Predictive value of 99mTc-MAA-based dosimetry in personalized 90Y-SIRT planning for liver malignancies

BackgroundSelective internal radiation therapy with Y-90 radioembolization aims to selectively irradiate liver tumours by administering radioactive microspheres under the theragnostic assumption that the pre-therapy injection of Tc-99m labelled macroaggregated albumin (Tc-99m-MAA) provides an estimation of the Y-90 microspheres biodistribution, which is not always the case. Due to the growing interest in theragnostic dosimetry for personalized radionuclide therapy, a robust relationship between the delivered and pre-treatment radiation absorbed doses is required. In this work, we aim to investigate the predictive value of absorbed dose metrics calculated from Tc-99m-MAA (simulation) compared to those obtained from Y-90 post-therapy SPECT/CT.ResultsA total of 79 patients were analysed. Pre- and post-therapy 3D-voxel dosimetry was calculated on Tc-99m-MAA and Y-90 SPECT/CT, respectively, based on Local Deposition Method. Mean absorbed dose, tumour-to-normal ratio, and absorbed dose distribution in terms of dose-volume histogram (DVH) metrics were obtained and compared for each volume of interest (VOI). Mann-Whitney U-test and Pearson's correlation coefficient were used to assess the correlation between both methods. The effect of the tumoral liver volume on the absorbed dose metrics was also investigated. Strong correlation was found between simulation and therapy mean absorbed doses for all VOIs, although simulation tended to overestimate tumour absorbed doses by 26%. DVH metrics showed good correlation too, but significant differences were found for several metrics, mostly on non-tumoral liver. It was observed that the tumoral liver volume does not significantly affect the differences between simulation and therapy absorbed dose metrics.ConclusionThis study supports the strong correlation between absorbed dose metrics from simulation and therapy dosimetry based on Y-90 SPECT/CT, highlighting the predictive ability of Tc-99m-MAA, not only in terms of mean absorbed dose but also of the dose distribution.

Automated summary

This study found a strong correlation between absorbed dose metrics from Tc-99m-MAA simulation and Y-90 therapy dosimetry based on SPECT/CT. Although the simulation tended to overestimate tumour absorbed doses, it highlights the predictive ability of Tc-99m-MAA not only in terms of mean absorbed dose but also of the dose distribution.