Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases: A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT

Orapin Chansanti; Younes Jahangiri; Yusuke Matsui; Akira Adachi; Yindee Geeratikun; John A. Kaufman; Kenneth J. Kolbeck; Jeffrey S. Stevens; Khashayar Farsad

doi:10.1016/j.jvir.2017.07.008

Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases: A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT

Orapin Chansanti
, Younes Jahangiri
, Yusuke Matsui
, Akira Adachi
, Yindee Geeratikun
, John A. Kaufman
, Kenneth J. Kolbeck
, Jeffrey S. Stevens
, Khashayar Farsad

Research output: Contribution to journal › Article › peer-review

49 Scopus citations

Abstract

Purpose To evaluate dose-response relationship in yttrium-90 (⁹⁰Y) resin microsphere radioembolization for neuroendocrine tumor (NET) liver metastases using a tumor-specific dose estimation based on technetium-99m–labeled macroaggregated albumin (^99mTc MAA) single photon emission computed tomography (SPECT)-CT. Materials and Methods Fifty-five tumors (mean size 3.9 cm) in 15 patients (10 women; mean age 57 y) were evaluated. Tumor-specific absorbed dose was estimated using a partition model. Initial (median 2.3 months) follow-up data were available for all tumors; last (median 7.6 months) follow-up data were available for 45 tumors. Tumor response was evaluated using Modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow-up CT. Tumors with complete or partial response were considered responders. Mean tumor absorbed dose was 231.4 Gy ± 184.3, and mean nontumor liver absorbed dose was 39.0 Gy ± 18.0. Results Thirty-six (65.5%) and 30 (66.7%) tumors showed response at initial and last follow-up, respectively. Mean absorbed doses in responders and nonresponders at initial and last follow-up were 285.8 Gy ± 191.1 and 128.1 Gy ± 117.1 (P =.0004) and 314.3 Gy ± 195.8 and 115.7 Gy ± 117.4 (P =.0001). Cutoff value of ≥ 191.3 Gy for tumor-specific absorbed dose predicted tumor response with 93% specificity, whereas < 72.8 Gy predicted nonresponse with 100% specificity at last follow-up. Estimated mean absorbed tumor dose per patient was significantly higher in responders versus nonresponders over the follow-up period (224.5 Gy ± 90.3 vs 70.0 Gy ± 28.0; P =.007). Conclusions Tumor-specific absorbed dose, estimated with a partition model, was significantly associated with tumor response in NET liver metastases. An estimated dose ≥ 191.3 Gy predicted treatment response with high sensitivity and specificity.

Original language	English (US)
Pages (from-to)	1528-1535
Number of pages	8
Journal	Journal of Vascular and Interventional Radiology
Volume	28
Issue number	11
DOIs	https://doi.org/10.1016/j.jvir.2017.07.008
State	Published - Nov 2017

Funding

J.A.K. is a paid consultant for Cook, Inc (Bloomington, Indiana), Guerbet LLC (Bloomington, Indiana), Covidien (Mansfield, Massachusetts), Delcath Systems (Queensbury, New York), and Zimmer Biomet (Warsaw, Indiana); receives grants from the National Institutes of Health (Bethesda, Maryland), W.L. Gore & Associates (Flagstaff, Arizona), Cook, Inc, and Guerbet LLC; owns Hatch Medical (Atlanta, Georgia), VuMedi, Inc (Lafayette, California), EndoShape, Inc (Boulder, Colorado), and VENITI, Inc (Fremont, California); receives royalties from Elsevier (Philadelphia, Pennsylvania); and is a shareholder in Bio2 Medical, Inc (San Antonio, Texas), Javelin Medical (Estero, Florida), and AV Medical Technologies Ltd (Tel Aviv, Israel). K.J.K. receives grants from Guerbet LLC and personal fees from Bayer Corp (Pittsburgh, Pennsylvania). K.F. is a paid consultant for Cook, Inc, Bayer Corp, and NeuWave Medical, Inc (Madison, Wisconsin) and receives grants from Terumo Medical Corp (Somerset, New Jersey) and Guerbet LLC. None of the other authors have identified a conflict of interest.

