Etienne Garin MD, Presenter: Consultant, Nordion, Inc

Sophie Laffont, Abstract Co-Author: Nothing to Disclose

Jean-Luc Raoul, Abstract Co-Author: Consultant, Bayer AG

Eveline Boucher, Abstract Co-Author: Nothing to Disclose

H. Mesbah, Abstract Co-Author: Nothing to Disclose

Yan Rolland MD, PhD, Abstract Co-Author: Consultant, Nordion, Inc

Evaluation of the impact of MAA SPECT/CT based dosimetry in the prediction of response, survival and in the treatment planning for hepatocellular carcinoma patients treated with Therasphere®.

Therasphere® was administered in 72 inoperable hepatocellular carcinoma patients (BCLC classification: A= 5, B= 36 C= 31). MAA SPECT/CT quantitative analysis was used for the calculation of the tumour dose (TD), the healthy injected liver dose (HLD) and the total injected liver dose (LD). Response was evaluated at 3 months using EASL criteriae. PFS and OS were evaluated using Kaplan and Meyer tests.

Mean 90Y-loaded glass microspheres injected activity was 2.9±1.5 GBq. Mean LD was 124±35 Gy. Mean HLD was 76±35Gy. Median TD was 311Gy for responding lesions versus 178Gy for non responding lesion (p<0.001). With a threshold TD of 205Gy, MAA-SPECT/CT was predictive of response with a sensibility of 100%, and an overall accuracy of 90% (0FN, 7FP). Knowing the TD and the HLD, 16 patients received an intensification of the treatment (increase of the injected activity with the goal to achieve a TD> 205Gy with a LD > 150 Gy and with a HLD<120Gy) with a good response rate (81% as against 71% for not boosted patients) and without increased liver grade III toxicity (12% as against 21% in the non boosted patients). Median TTP was 7 months [2-19] for patients with a TD< 205Gy versus 14m. [11-∞] for patients with a TD>205Gy (p=0.02). Median OS was 10m. [2-31] for patients with a TD<205Gy versus 21m. [14-∞] for patients with a TD>205Gy (p=0.02). For PVT patients (n=30), median TTP was 4,5m. [2-7] for patients with a TD< 205Gy versus 11m. [8-∞] for patients with a TD>205Gy (p=0.01) and median OS was 5m. [2-∞] for patients with a TD<205Gy versus 17m. [11-∞] for patients with a TD>205Gy (p=0.005).

MAA SPECT/CT based dosimetry is accurately predictive of response and survival for patients treated with Therasphere®. MAA SPECT/CT based dosimetry can also be used for an adaptation of the injected activity introducing the new concept of boosted selective internal radiation therapy without increasing liver toxicity.  

Hepatocellular carcinoma

Garin, E, Laffont, S, Raoul, J, Boucher, E, Mesbah, H, Rolland, Y, Boosted Selective Internal Radiation Therapy (B-SIRT) Using 90Y-loaded Glass Microspheres for Hepatocellular Carcinoma Patients: A New Promising Concept.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12030372.html