International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

Hugo Levillain*, Oreste Bagni, Christophe M. Deroose, Arnaud Dieudonné, Silvano Gnesin, Oliver S. Grosser, S. Cheenu Kappadath, Andrew Kennedy, Nima Kokabi, David M. Liu, David C. Madoff, Armeen Mahvash, Antonio Martinez de la Cuesta, David C.E. Ng, Philipp M. Paprottka, Cinzia Pettinato, Macarena Rodríguez-Fraile, Riad Salem, Bruno Sangro, Lidia StrigariDaniel Y. Sze, Berlinda J. de Wit van der veen, Patrick Flamen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

128 Scopus citations


Purpose: A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-resin microspheres. Methods: A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results: Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99mTc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion: Practitioners are encouraged to work towards adoption of these recommendations.

Original languageEnglish (US)
Pages (from-to)1570-1584
Number of pages15
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number5
StatePublished - May 2021


  • Dosimetry
  • Liver tumours
  • Recommendations
  • SIRT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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