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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.
European Radiology
|September 9, 2020
Summary
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.
