Abstract:
PURPOSE:Fusion dual-tracer SPECT imaging enables physiological rather than morphological voxel-based partitioning and dosimetry for (90)Y hepatic radioembolization (RE). We evaluated its prognostic value in a large heterogeneous cohort of patients with extensive hepatic malignancy. METHODS:A total of 122 patients with primary or secondary liver malignancy (18 different cell types) underwent SPECT imaging after intraarterial injection of (99m)Tc macroaggregated albumin (TcMAA) as a simulation of subsequent (90)Y microsphere distribution, followed by administration of an excess of intravenous (99m)Tc-labelled sulphur colloid (TcSC) as a biomarker for functional liver, and a second SPECT scan. TcMAA distribution was used to estimate (90)Y radiation absorbed dose in tumour (D T) and in functional liver. Laboratory and clinical follow-up were recorded for 12 weeks after RE, and radiographic responses according to (m)RECIST were evaluated at 3 and 6 months. Dose-response relationships were determined for efficacy and toxicity. RESULTS:Patients were treated with a median of 1.73 GBq activity of resin microspheres (98 patients) or glass microspheres (24 patients), in a whole-liver approach (97 patients) or a lobar approach (25 patients). The objective response rate was 41% at 3 months and 48% at 6 months. Response was correlated with D T (P < 0.01). Median overall survival was 10.1 months (95% confidence interval 7.4 - 12.8 months). Responders lived for 36.0 months compared to 8.7 months for nonresponders (P < 0.01). Stratified for tumour cell type, D T was independently associated with survival (P < 0.01). Absorbed dose in functional liver was correlated with toxicity grade change (P < 0.05) and RE-induced liver disease (P < 0.05). CONCLUSION:Fusion dual-tracer SPECT imaging offers a physiology-based functional imaging tool to predict efficacy and toxicity of RE. This technique can be refined to define dosing thresholds for specific tumour types and treatments, but appears generally predictive even in a heterogeneous cohort.
journal_name
Eur J Nucl Med Mol Imagingauthors
Lam MG,Banerjee A,Goris ML,Iagaru AH,Mittra ES,Louie JD,Sze DYdoi
10.1007/s00259-015-3048-zsubject
Has Abstractpub_date
2015-07-01 00:00:00pages
1192-201issue
8eissn
1619-7070issn
1619-7089journal_volume
42pub_type
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journal_title:European journal of nuclear medicine and molecular imaging
pub_type: 临床试验,杂志文章
doi:10.1007/s00259-011-1819-8
更新日期:2011-08-01 00:00:00
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journal_title:European journal of nuclear medicine and molecular imaging
pub_type: 杂志文章
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journal_title:European journal of nuclear medicine and molecular imaging
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更新日期:2011-04-01 00:00:00
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journal_title:European journal of nuclear medicine and molecular imaging
pub_type: 临床试验,杂志文章
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journal_title:European journal of nuclear medicine and molecular imaging
pub_type: 杂志文章,meta分析
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journal_title:European journal of nuclear medicine and molecular imaging
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journal_title:European journal of nuclear medicine and molecular imaging
pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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更新日期:2009-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:2020-09-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:2019-01-01 00:00:00