基于钇-90 PET/CT剂量测定中肿瘤剂量不足体积预测树脂微球放射段切除术后肝细胞癌的复发情况

Prediction of Recurrence of Hepatocellular Carcinoma Following Radiation Segmentectomy with Resin Microspheres Based on Underdosed Tumor Volume on Yttrium-90 PET/CT Dosimetry.

作者信息

Vo Nhi H, Malik Muhammad Saad, Tahir Muhammad Mohid, Parker J Anthony, Tsai Leo L, Dinh Diana, Lam Marnix, Weinstein Jeffrey, Ahmed Muneeb, Sarwar Ammar

机构信息

Department of Radiology, Division of Interventional Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA 02215.

Department of Radiology, Division of Nuclear Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.

出版信息

J Vasc Interv Radiol. 2025 Jun 28. doi: 10.1016/j.jvir.2025.06.018.

DOI:10.1016/j.jvir.2025.06.018

PMID:40588024

Abstract

PURPOSE

As Yttrium-90 radiation segmentectomy (Y-RS) with ablative dosimetry is increasing in clinical practice for the treatment of hepatocellular carcinoma (HCC), verification of tumor absorbed dose is desirable to predict tumors that do not achieve complete response. The objective of this study is to evaluate the use of immediate post Y-RS PET/CT and dosimetry software in predicting incomplete response in early-stage HCC.

MATERIALS AND METHODS

Early-stage HCC patients undergoing resin Y-RS (7/2014 - 12/2022) prescribed using the single-compartment MIRD model with post Y-TARE PET/CT were reviewed. Forty patients (42 HCCs; 69 years [IQR:63-77], 75% male), with a median tumor size 3.4 cm (IQR:2.2-4.6) met criteria. Dose-volume histograms were generated using MIM SurePlan LiverY90 (v7.2.3). mRECIST treatment responses were correlated with quantitative volumetric analyses of tumor absorbed dose and underdosed tumor volume, defined as volume of tumor receiving less than 100 Gy (V). Additional subgroup dosimetry analysis was performed between tumors with complete response (CR) and incomplete response.

RESULTS

Tumors treated showed 86% CR and 100% ORR at 6-month follow-up. Subgroup analysis between CRs and incomplete responders showed no difference in tumor size, volume, prescribed tissue dose, prescribed, delivered, or specific activity. Incomplete responders had a lower D compared to CRs (162 vs 273 Gy, p=0.040), lower particle density (36,310 vs. 66,980 particles/cc, p=0.040), higher absolute (10 vs. 0.7 mL; p=0.011) and proportion (33% vs. 5%; p=0.001) of underdosed tumor volumes (V). Underdosed tumor volume (V) of >28% had an increased likelihood of incomplete response (OR 75, p=0.001).

CONCLUSION

Y-TARE PET/CT can identify tumors incompletely treated with an ablative Y-RS dose and guide decision for closer follow-up or early re-treatment.

摘要

目的

随着采用消融剂量测定法的钇-90放射段切除术（Y-RS）在肝细胞癌（HCC）治疗的临床实践中日益增多，验证肿瘤吸收剂量对于预测未达到完全缓解的肿瘤是很有必要的。本研究的目的是评估Y-RS后即刻PET/CT和剂量测定软件在预测早期HCC不完全缓解中的应用。

材料与方法

回顾了2014年7月至2022年12月期间接受树脂Y-RS治疗并使用单室MIRD模型及Y-TARE后PET/CT进行剂量处方的早期HCC患者。40例患者（42个HCC；年龄69岁[四分位间距：63 - 77岁]，75%为男性），中位肿瘤大小3.4 cm（四分位间距：2.2 - 4.6 cm）符合标准。使用MIM SurePlan LiverY90（v7.2.3）生成剂量体积直方图。mRECIST治疗反应与肿瘤吸收剂量和低剂量肿瘤体积的定量体积分析相关，低剂量肿瘤体积定义为接受小于100 Gy（V）的肿瘤体积。对完全缓解（CR）和不完全缓解的肿瘤进行了额外的亚组剂量测定分析。

结果

在6个月随访时，接受治疗的肿瘤显示CR率为86%，ORR为100%。CR组和不完全缓解组之间的亚组分析显示，肿瘤大小、体积、处方组织剂量、处方、给予的或比活度无差异。与CR组相比，不完全缓解组的D较低（162 vs 273 Gy，p = 0.040），粒子密度较低（36,310 vs. 66,980个粒子/立方厘米，p = 0.040），低剂量肿瘤体积的绝对值（10 vs. 0.7 mL；p = 0.011）和比例（33% vs. 5%；p = 0.001）较高。低剂量肿瘤体积（V）>28%时，不完全缓解的可能性增加（OR 75，p = 0.001）。