Yttrium-90 radioembolization using MIRD dosimetry with resin microspheres
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VASCULAR-INTERVENTIONAL
Yttrium-90 radioembolization using MIRD dosimetry with resin microspheres Ammar Sarwar 1 & Alexei Kudla 1 & Jeffrey L. Weinstein 1 & Aamir Ali 1 & Raza Malik 2 & Andrea Bullock 3 & Khalid O. Khwaja 4 & Michael Curry 2 & Salomao Faintuch 1 & Muneeb Ahmed 1 Received: 21 May 2020 / Revised: 17 July 2020 / Accepted: 26 August 2020 # European Society of Radiology 2020
Abstract Objective To review the technical feasibility of resin microsphere (SIR-Spheres®) yttrium-90 radioembolization prescribed using the medical internal radiation dose (MIRD) model. Methods All radioembolization procedures for hepatic malignancies using resin microspheres with MIRD model between November 2015 and February 2019 were included in this IRB-approved study (n = 60). Student’s T test was used to compare prescribed activity based on MIRD and BSA models. Adverse events were assessed immediately, 30 days, and 6 months post-treatment. Results Sixty radioembolizations were performed in 54 patients (age 68 ± 9 years, 48–87 years, 35% female). Mean prescribed activity calculated by the MIRD model (target absorbed dose 120–200 Gy for primary and 80–200 Gy for metastatic liver cancers) was 1.7 GBq (0.3–6.4) compared with 0.6 GBq (0.12–2.1) if BSA had been used (p < 0.0001). The prescribed activity was successfully delivered in 93% (56/60) treatments. Prophylactic embolization and anti-reflux catheters were used in 20% (12/ 60) and 5% (3/60) treatments, respectively. No immediate post-procedural complications occurred. Abdominal pain was the most common clinical Grade 3 CTCAE in 30 days (10%) and 6 months (12%). Radiation pneumonitis occurred in 3 (5%) patients but no radiation-induced gastric ulcer or radiation-induced liver disease occurred. Conclusion MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry with resin microspheres. MIRD prescribed activity with target absorbed doses up to 200 Gy can be successfully administered without prophylactic embolization in selected patients. Key Points •MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry for radioembolization. •MIRD dosimetry can be used for yttrium-90 resin microsphere radioembolization with acceptable safety profile. Keywords Liver neoplasms . Yttrium . Microspheres . Embolization, Therapeutic
* Ammar Sarwar [email protected] 1
Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
2
Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
3
Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
4
Transplantation Institute, Department of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, US
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