TY - JOUR
T1 - International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres
AU - Levillain, Hugo
AU - Bagni, Oreste
AU - Deroose, Christophe M.
AU - Dieudonné, Arnaud
AU - Gnesin, Silvano
AU - Grosser, Oliver S.
AU - Kappadath, S. Cheenu
AU - Kennedy, Andrew
AU - Kokabi, Nima
AU - Liu, David M.
AU - Madoff, David C.
AU - Mahvash, Armeen
AU - Martinez de la Cuesta, Antonio
AU - Ng, David C.E.
AU - Paprottka, Philipp M.
AU - Pettinato, Cinzia
AU - Rodríguez-Fraile, Macarena
AU - Salem, Riad
AU - Sangro, Bruno
AU - Strigari, Lidia
AU - Sze, Daniel Y.
AU - de Wit van der veen, Berlinda J.
AU - Flamen, Patrick
N1 - Funding Information:
We thank the additional members of the expert panel who kindly completed the electronic questionnaires that formed the basis of these recommendations: Hojjat Ahmadzadehfar (University Hospital Bonn, Germany), Nuri Arslan (Near East University Hospital, Nicosia, Cyprus), Jon Bell (The Christie NHS Foundation Trust, Manchester, UK), Guiseppe Boni (Pisa University Hospital, Pisa, Italy), Daniel B. Brown (Vanderbilt University Medical Center, Nashville, USA), William A. Dezarn (Wake Forest School of Medicine, Winston-Salem, USA), Harun Ilhan (Ludwig Maximilians University of Munich, Germany), Alexander Kim (Georgetown University, Washington DC, USA), Walter Noordzij (University of Groningen, The Netherlands), Javier Orcajo Rincón (Hospital General Universitario Gregorio Marañón, Madrid, Spain), Lorraine Portelance (Sylvester Comprehensive Cancer Center, Miami, USA), Daphne Rietbergen (Leiden University Medical Centre, Leiden, The Netherlands), William S. Rilling (Medical College of Wisconsin, Milwaukee, USA), Amanda Rotger (Hospital General Universitario Gregorio Marañón, Madrid, Spain), Shyam M. Srinivas (UPMC, Pittsburgh, USA), Lars Stegger (University of Münster, Germany), Andrei Todica (Ludwig Maximilians University of Munich, Germany), Kathy Willowson (University of Sydney, Australia). Martin Gilmour of Empowering Strategic Performance (ESP) Ltd., Crowthorne, UK provided medical writing and editorial support, which was sponsored by Sirtex Medical in accordance with Good Publication Practice guidelines.
Funding Information:
Funding of honoraria to attend meetings, and logistical and editorial support for this investigator-initiated venture was provided by an independent study grant from Sirtex Medical.
Funding Information:
Martin Gilmour of Empowering Strategic Performance (ESP) Ltd., Crowthorne, UK provided medical writing and editorial support, which was sponsored by Sirtex Medical in accordance with Good Publication Practice guidelines.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - Dosimetry
KW - Liver tumours
KW - Recommendations
KW - SIRT
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U2 - 10.1007/s00259-020-05163-5
DO - 10.1007/s00259-020-05163-5
M3 - Article
C2 - 33433699
AN - SCOPUS:85099352251
SN - 1619-7070
VL - 48
SP - 1570
EP - 1584
JO - European Journal of Nuclear Medicine and Molecular Imaging
JF - European Journal of Nuclear Medicine and Molecular Imaging
IS - 5
ER -