Funders
Guerbet LLC

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.jvir.2017.07.008

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Chansanti, O., Jahangiri, Y., Matsui, Y., Adachi, A., Geeratikun, Y., Kaufman, J. A., Kolbeck, K. J., Stevens, J. S., & Farsad, K. (2017). Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases: A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT. Journal of Vascular and Interventional Radiology, 28(11), 1528-1535. https://doi.org/10.1016/j.jvir.2017.07.008

Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases: A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT. / Chansanti, Orapin; Jahangiri, Younes; Matsui, Yusuke et al.
In: Journal of Vascular and Interventional Radiology, Vol. 28, No. 11, 11.2017, p. 1528-1535.

Research output: Contribution to journal › Article › peer-review

Chansanti, O, Jahangiri, Y, Matsui, Y, Adachi, A, Geeratikun, Y, Kaufman, JA, Kolbeck, KJ, Stevens, JS & Farsad, K 2017, 'Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases: A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT', Journal of Vascular and Interventional Radiology, vol. 28, no. 11, pp. 1528-1535. https://doi.org/10.1016/j.jvir.2017.07.008

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title = "Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases: A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT",

abstract = "Purpose To evaluate dose-response relationship in yttrium-90 (90Y) resin microsphere radioembolization for neuroendocrine tumor (NET) liver metastases using a tumor-specific dose estimation based on technetium-99m–labeled macroaggregated albumin (99mTc MAA) single photon emission computed tomography (SPECT)-CT. Materials and Methods Fifty-five tumors (mean size 3.9 cm) in 15 patients (10 women; mean age 57 y) were evaluated. Tumor-specific absorbed dose was estimated using a partition model. Initial (median 2.3 months) follow-up data were available for all tumors; last (median 7.6 months) follow-up data were available for 45 tumors. Tumor response was evaluated using Modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow-up CT. Tumors with complete or partial response were considered responders. Mean tumor absorbed dose was 231.4 Gy ± 184.3, and mean nontumor liver absorbed dose was 39.0 Gy ± 18.0. Results Thirty-six (65.5\%) and 30 (66.7\%) tumors showed response at initial and last follow-up, respectively. Mean absorbed doses in responders and nonresponders at initial and last follow-up were 285.8 Gy ± 191.1 and 128.1 Gy ± 117.1 (P =.0004) and 314.3 Gy ± 195.8 and 115.7 Gy ± 117.4 (P =.0001). Cutoff value of ≥ 191.3 Gy for tumor-specific absorbed dose predicted tumor response with 93\% specificity, whereas < 72.8 Gy predicted nonresponse with 100\% specificity at last follow-up. Estimated mean absorbed tumor dose per patient was significantly higher in responders versus nonresponders over the follow-up period (224.5 Gy ± 90.3 vs 70.0 Gy ± 28.0; P =.007). Conclusions Tumor-specific absorbed dose, estimated with a partition model, was significantly associated with tumor response in NET liver metastases. An estimated dose ≥ 191.3 Gy predicted treatment response with high sensitivity and specificity.",

author = "Orapin Chansanti and Younes Jahangiri and Yusuke Matsui and Akira Adachi and Yindee Geeratikun and Kaufman, \{John A.\} and Kolbeck, \{Kenneth J.\} and Stevens, \{Jeffrey S.\} and Khashayar Farsad",

note = "Publisher Copyright: {\textcopyright} 2017 SIR",

year = "2017",

month = nov,

doi = "10.1016/j.jvir.2017.07.008",

language = "English (US)",

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T1 - Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases

T2 - A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT

AU - Chansanti, Orapin

AU - Jahangiri, Younes

AU - Matsui, Yusuke

AU - Adachi, Akira

AU - Geeratikun, Yindee

AU - Kaufman, John A.

