Safety Analysis of Holmium-166 Microsphere Scout Dose Imaging During Radioembolisation Work-up: A Cohort Study

Overview

Journal Eur Radiol

Specialty Radiology

Date 2017 Aug 9

PMID 28786008

Citations 28

Authors

Arthur J A T Braat

Jip F Prince

Rob van Rooij

Rutger C G Bruijnen

Maurice A A J van den Bosch

Marnix G E H Lam

Affiliations

Soon will be listed here.

Abstract

Objective: Radioembolisation is generally preceded by a scout dose of technetium-99m-macroaggregated albumin to estimate extrahepatic shunting of activity. Holmium-166 microspheres can be used as a scout dose (±250 MBq) and as a therapeutic dose. The general toxicity of a holmium-166 scout dose (Ho-SD) and safety concerns of an accidental extrahepatic deposition of Ho-SD were investigated.

Methods: All patients who received a Ho-SD in our institute were reviewed for general toxicity and extrahepatic depositions. The absorbed dose in extrahepatic tissue was calculated on SPECT/CT and correlated to clinical toxicities.

Results: In total, 82 patients were included. No relevant clinical toxicity occurred. Six patients had an extrahepatic deposition of Ho-SD (median administered activity 270 MBq). The extrahepatic depositions (median activity 3.7 MBq) were located in the duodenum (3x), gastric fundus, falciform ligament and the lesser curvature of the stomach, and were deposited in a median volume of 15.3 ml, which resulted in an estimated median absorbed dose of 3.6 Gy (range 0.3-13.8 Gy). No adverse events related to the extrahepatic deposition of the Ho-SD occurred after a median follow-up of 4 months (range 1-12 months).

Conclusion: These results support the safety of 250 MBq Ho-SD in a clinical setting.

Key Points: • A holmium-166 scout dose is safe in a clinical setting. • Holmium-166 scout dose is a safe alternative for Tc-MAA for radioembolisation work-up. • Holmium-166 scout dose potentially has several benefits over Tc-MAA for radioembolisation work-up.

Citing Articles

Angiographic Aspects of Transarterial Radioembolization: A Comparison of Technical Options to Avoid Extrahepatic Microsphere Depositions.

Etzel P, Drescher R, Burckenmeyer F, Freesmeyer M, Werner A Biomedicines. 2024; 12(8).

PMID: 39200258 PMC: 11352075. DOI: 10.3390/biomedicines12081794.

Safety and efficacy of Holmium-166 selective internal radiotherapy of primary and secondary liver cancer confirmed by real-world data.

Schulze-Zachau V, Verset G, De Bondt P, De Keukeleire K, Guhne F, Heuschkel M Front Oncol. 2024; 14:1404621.

PMID: 38919523 PMC: 11197077. DOI: 10.3389/fonc.2024.1404621.

Gamma camera imaging characteristics of Ho and Tc used in Selective Internal Radiation Therapy.

Kastner D, Braune A, Brogsitter C, Freudenberg R, Kotzerke J, Michler E EJNMMI Phys. 2024; 11(1):35.

PMID: 38581559 PMC: 10998827. DOI: 10.1186/s40658-024-00633-3.

Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [Ho]-Scout Over [Tc]MAA in a Prospective Cohort Study.

Wagemans M, Braat A, van Rooij R, Smits M, Bruijnen R, Prince J Cardiovasc Intervent Radiol. 2024; 47(4):443-450.

PMID: 38326577 PMC: 10997535. DOI: 10.1007/s00270-023-03656-y.

Intraprocedural C-arm dual-phase cone-beam enhancement patterns correlate with tumor absorbed dose after radioembolization.

Bastiaannet R, Lin M, Frey E, W A M de Jong H Med Phys. 2023; 51(4):3045-3052.

PMID: 38064591 PMC: 10994751. DOI: 10.1002/mp.16882.

References

Smits M, Nijsen J, van den Bosch M, Lam M, Vente M, Mali W . Holmium-166 radioembolisation in patients with unresectable, chemorefractory liver metastases (HEPAR trial): a phase 1, dose-escalation study. Lancet Oncol. 2012; 13(10):1025-34. DOI: 10.1016/S1470-2045(12)70334-0. View

van den Hoven A, Prince J, van den Bosch M, Lam M . Hepatic radioembolization as a true single-session treatment. J Vasc Interv Radiol. 2014; 25(7):1143-4. DOI: 10.1016/j.jvir.2014.01.037. View

Bol G, Kotte A, van der Heide U, Lagendijk J . Simultaneous multi-modality ROI delineation in clinical practice. Comput Methods Programs Biomed. 2009; 96(2):133-40. DOI: 10.1016/j.cmpb.2009.04.008. View

Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M . Accessory left gastric artery from left hepatic artery shown on MDCT and conventional angiography: correlation with CT hepatic arteriography. AJR Am J Roentgenol. 2006; 187(4):1002-9. DOI: 10.2214/AJR.05.1114. View

Nijsen J, Seppenwoolde J, Havenith T, Bos C, Bakker C, van het Schip A . Liver tumors: MR imaging of radioactive holmium microspheres--phantom and rabbit study. Radiology. 2004; 231(2):491-9. DOI: 10.1148/radiol.2312030594. View

van de Maat G, Seevinck P, Elschot M, Smits M, de Leeuw H, van het Schip A . MRI-based biodistribution assessment of holmium-166 poly(L-lactic acid) microspheres after radioembolisation. Eur Radiol. 2012; 23(3):827-35. PMC: 3563959. DOI: 10.1007/s00330-012-2648-2. View

Elschot M, Nijsen J, Lam M, Smits M, Prince J, Viergever M . (⁹⁹m)Tc-MAA overestimates the absorbed dose to the lungs in radioembolization: a quantitative evaluation in patients treated with ¹⁶⁶Ho-microspheres. Eur J Nucl Med Mol Imaging. 2014; 41(10):1965-75. DOI: 10.1007/s00259-014-2784-9. View

Yu N, Srinivas S, DiFilippo F, Shrikanthan S, Levitin A, McLennan G . Lung dose calculation with SPECT/CT for ⁹⁰Yittrium radioembolization of liver cancer. Int J Radiat Oncol Biol Phys. 2012; 85(3):834-9. DOI: 10.1016/j.ijrobp.2012.06.051. View

Braat A, Smits M, Braat M, van den Hoven A, Prince J, W A M de Jong H . ⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments. J Nucl Med. 2015; 56(7):1079-87. DOI: 10.2967/jnumed.115.157446. View

10.

Kao Y, Steinberg J, Tay Y, Lim G, Yan J, Townsend D . Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI Res. 2013; 3(1):57. PMC: 3733999. DOI: 10.1186/2191-219X-3-57. View

11.

Kao Y, Steinberg J, Tay Y, Lim G, Yan J, Townsend D . Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting. EJNMMI Res. 2013; 3(1):56. PMC: 3726297. DOI: 10.1186/2191-219X-3-56. View

12.

Gates V, Salem R . Reply to "hepatic radioembolization as a true single-session treatment". J Vasc Interv Radiol. 2014; 25(7):1144-6. DOI: 10.1016/j.jvir.2014.02.011. View

13.

Abdelmaksoud M, Hwang G, Louie J, Kothary N, Hofmann L, Kuo W . Development of new hepaticoenteric collateral pathways after hepatic arterial skeletonization in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol. 2010; 21(9):1385-95. DOI: 10.1016/j.jvir.2010.04.030. View

14.

Wondergem M, Smits M, Elschot M, W A M de Jong H, Verkooijen H, van den Bosch M . 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic radioembolization. J Nucl Med. 2013; 54(8):1294-301. DOI: 10.2967/jnumed.112.117614. View

15.

Prince J, van Rooij R, Bol G, W A M de Jong H, van den Bosch M, Lam M . Safety of a Scout Dose Preceding Hepatic Radioembolization with 166Ho Microspheres. J Nucl Med. 2015; 56(6):817-23. DOI: 10.2967/jnumed.115.155564. View

16.

Elschot M, Smits M, Nijsen J, Lam M, Zonnenberg B, van den Bosch M . Quantitative Monte Carlo-based holmium-166 SPECT reconstruction. Med Phys. 2013; 40(11):112502. DOI: 10.1118/1.4823788. View

17.

Theysohn J, Ruhlmann M, Muller S, Dechene A, Best J, Haubold J . Radioembolization with Y-90 Glass Microspheres: Do We Really Need SPECT-CT to Identify Extrahepatic Shunts?. PLoS One. 2015; 10(9):e0137587. PMC: 4559400. DOI: 10.1371/journal.pone.0137587. View

18.

Beekman F, W A M de Jong H, van Geloven S . Efficient fully 3-D iterative SPECT reconstruction with Monte Carlo-based scatter compensation. IEEE Trans Med Imaging. 2002; 21(8):867-77. DOI: 10.1109/TMI.2002.803130. View

19.

Gates V, Marshall K, Salzig K, Williams M, Lewandowski R, Salem R . Outpatient single-session yttrium-90 glass microsphere radioembolization. J Vasc Interv Radiol. 2013; 25(2):266-70. DOI: 10.1016/j.jvir.2013.11.005. View

20.

Song S, Chung J, Lim H, Park J . Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients. J Vasc Interv Radiol. 2006; 17(3):461-9. DOI: 10.1097/01.rvi.0000202718.16416.18. View