Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres

Wan Yee Lau*, Andrew S. Kennedy, Yun Hwan Kim, Hee Kit Lai, Rheun Chuan Lee, Thomas W.T. Leung, Ching Sheng Liu, Riad Salem, Bruno Sangro, Borys Shuter, Shih Chang Wang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

128 Scopus citations

Abstract

Purpose: Selective internal radiotherapy (SIRT) with yttrium-90 ( 90Y) resin microspheres can improve the clinical outcomes for selected patients with inoperable liver cancer. This technique involves intra-arterial delivery of β-emitting microspheres into hepatocellular carcinomas or liver metastases while sparing uninvolved structures. Its unique mode of action, including both 90Y brachytherapy and embolization of neoplastic microvasculature, necessitates activity planning methods specific to SIRT. Methods and Materials: A panel of clinicians experienced in 90Y resin microsphere SIRT was convened to integrate clinical experience with the published data to propose an activity planning pathway for radioembolization. Results: Accurate planning is essential to minimize potentially fatal sequelae such as radiation-induced liver disease while delivering tumoricidal 90Y activity. Planning methods have included empiric dosing according to degree of tumor involvement, empiric dosing adjusted for the body surface area, and partition model calculations using Medical Internal Radiation Dose principles. It has been recommended that at least two of these methods be compared when calculating the microsphere activity for each patient. Conclusions: Many factors inform 90Y resin microsphere SIRT activity planning, including the therapeutic intent, tissue and vasculature imaging, tumor and uninvolved liver characteristics, previous therapies, and localization of the microsphere infusion. The influence of each of these factors has been discussed.

Original languageEnglish (US)
Pages (from-to)401-407
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number1
DOIs
StatePublished - Jan 1 2012

Keywords

  • Interventional radiology
  • Liver neoplasms
  • Microspheres
  • Radiation dosage
  • Yttrium radioisotopes

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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