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Yttrium-90 radioembolization using MIRD dosimetry with resin microspheres
Ammar Sarwar1, Alexei Kudla2, Jeffrey L Weinstein2
1Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA. asarwar@bidmc.harvard.edu.
Objective:
To review the technical feasibility of resin microsphere (SIR-Spheres®) yttrium-90 radioembolization prescribed using the medical internal radiation dose (MIRD) model.
Methods:
All radioembolization procedures for hepatic malignancies using resin microspheres with MIRD model between November 2015 and February 2019 were included in this IRB-approved study (n = 60). Student's T test was used to compare prescribed activity based on MIRD and BSA models. Adverse events were assessed immediately, 30 days, and 6 months post-treatment.
Results:
Sixty radioembolizations were performed in 54 patients (age 68 ± 9 years, 48-87 years, 35% female). Mean prescribed activity calculated by the MIRD model (target absorbed dose 120-200 Gy for primary and 80-200 Gy for metastatic liver cancers) was 1.7 GBq (0.3-6.4) compared with 0.6 GBq (0.12-2.1) if BSA had been used (p < 0.0001). The prescribed activity was successfully delivered in 93% (56/60) treatments. Prophylactic embolization and anti-reflux catheters were used in 20% (12/60) and 5% (3/60) treatments, respectively. No immediate post-procedural complications occurred. Abdominal pain was the most common clinical Grade 3 CTCAE in 30 days (10%) and 6 months (12%). Radiation pneumonitis occurred in 3 (5%) patients but no radiation-induced gastric ulcer or radiation-induced liver disease occurred.
Conclusion:
MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry with resin microspheres. MIRD prescribed activity with target absorbed doses up to 200 Gy can be successfully administered without prophylactic embolization in selected patients.
Key Points:
•MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry for radioembolization. •MIRD dosimetry can be used for yttrium-90 resin microsphere radioembolization with acceptable safety profile.
Insights
The Medical Internal Radiation Dose (MIRD) model prescribes higher activity for yttrium-90 resin microsphere radioembolization compared to the Body Surface Area (BSA) model. This MIRD approach is technically feasible and safe for selected patients.
Area of Science:
- Interventional Radiology
- Nuclear Medicine
- Oncology
Background:
- Radioembolization using yttrium-90 resin microspheres is a treatment for hepatic malignancies.
- Accurate dosimetry is crucial for effective and safe radioembolization.
- The Medical Internal Radiation Dose (MIRD) model offers a method for calculating radiation dose.
Purpose of the Study:
- To evaluate the technical feasibility of prescribing yttrium-90 resin microsphere radioembolization using the MIRD model.
- To compare MIRD dosimetry with the Body Surface Area (BSA) model for activity prescription.
- To assess the safety and adverse events associated with MIRD-prescribed radioembolization.
Main Methods:
- Retrospective review of 60 radioembolization procedures for hepatic malignancies using resin microspheres and the MIRD model (November 2015 - February 2019).
- Comparison of prescribed activity between MIRD and BSA models using Student's T test.
- Assessment of adverse events at immediate, 30-day, and 6-month follow-ups.
Main Results:
- The MIRD model resulted in significantly higher prescribed activity (1.7 GBq) compared to the BSA model (0.6 GBq) (p < 0.0001).
- Successful delivery of prescribed activity was achieved in 93% of treatments.
- The most common Grade 3 adverse event was abdominal pain; radiation pneumonitis occurred in 5% of patients, with no cases of radiation-induced gastric ulcer or liver disease.
Conclusions:
- MIRD dosimetry leads to higher prescribed activity for yttrium-90 resin microsphere radioembolization compared to BSA dosimetry.
- MIRD-prescribed activity, with target absorbed doses up to 200 Gy, can be safely administered in selected patients without the routine need for prophylactic embolization.
- MIRD dosimetry demonstrates an acceptable safety profile for yttrium-90 resin microsphere radioembolization.
