TY - JOUR
T1 - The physics of radioembolization
AU - Bastiaannet, Remco
AU - Kappadath, S. Cheenu
AU - Kunnen, Britt
AU - Braat, Arthur J.A.T.
AU - Lam, Marnix G.E.H.
AU - de Jong, Hugo W.A.M.
N1 - Funding Information:
This work was supported in part by a research grant from Siemens Medical Solutions (HWAMdJ). Siemens did not participate in the design of the study, the collection, analysis, and interpretation of the data nor in the writing of the manuscript. This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. [646734]).
Publisher Copyright:
© 2018, The Author(s).
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Radioembolization is an established treatment for chemoresistant and unresectable liver cancers. Currently, treatment planning is often based on semi-empirical methods, which yield acceptable toxicity profiles and have enabled the large-scale application in a palliative setting. However, recently, five large randomized controlled trials using resin microspheres failed to demonstrate a significant improvement in either progression-free survival or overall survival in both hepatocellular carcinoma and metastatic colorectal cancer. One reason for this might be that the activity prescription methods used in these studies are suboptimal for many patients. In this review, the current dosimetric methods and their caveats are evaluated. Furthermore, the current state-of-the-art of image-guided dosimetry and advanced radiobiological modeling is reviewed from a physics’ perspective. The current literature is explored for the observation of robust dose-response relationships followed by an overview of recent advancements in quantitative image reconstruction in relation to image-guided dosimetry. This review is concluded with a discussion on areas where further research is necessary in order to arrive at a personalized treatment method that provides optimal tumor control and is clinically feasible.
AB - Radioembolization is an established treatment for chemoresistant and unresectable liver cancers. Currently, treatment planning is often based on semi-empirical methods, which yield acceptable toxicity profiles and have enabled the large-scale application in a palliative setting. However, recently, five large randomized controlled trials using resin microspheres failed to demonstrate a significant improvement in either progression-free survival or overall survival in both hepatocellular carcinoma and metastatic colorectal cancer. One reason for this might be that the activity prescription methods used in these studies are suboptimal for many patients. In this review, the current dosimetric methods and their caveats are evaluated. Furthermore, the current state-of-the-art of image-guided dosimetry and advanced radiobiological modeling is reviewed from a physics’ perspective. The current literature is explored for the observation of robust dose-response relationships followed by an overview of recent advancements in quantitative image reconstruction in relation to image-guided dosimetry. This review is concluded with a discussion on areas where further research is necessary in order to arrive at a personalized treatment method that provides optimal tumor control and is clinically feasible.
KW - Dose-effect relationship
KW - Dosimetry
KW - Personalized medicine
KW - Radiobiological model
KW - Radioembolization
KW - Theranostics
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U2 - 10.1186/s40658-018-0221-z
DO - 10.1186/s40658-018-0221-z
M3 - Review article
C2 - 30386924
AN - SCOPUS:85056388704
SN - 2197-7364
VL - 5
JO - EJNMMI Physics
JF - EJNMMI Physics
IS - 1
M1 - 22
ER -