AU - Kolbeck, Kenneth J.

AU - Stevens, Jeffrey S.

AU - Farsad, Khashayar

PY - 2017/11

Y1 - 2017/11

N2 - Purpose To evaluate dose-response relationship in yttrium-90 (90Y) resin microsphere radioembolization for neuroendocrine tumor (NET) liver metastases using a tumor-specific dose estimation based on technetium-99m–labeled macroaggregated albumin (99mTc MAA) single photon emission computed tomography (SPECT)-CT. Materials and Methods Fifty-five tumors (mean size 3.9 cm) in 15 patients (10 women; mean age 57 y) were evaluated. Tumor-specific absorbed dose was estimated using a partition model. Initial (median 2.3 months) follow-up data were available for all tumors; last (median 7.6 months) follow-up data were available for 45 tumors. Tumor response was evaluated using Modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow-up CT. Tumors with complete or partial response were considered responders. Mean tumor absorbed dose was 231.4 Gy ± 184.3, and mean nontumor liver absorbed dose was 39.0 Gy ± 18.0. Results Thirty-six (65.5%) and 30 (66.7%) tumors showed response at initial and last follow-up, respectively. Mean absorbed doses in responders and nonresponders at initial and last follow-up were 285.8 Gy ± 191.1 and 128.1 Gy ± 117.1 (P =.0004) and 314.3 Gy ± 195.8 and 115.7 Gy ± 117.4 (P =.0001). Cutoff value of ≥ 191.3 Gy for tumor-specific absorbed dose predicted tumor response with 93% specificity, whereas < 72.8 Gy predicted nonresponse with 100% specificity at last follow-up. Estimated mean absorbed tumor dose per patient was significantly higher in responders versus nonresponders over the follow-up period (224.5 Gy ± 90.3 vs 70.0 Gy ± 28.0; P =.007). Conclusions Tumor-specific absorbed dose, estimated with a partition model, was significantly associated with tumor response in NET liver metastases. An estimated dose ≥ 191.3 Gy predicted treatment response with high sensitivity and specificity.

AB - Purpose To evaluate dose-response relationship in yttrium-90 (90Y) resin microsphere radioembolization for neuroendocrine tumor (NET) liver metastases using a tumor-specific dose estimation based on technetium-99m–labeled macroaggregated albumin (99mTc MAA) single photon emission computed tomography (SPECT)-CT. Materials and Methods Fifty-five tumors (mean size 3.9 cm) in 15 patients (10 women; mean age 57 y) were evaluated. Tumor-specific absorbed dose was estimated using a partition model. Initial (median 2.3 months) follow-up data were available for all tumors; last (median 7.6 months) follow-up data were available for 45 tumors. Tumor response was evaluated using Modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow-up CT. Tumors with complete or partial response were considered responders. Mean tumor absorbed dose was 231.4 Gy ± 184.3, and mean nontumor liver absorbed dose was 39.0 Gy ± 18.0. Results Thirty-six (65.5%) and 30 (66.7%) tumors showed response at initial and last follow-up, respectively. Mean absorbed doses in responders and nonresponders at initial and last follow-up were 285.8 Gy ± 191.1 and 128.1 Gy ± 117.1 (P =.0004) and 314.3 Gy ± 195.8 and 115.7 Gy ± 117.4 (P =.0001). Cutoff value of ≥ 191.3 Gy for tumor-specific absorbed dose predicted tumor response with 93% specificity, whereas < 72.8 Gy predicted nonresponse with 100% specificity at last follow-up. Estimated mean absorbed tumor dose per patient was significantly higher in responders versus nonresponders over the follow-up period (224.5 Gy ± 90.3 vs 70.0 Gy ± 28.0; P =.007). Conclusions Tumor-specific absorbed dose, estimated with a partition model, was significantly associated with tumor response in NET liver metastases. An estimated dose ≥ 191.3 Gy predicted treatment response with high sensitivity and specificity.

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Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases: A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT

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