TY - JOUR T1 - Dose–Response and Dose–Toxicity Relationships for Glass <sup>90</sup>Y Radioembolization in Patients with Liver Metastases from Colorectal Cancer JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1616 LP - 1623 DO - 10.2967/jnumed.120.255745 VL - 62 IS - 11 AU - Ahmed A. Alsultan AU - Caren van Roekel AU - Maarten W. Barentsz AU - Maarten L.J. Smits AU - Britt Kunnen AU - Miriam Koopman AU - Arthur J.A.T. Braat AU - Rutger C.G. Bruijnen AU - Bart de Keizer AU - Marnix G.E.H. Lam Y1 - 2021/11/01 UR - http://jnm.snmjournals.org/content/62/11/1616.abstract N2 - Radioembolization based on personalized treatment planning requires established dose–response and dose–toxicity relationships. The aim of this study was to investigate dose–response and dose–toxicity relationships in patients with colorectal liver metastases (CRLMs) treated with glass 90Y-microspheres. Methods: All CRLM patients treated with glass 90Y-microspheres in our institution were retrospectively analyzed. The tumor-absorbed dose was calculated for each measurable metastasis (i.e.,18F-FDG–positive and more than a 5-cm3 tumor volume) on posttreatment 90Y PET. Metabolic tumor response was determined on 18F-FDG PET/CT by measuring the total lesion glycolysis at baseline and at 3 mo after treatment. The relationship between tumor-absorbed dose and metabolic response was determined on a per-lesion and per-patient basis using a linear mixed-effects regression model. Clinical toxicity and laboratory toxicity were correlated with healthy liver–absorbed dose. Results: Thirty-one patients were included. The median tumor-absorbed dose of 85 measurable metastases was 133 Gy (range, 20–1001 Gy). Per response category, this was 196 Gy for complete response (CR), 177 Gy for partial response (PR), 72 Gy for stable disease, and 95 Gy for progressive disease (PD). A significant dose–response relationship was found on a tumor level, with a significantly higher tumor-absorbed dose in metastases with CR (+94%) and PR (+74%) than in metastases with PD (P &lt; 0.001). A similar relationship was found on a patient level, with PR having a higher tumor-absorbed dose than did PD (+58%, P = 0.044). A tumor-absorbed dose of more than 139 Gy predicted a 3-mo metabolic response with the greatest accuracy (89% specificity and 77% sensitivity), whereas a tumor-absorbed dose of more than 189 Gy predicted response with 97% specificity and 45% sensitivity. The median healthy liver–absorbed dose was 63 Gy (range, 24–113 Gy). Toxicity was limited mostly to grades 1 and 2, with 1 case of radioembolization-induced liver disease in a patient who received the highest healthy liver–absorbed dose. A positive trend was seen for most laboratory parameters in our dose–toxicity analysis. Conclusion: A significant relationship was observed between dose and response in CRLM patients treated with glass 90Y radioembolization. ER -