Optimizing (90)Y particle density improves outcomes after radioembolization Journal Article


Authors: Maxwell, A. W. P.; Mendoza, H. G.; Sellitti, M. J.; Camacho, J. C.; Deipolyi, A. R.; Ziv, E.; Sofocleous, C. T.; Yarmohammadi, H.; Maybody, M.; Humm, J. L.; Schwartz, J.; Juluru, K.; Dunphy, M. P.; Boas, F. E.
Article Title: Optimizing (90)Y particle density improves outcomes after radioembolization
Abstract: Purpose: To determine how particle density affects dose distribution and outcomes after lobar radioembolization. Methods: Matched pairs of patients, treated with glass versus resin microspheres, were selected by propensity score matching (114 patients), in this single-institution retrospective study. For each patient, tumor and liver particle density (particles/cm3) and dose (Gy) were determined. Tumor-to-normal ratio was measured on both 99mTc-MAA SPECT/CT and post-90Y bremsstrahlung SPECT/CT. Microdosimetry simulations were used to calculate first percentile dose, which is the dose in the cold spots between microspheres. Local progression-free survival (LPFS) and overall survival were analyzed. Results: As more particles were delivered, doses on 90Y SPECT/CT became more uniform throughout the treatment volume: tumor and liver doses became more similar (p = 0.04), and microscopic cold spots between particles disappeared. For hypervascular tumors (tumor-to-normal ratio ≥ 2.6 on MAA scan), delivering fewer particles (< 6000 particles/cm3 treatment volume) was associated with better LPFS (p = 0.03). For less vascular tumors (tumor-to-normal ratio < 2.6), delivering more particles (≥ 6000 particles/cm3) was associated with better LPFS (p = 0.02). In matched pairs of patients, using the optimal particle density resulted in improved overall survival (11.5 vs. 6.8 months, p = 0.047), compared to using suboptimal particle density. Microdosimetry resulted in better predictions of LPFS (p = 0.03), and overall survival (p = 0.02), compared to conventional dosimetry. Conclusion: The number of particles delivered can be chosen to maximize the tumor dose and minimize the liver dose, based on tumor vascularity. Optimizing the particle density resulted in improved LPFS and overall survival. © 2022, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
Keywords: dosimetry; embolization; microdosimetry; radioembolization; tumor vascularity
Journal Title: CardioVascular and Interventional Radiology
Volume: 45
Issue: 7
ISSN: 0174-1551
Publisher: Springer  
Date Published: 2022-07-01
Start Page: 958
End Page: 969
Language: English
DOI: 10.1007/s00270-022-03139-6
PUBMED: 35459960
PROVIDER: scopus
PMCID: PMC10103908
DOI/URL:
Notes: Erratum issued - please see DOI: 10.1007/s00270-022-03171-6 -- Source: Scopus
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MSK Authors
  1. Mark Phillip Dunphy
    82 Dunphy
  2. Majid Maybody
    98 Maybody
  3. John Laurence Humm
    437 Humm
  4. Franz Edward Boas
    77 Boas
  5. Krishna   Juluru
    35 Juluru
  6. Etay   Ziv
    116 Ziv