钇-90动脉内超选择性给药治疗复发性胶质母细胞瘤：基于计算机模拟的概念验证及可行性与安全性分析
Intra-Arterial Super-Selective Delivery of Yttrium-90 for the Treatment of Recurrent Glioblastoma: In Silico Proof of Concept with Feasibility and Safety Analysis.
作者信息
Paolani Giulia, Minosse Silvia, Strolin Silvia, Santoro Miriam, Pucci Noemi, Di Giuliano Francesca, Garaci Francesco, Oddo Letizia, Toumia Yosra, Guida Eugenia, Riccitelli Francesco, Perilli Giulia, Vitaliti Alessandra, Bedini Angelico, Dolci Susanna, Paradossi Gaio, Domenici Fabio, Da Ros Valerio, Strigari Lidia
机构信息
Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy.
U.O.C Diagnostic Imaging, Department of Integrated Care Processes, Fondazione PTV Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
出版信息
Pharmaceutics. 2025 Mar 7;17(3):345. doi: 10.3390/pharmaceutics17030345.
: Intra-arterial cerebral infusion (IACI) of radiotherapeutics is a promising treatment for glioblastoma (GBM) recurrence. We investigated the in silico feasibility and safety of Yttrium-90-Poly(vinyl alcohol)-Microbubble (Y-PVA-MB) IACI in patients with recurrent GBM and compared the results with those of external beam radiation therapy (EBRT). : Contrast-enhanced T1-weighted magnetic resonance imaging (T1W-MRI) was used to delineate the tumor volumes and CT scans were used to automatically segment the organs at risk in nine patients with recurrent GBM. Volumetric Modulated Arc Therapy (VMAT) treatment plans were generated using a clinical treatment planning system. Assuming the relative intensity of each voxel from the MR-T1W as a valid surrogate for the post-IACI Y-PVA-MB distribution, a specific Y dose voxel kernel was obtained through Monte Carlo (MC) simulations and convolved with the MRI, resulting in a Y-PVA-MB-based dose distribution that was then compared with the VMAT plans. : The physical dose distribution obtained from the simulation of 1GBq of Y-PVA-MBs was rescaled to ensure that 95% of the prescribed dose was delivered to 95% or 99% of the target (i.e., A95% and A99%, respectively). The calculated activities were A95% = 269.2 [63.6-2334.1] MBq and A99% = 370.6 [93.8-3315.2] MBq, while the mean doses to the target were 58.2 [58.0-60.0] Gy for VMAT, and 123.1 [106.9-153.9] Gy and 170.1 [145.9-223.8] Gy for A95% and A99%, respectively. Additionally, non-target brain tissue was spared in the Y-PVA-MB treatment compared to the VMAT approach, with a median [range] of mean doses of 12.5 [12.0-23.0] Gy for VMAT, and 0.6 [0.2-1.0] Gy and 0.9 [0.3-1.5] Gy for the Y treatments assuming A95% and A99%, respectively. : Y-PVA-MB IACI using MR-T1W appears to be feasible and safe, as it enables the delivery of higher doses to tumors and lower doses to non-target volumes compared to the VMAT approach.
动脉内脑灌注（IACI）放射性治疗药物是胶质母细胞瘤（GBM）复发的一种有前景的治疗方法。我们研究了钇 - 90 - 聚乙烯醇 - 微泡（Y - PVA - MB）IACI在复发性GBM患者中的计算机模拟可行性和安全性，并将结果与外照射放疗（EBRT）的结果进行比较。：使用对比增强T1加权磁共振成像（T1W - MRI）描绘肿瘤体积，并使用CT扫描自动分割9例复发性GBM患者的危及器官。使用临床治疗计划系统生成容积调强弧形治疗（VMAT）治疗计划。假设来自MR - T1W的每个体素的相对强度作为IACI后Y - PVA - MB分布的有效替代物，通过蒙特卡罗（MC）模拟获得特定的Y剂量体素核，并与MRI卷积，得到基于Y - PVA - MB的剂量分布，然后将其与VMAT计划进行比较。：将1GBq Y - PVA - MB模拟得到的物理剂量分布重新缩放，以确保规定剂量的95％输送到95％或99％的靶区（即分别为A95％和A99％）。计算得到的活度为A95％ = 269.2 [63.6 - 2334.1] MBq和A99％ = 370.6 [93.8 - 3315.2] MBq，而VMAT对靶区的平均剂量为58.2 [58.0 - 60.0] Gy，A95％和A99％分别为123.1 [106.9 - 153.9] Gy和170.1 [145.9 - 223.8] Gy。此外，与VMAT方法相比，Y - PVA - MB治疗可使非靶区脑组织免受辐射，VMAT的平均剂量中位数[范围]为12.5 [12.0 - 23.0] Gy，假设A95％和A99％时，Y治疗的平均剂量分别为0.6 [0.2 - 1.0] Gy和0.9 [0.3 - 1.5] Gy。：使用MR - T1W的Y - PVA - MB IACI似乎是可行和安全的，因为与VMAT方法相比，它能够向肿瘤输送更高剂量，向非靶区输送更低剂量。
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