PT  - JOURNAL ARTICLE
AU  - Kao, Yung Hsiang
AU  - Hock Tan, Andrew Eik
AU  - Burgmans, Mark Christiaan
AU  - Irani, Farah Gillian
AU  - Khoo, Li Ser
AU  - Gong Lo, Richard Hoau
AU  - Tay, Kiang Hiong
AU  - Tan, Bien Soo
AU  - Hoe Chow, Pierce Kah
AU  - Eng Ng, David Chee
AU  - Whatt Goh, Anthony Soon
TI  - Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective <sup>90</sup>Y Radioembolization
AID  - 10.2967/jnumed.111.097469
DP  - 2012 Apr 01
TA  - Journal of Nuclear Medicine
PG  - 559--566
VI  - 53
IP  - 4
4099  - http://jnm.snmjournals.org/content/53/4/559.short
4100  - http://jnm.snmjournals.org/content/53/4/559.full
SO  - J Nucl Med2012 Apr 01; 53
AB  - Compliance with radiobiologic principles of radionuclide internal dosimetry is fundamental to the success of 90Y radioembolization. The artery-specific SPECT/CT partition model is an image-guided personalized predictive dosimetric technique developed by our institution, integrating catheter-directed CT hepatic angiography (CTHA), 99mTc-macroaggregated albumin SPECT/CT, and partition modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates 99mTc-macroaggregated albumin hepatic biodistribution. The partition model is validated for 90Y resin microspheres based on MIRD macrodosimetry. Methods: This was a retrospective analysis of our early clinical outcomes for inoperable hepatocellular carcinoma. Mapping hepatic angiography was performed according to standard technique with the addition of catheter-directed CTHA. 99mTc-MAA planar scintigraphy was used for liver-to-lung shunt estimation, and SPECT/CT was used for liver dosimetry. Artery-specific SPECT/CT partition modeling was planned by experienced nuclear medicine physicians. Results: From January to May 2011, 20 arterial territories were treated in 10 hepatocellular carcinoma patients. Median follow-up was 21 wk (95% confidence interval [CI], 12–50 wk). When analyzed strictly as brachytherapy, 90Y radioembolization planned by predictive dosimetry achieved index tumor regression in 8 of 8 patients, with a median size decrease of 58% (95% CI, 40%–72%). Tumor thrombosis regressed or remained stable in 3 of 4 patients with baseline involvement. The best α-fetoprotein reduction ranged from 32% to 95%. Clinical success was achieved in 7 of 8 patients, including 2 by sublesional dosimetry, in 1 of whom there was radioembolization lobectomy intent. Median predicted mean radiation absorbed doses were 106 Gy (95% CI, 105–146 Gy) to tumor, 27 Gy (95% CI, 22–33 Gy) to nontumorous liver, and 2 Gy (95% CI, 1.3–7.3 Gy) to lungs. Across all patients, tumor, nontumorous liver, and lungs received predicted ≥91 Gy, ≤51 Gy, and ≤16 Gy, respectively, via at least 1 target arterial territory. No patients developed significant toxicities within 3 mo after radioembolization. The median time to best imaging response was 76 d (95% CI, 55–114 d). Median time to progression and overall survival were not reached. SPECT/CT-derived mean tumor–to–normal liver ratios varied widely across all planning target volumes (median, 5.4; 95% CI, 4.1–6.7), even within the same patient. Conclusion: Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling achieves high clinical success rates for safe and effective 90Y radioembolization.