1Institute of Medical Physics, The University of Sydney
2The department fo Nuclear Medicine, Royal North Shore Hospital
3Department of Radiology, Royal North Shore Hospital
4Department of Medical Oncology, Royal North Shore Hospital
5Department of Nuclear Medicine, Royal North Shore Hospital Faculty of Health Sciences, The University of Sydney
A 65 year old male with metastatic colorectal cancer (mCRC) in the liver was referred for selective internal radionuclide therapy (SIRT) following a history of extensive systemic chemotherapy. 90Y PET imaging was performed immediately after treatment and used to confirm lesion targeting and measure individual lesion absorbed doses. Lesion dosimetry was highly predictive of eventual response in the follow-up FDG PET performed 8 weeks after therapy. The derived radiation dose map was used to plan a second SIRT procedure aiming to protect healthy liver by keeping absorbed dose below the critical dose threshold, whilst targeting the remaining lesions that had received sub-critical dosing. Again, 90Y PET was performed immediately post-treatment and used to derive absorbed dose measures to both lesions and healthy parenchyma. Additional followup FDG PET imaging again confirmed the role of the 90Y PET dose map as an early predictor of response, and a tool for safe repeat treatment planning.
1. Sirtex Medical Limited: SIR-Spheres package insert. 2014. 2. Gil-Alzugaray B, Chopitea A, Inarrairaequi M, Bilbao JI, Rodriguez-Fraile M, Rodriguez J, et al. Prognostic factors and prevention of radioembolizationinduced liver disease. Hepatology. 2013;57: 1078-87. 3. Lhommel R, Goffette P, Van Den Eynde M, Jamar F, Pauwels S, Bilbao JI, et al. Yttrium-90 TOF PET scan demonstrates high-resolution biodistribution after liver SIRT. Eur J Nucl Med Mol Imaging. 2009; 36:1696. 4. Willowson K, Tapner M, Bailey DL. The QUEST study: Correlating metabolic response with 90Y PET dosimetry for the treatment of metastatic liver cancer with radioembolisation. Eur J Nucl Med Mol Imaging. 2015;41:S240. 5. Bailey DL, Willowson KP, Bernard EJ, Chan D, Pavlakis N, Clarke S. Preliminary direct evidence of a dose-response relationship for [Y-90]-microsphere selective internal radionuclide therapy (SIRT) in hepatic malignancy. J Clin Oncol. 2015;33 (suppl; abstract 11064). 6. Van den Hoven AF, Rosenbaum CENM, Elias SG, De Jong H, Koopman M, verkooijen H, et al. Insights into the dose-response relationship of radioembolization with resin 90Y-microspheres: A prospective cohort study in patients with colorectal cancer liver metastases. J Nucl Med. 2016;57:1014-9. 7. Walrand S, Hesse M, Jamar F, Lhommel R. A hepatic dose-toxicity model opening the way toward individualized radioembolization planning. J Nucl Med. 2014;55:1-6.