Research ArticleClinical Investigation

Lung Dose Measured on Postradioembolization 90Y PET/CT and Incidence of Radiation Pneumonitis

Martina Stella, Rob van Rooij, Marnix G.E.H. Lam, Hugo W.A.M. de Jong and Arthur J.A.T. Braat
Journal of Nuclear Medicine July 2022, 63 (7) 1075-1080; DOI: https://doi.org/10.2967/jnumed.121.263143

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Posttreatment 90Y PET/CT scan of 47-y-old man diagnosed with colorectal cancer. LMD considering both lobes was 61 Gy. 90Y PET image shows activity in right lung (blue contour) due to liver motion in craniocaudal direction and rim field-of-view artifact and leading to right LMD of 100 Gy, which was main contributor to LMD. Left LMD (computed within green contour) was 3 Gy.

  • FIGURE 2.
    FIGURE 2.

    Box plots depicting LSFY-90, together with corresponding median, divided by tumor type. Statistically significant difference was reported between neuroendocrine tumor patients and colorectal cancer patients (P = 0.008), between neuroendocrine tumor and HCC patients (P = 0.010), and between neuroendocrine tumor and patients in group “others” (P = 0.022). CC = cholangiocellular carcinoma; CRC = colorectal cancer; NET = neuroendocrine tumor.

  • FIGURE 3.
    FIGURE 3.

    Distribution of LMDY-90 as function of corresponding LMDMAA. On the basis of limit of 30 Gy for estimate of absorbed radiation dose to lungs during pretreatment phase and 12 Gy for LMDY-90, below which no radiation pneumonitis cases were reported, subjects were divided into 4 quadrants: true-positive, false-positive, true-negative, and false-negative. According to chosen limits, 12 false-positives were detected. True-positive (red triangles) corresponds to 2 patients who developed radiation pneumonitis, whereas false-negative (blue triangle) corresponds to patient who died of progressive disease before follow-up.

Tables

  • TABLE 1.

    Baseline and Treatment Characteristics

    CharacteristicData
    Patients272
    Procedures317
    Sex
     Male170 (62.5%)
     Female102 (37.5%)
    Mean age64.56 (17–90)
    Sphere type
     Glass200 (63%)
     Resin117 (37%)
    Median administered activity (MBq)
     Glass2,278 (277–9,636)
     Resin1,877 (516–3,245)
    Mean number of 90Y sessions1.17 (1–5)
    Tumor types
     Colorectal cancer104 (38%)
     HCC68 (25%)
     Neuroendocrine tumor45 (16%)
     Cholangiocellular carcinoma21 (8%)
     Others34 (13%)
    Thrombus
     Segmental right portal vein9
     Lobar left portal vein4
     Segmental right portal vein plus  lobar left portal vein1
     Tumor thrombosis, main portal vein2
     Tumor thrombosis, right hepatic vein1
    Portal hypertension33
    LSFMAA (%)
     Mean5.73 (0.49–50.44)
     Median3.87 (4.60)
     Number of cases > 20%11
    LSFY-90 (%)
     Mean5.90 (0.27–39.02)
     Median4.13 (5.28)
     Number of cases > 20%7
    99mTc-based prediction of LMD (Gy)
     Mean6.93 (0.17–89.03)
     Median3.52 (6.48)
     Number of cases > 30 Gy14
    90Y PET–based left lung dose (Gy)
     Mean1.59 (0.02–22.14)
     Median0.95 (1.16)
     Number of cases > 12 Gy3
    Median total lung volume (mL)1,713 (392–7,851)
    Median left lung volume (mL)733 (80–3,792)

    • Qualitative data are number; continuous data are mean and range or median and interquartile range.

  • TABLE 2.

    Matrix of Statistical Significance of Differences Between Tumor Types in Terms of LSFY-90

    LSFY-90
    TypeCholangiocellular carcinomaColorectal cancerHCCNeuroendocrine tumorOthers
    Cholangiocellular carcinoma—0.50.50.060.5
    Colorectal cancer—0.40.008*0.5
    HCC—0.01*0.4
    Neuroendocrine tumor—0.02*
    Others—

    • * Statistically significant (P < 0.05).

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