Lam Marnix, Salem Riad, Toskich Beau, Kappadath S Cheenu, Chiesa Carlo, Fowers Kirk, Haste Paul, Herman Joseph M, Kim Edward, Leung Thomas, Padia Siddharth A, Sangro Bruno, Sze Daniel Y, Garin Etienne
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Huispostnummer E01.132, Postbus 85500, 3508 GA, Utrecht, The Netherlands.
Univ Rennes, INSERM, INRA, Centre de Lutte Contre Le Cancer Eugène Marquis, Institut NUMECAN (Nutrition Metabolisms and Cancer), 35000, Rennes, France.
Eur J Nucl Med Mol Imaging. 2025 Mar 28. doi: 10.1007/s00259-025-07229-8.
The TheraSphere Global Steering Committee reconvened to review clinical data and address knowledge gaps related to treatment and dosimetry in non-HCC indications using Yttrium-90 (Y) glass microspheres.
A PubMed search was performed. References were reviewed and adjudicated by the Delphi method. Recommendations were graded according to the degree of recommendation and strength of consensus. Dosimetry focused on a mean dose approach, i.e., aiming for an average dose over either single or multicompartment volumes of interests. Committee discussion and consensus focused on optimal patient selection, disease presentation, liver function, tumour type, tumour vascularity, and curative/palliative treatment intent for intrahepatic cholangiocarcinoma (iCCA) and colorectal and neuroendocrine carcinoma liver metastases (mCRC, mNET).
For all indications, single compartment average perfused volume absorbed dose ≥ 400 Gy is recommended for radiation segmentectomy and 150 Gy for radiation lobectomy. Single compartment 120 Gy for uni- and bilobar treatment reflects current clinical practice, which results in variable tumour and normal tissue absorbed doses. Therefore, multicompartment dosimetry is recommended for uni- and bilobar treatment, aiming for maximum 75 Gy to normal tissue and 150-200 Gy (mCRC, mNET), ≥ 205 (iCCA) tumour absorbed doses. These dose thresholds are preliminary and should be used with caution accounting for patient specific characteristics.
Consensus recommendations are provided to guide clinical and dosimetry approaches for Y glass microsphere radioembolization in iCCA, mCRC and mNET.
not applicable.
TheraSphere全球指导委员会再次召开会议，以审查临床数据，并解决与使用钇-90（Y）玻璃微球治疗非肝细胞癌适应症及剂量测定相关的知识空白。
进行了PubMed检索。参考文献通过德尔菲法进行审查和裁决。建议根据推荐程度和共识强度进行分级。剂量测定侧重于平均剂量法，即针对单个或多区域感兴趣体积的平均剂量。委员会的讨论和共识集中在肝内胆管癌（iCCA）、结直肠癌和神经内分泌癌肝转移（mCRC、mNET）的最佳患者选择、疾病表现、肝功能、肿瘤类型、肿瘤血管以及治愈性/姑息性治疗意图。
对于所有适应症，推荐辐射段切除术的单区域平均灌注体积吸收剂量≥400 Gy，辐射叶切除术为150 Gy。单区域120 Gy用于单叶和双叶治疗反映了当前的临床实践，这导致肿瘤和正常组织的吸收剂量各不相同。因此，推荐单叶和双叶治疗采用多区域剂量测定法，目标是正常组织的最大吸收剂量为75 Gy，肿瘤吸收剂量为150 - 200 Gy（mCRC、mNET），≥205 Gy（iCCA）。这些剂量阈值是初步的，应谨慎使用，并考虑患者的具体特征。
提供了共识性建议，以指导iCCA、mCRC和mNET中Y玻璃微球放射性栓塞的临床和剂量测定方法。
不适用。
