值分割为1.19（95%置信区间：1.04-1.37；p = 0.012））。更高的总灌注TAD与改善的OS相关（解剖学分割每增加100 Gy TAD的风险比为0.826（95%置信区间：0.714-0.954；p = 0.009），[Tc]TcMAA阈值分割为0.847（95%置信区间：0.765-0.936；p = 0.001））。对于治疗前与治疗后剂量测定的比较，总灌注TAD的平均偏差为+11.5 Gy（95%一致性界限：-227.0至250.0），具有强正相关性（Pearson相关系数 = 0.80）。
实际数据支持在使用玻璃[钇-90]微球治疗HCC之前，使用[Tc]TcMAA成像来估计吸收剂量。解剖学和[Tc]TcMAA阈值方法均适用于治疗计划。
NCT03295006。
