Can pretreatment hepatic artery perfusion scintigraphy in patients with liver malignancies predict the treatment response of the selective internal radiation therapy with 90Y resin microspheres?
Year: 2022
Type: article
Study design: Observational Study
Abstract: We aimed to evaluate whether the perfusion pattern from pretreatment hepatic artery perfusion scintigraphy (HAPS) in patients with liver malignancies can predict response to selective internal radiation therapy (SIRT). METHODSThis retrospective study analyzed 152 consecutive patients treated with yttrium-90 ( 90 Y) resin microspheres between April 2015 and July 2017.HAPS using single-photon emission computed tomography/computed tomography (SPECT/CT) with 99m technetium macroaggregated albumin ( 99m Tc-MAA) was performed before SIRT.Investigators visually classified perfusion patterns of tumors as heterogeneous or diffuse in HAPS.Between diffuse and heterogeneous pattern group, positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) were performed in third and sixth month after SIRT, and tumor response assessed and compared by using RECIST 1.1 or mRECIST.Overall survival (OS) and progression-free survival (PFS) were also compared with Kaplan-Meier/log-rank analyses. RESULTSOf 216 SIRT procedures, 172 were classified as heterogeneous and 44 as diffuse.Diffuse 99m Tc-MAA uptake was associated with longer median OS than heterogeneous (22.2 vs. 14.4 months, respectively; P = .047).Subsegmental infusion was associated with longer OS than either lobar or segmental infusion (P = .090).Mean estimated OS was longer in patients with hepatocellular carcinoma (HCC) (34.2 months) than with colorectal carcinoma (CRC) (16.4 months) (P = .044).Patients with both diffuse and heterogeneous patterns were able to show complete response after SIRT.No statistically significant differences were observed between perfusion patterns and PFS or response rates to SIRT. CONCLUSIONAlthough tumor perfusion patterns from preplanning HAPS analyses are useful for estimating tumor uptake of 90 Y, they may not reliably predict hepatic treatment response, as patients with different perfusion patterns can show clinical response to SIRT.S elective internal radiation therapy (SIRT) with yttrium-90 ( 90 Y)-labeled microspheres has shown promising results in the treatment of patients with unresectable primary and metastatic liver cancer.1,2 SIRT takes advantage of the dual blood supply of liver; while the normal liver mostly receives blood from the portal vein, liver tumor neovascularization mainly originates from the hepatic artery.Targeted administration of 90 Y microspheres through the hepatic artery can deliver high doses of radiation to hepatic tumors with minimal exposure to healthy liver parenchyma.3 Hemodynamic flow within the hepatic arterial system and tumor vasculature affect microsphere distribution, as well as activity and delivered dose of 90 Y. 4 Evaluating intratumoral heterogeneity with functional molecular imaging can predict the behavior of malignant tumors and eventual treatment response.Heterogeneity of uptake among metastatic lesions is influenced by factors such as cellular hypoxia, necrosis, vascularization, and proliferation-all which affect treatment response.5,6 Assessment of tumor perfusion is an essential preparatory step in SIRT to predict 90 Y microsphere distribution.A pretreatment planning angiography maps the hepatic and tumor vasculature and identifies From the Departments of Nuclear Medicine (I.B.G.
Institution: Cukurova University
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4213358221