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Mark Christiaan Burgmans - One of the best experts on this subject based on the ideXlab platform.
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Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective 90Y Radioembolization
2016Co-Authors: Yung Hsiang Kao, Andrew Eik, Hock Tan, Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Richard Hoau, Kiang Hiong Tay, Bien Soo TanAbstract:Compliance with radiobiologic principles of radionuclide in-ternal dosimetry is fundamental to the success of 90Y radioem-bolization. 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 albu-min SPECT/CT, and Partition Modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates 99mTc-macro-aggregated albumin hepatic biodistribution. The Partition Model is validated for 90Y resin microspheres based on MIRD macro-dosimetry. 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 dosim-etry. 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%). Tu-mor thrombosis regressed or remained stable in 3 of 4 patients with baseline involvement. The best a-fetoprotein reduction ranged from 32 % to 95%. Clinical success was achieved i
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image guided personalized predictive dosimetry by artery specific spect ct Partition Modeling for safe and effective 90y radioembolization
The Journal of Nuclear Medicine, 2012Co-Authors: Yung Hsiang Kao, Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Kiang Hiong Tay, Bien Soo Tan, Andrew Eik Hock Tan, Pierce K H Chow, Anthony S W GohAbstract: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.
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image guided personalized predictive dosimetry by artery specific spect ct Partition Modeling for safe and effective 90y radioembolization
The Journal of Nuclear Medicine, 2012Co-Authors: Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Pierce K H Chow, Richard Hoau Gong Lo, David Chee Eng NgAbstract:UNLABELLED: Compliance with radiobiologic principles of radionuclide internal dosimetry is fundamental to the success of (90)Y 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), (99m)Tc-macroaggregated albumin SPECT/CT, and Partition Modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates (99m)Tc-macroaggregated albumin hepatic biodistribution. The Partition Model is validated for (90)Y 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. (99m)Tc-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, (90)Y 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 (90)Y radioembolization.
Farah Gillian Irani - One of the best experts on this subject based on the ideXlab platform.
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Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective 90Y Radioembolization
2016Co-Authors: Yung Hsiang Kao, Andrew Eik, Hock Tan, Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Richard Hoau, Kiang Hiong Tay, Bien Soo TanAbstract:Compliance with radiobiologic principles of radionuclide in-ternal dosimetry is fundamental to the success of 90Y radioem-bolization. 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 albu-min SPECT/CT, and Partition Modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates 99mTc-macro-aggregated albumin hepatic biodistribution. The Partition Model is validated for 90Y resin microspheres based on MIRD macro-dosimetry. 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 dosim-etry. 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%). Tu-mor thrombosis regressed or remained stable in 3 of 4 patients with baseline involvement. The best a-fetoprotein reduction ranged from 32 % to 95%. Clinical success was achieved i
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image guided personalized predictive dosimetry by artery specific spect ct Partition Modeling for safe and effective 90y radioembolization
The Journal of Nuclear Medicine, 2012Co-Authors: Yung Hsiang Kao, Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Kiang Hiong Tay, Bien Soo Tan, Andrew Eik Hock Tan, Pierce K H Chow, Anthony S W GohAbstract: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.
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image guided personalized predictive dosimetry by artery specific spect ct Partition Modeling for safe and effective 90y radioembolization
The Journal of Nuclear Medicine, 2012Co-Authors: Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Pierce K H Chow, Richard Hoau Gong Lo, David Chee Eng NgAbstract:UNLABELLED: Compliance with radiobiologic principles of radionuclide internal dosimetry is fundamental to the success of (90)Y 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), (99m)Tc-macroaggregated albumin SPECT/CT, and Partition Modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates (99m)Tc-macroaggregated albumin hepatic biodistribution. The Partition Model is validated for (90)Y 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. (99m)Tc-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, (90)Y 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 (90)Y radioembolization.
Li Ser Khoo - One of the best experts on this subject based on the ideXlab platform.
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Image-Guided Personalized Predictive Dosimetry by Artery-Specific SPECT/CT Partition Modeling for Safe and Effective 90Y Radioembolization
2016Co-Authors: Yung Hsiang Kao, Andrew Eik, Hock Tan, Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Richard Hoau, Kiang Hiong Tay, Bien Soo TanAbstract:Compliance with radiobiologic principles of radionuclide in-ternal dosimetry is fundamental to the success of 90Y radioem-bolization. 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 albu-min SPECT/CT, and Partition Modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates 99mTc-macro-aggregated albumin hepatic biodistribution. The Partition Model is validated for 90Y resin microspheres based on MIRD macro-dosimetry. 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 dosim-etry. 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%). Tu-mor thrombosis regressed or remained stable in 3 of 4 patients with baseline involvement. The best a-fetoprotein reduction ranged from 32 % to 95%. Clinical success was achieved i
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image guided personalized predictive dosimetry by artery specific spect ct Partition Modeling for safe and effective 90y radioembolization
The Journal of Nuclear Medicine, 2012Co-Authors: Yung Hsiang Kao, Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Kiang Hiong Tay, Bien Soo Tan, Andrew Eik Hock Tan, Pierce K H Chow, Anthony S W GohAbstract: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.
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image guided personalized predictive dosimetry by artery specific spect ct Partition Modeling for safe and effective 90y radioembolization
The Journal of Nuclear Medicine, 2012Co-Authors: Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Pierce K H Chow, Richard Hoau Gong Lo, David Chee Eng NgAbstract:UNLABELLED: Compliance with radiobiologic principles of radionuclide internal dosimetry is fundamental to the success of (90)Y 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), (99m)Tc-macroaggregated albumin SPECT/CT, and Partition Modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates (99m)Tc-macroaggregated albumin hepatic biodistribution. The Partition Model is validated for (90)Y 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. (99m)Tc-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, (90)Y 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 (90)Y radioembolization.
Anthony S W Goh - One of the best experts on this subject based on the ideXlab platform.
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image guided personalized predictive dosimetry by artery specific spect ct Partition Modeling for safe and effective 90y radioembolization
The Journal of Nuclear Medicine, 2012Co-Authors: Yung Hsiang Kao, Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Kiang Hiong Tay, Bien Soo Tan, Andrew Eik Hock Tan, Pierce K H Chow, Anthony S W GohAbstract: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.
David Chee Eng Ng - One of the best experts on this subject based on the ideXlab platform.
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image guided personalized predictive dosimetry by artery specific spect ct Partition Modeling for safe and effective 90y radioembolization
The Journal of Nuclear Medicine, 2012Co-Authors: Mark Christiaan Burgmans, Farah Gillian Irani, Li Ser Khoo, Pierce K H Chow, Richard Hoau Gong Lo, David Chee Eng NgAbstract:UNLABELLED: Compliance with radiobiologic principles of radionuclide internal dosimetry is fundamental to the success of (90)Y 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), (99m)Tc-macroaggregated albumin SPECT/CT, and Partition Modeling for unified dosimetry. Catheter-directed CTHA accurately delineates planning target volumes. SPECT/CT tomographically evaluates (99m)Tc-macroaggregated albumin hepatic biodistribution. The Partition Model is validated for (90)Y 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. (99m)Tc-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, (90)Y 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 (90)Y radioembolization.
