- Email: [email protected]
177Lu-Radiopeptide Therapy (Peptide Receptor Radionuclide Therapy – PRRT) and External Beam Radiation Therapy (EBRT) in neuroendocrine tumors (NETs)
Abstracts / Physica Medica 56 (2018) 133–278
259
Figure 1: results of EARL image quality acquisition varying reconstruction parameters.
a methodology which is able to estimate the error associated to Time-Integrated Activity Coefficient (TIAC). Methods. The Monte Carlo method is implemented in matlab and relied on the generation of a large number of data-set based on root mean square error (RMSE) associated to the fit model. Biokinetic data (time acquisition window of about 50 h) of 35 patients affected by metastatic differentiated thyroid cancer and administered with two different radionuclides (123I and 131I) were analysed, by fitting all data sets. Two classes of data sets were considered: Low Number of Points (LNP) and High Number of Points (HNP) time-activity data, consisting of 4 and 20 points respectively. The correlation between RMSE and bandwidths was also investigated. Results. The bandwidths assessed ([mean-lower, mean-upper]) was [ 14.3, +17.1]% for LNP and [ 9.3, +10.6]% for HNP. The RMSE is demonstrated to be correlated to the bandwidths with two different power laws for LNP and HNP. For LNP the R2 was 0.98 and 0.97 for lower and upper band respectively while for HNP the R2 was 0.94 and 0.97 for lower and upper band. Conclusion. The method is very simple to be implemented and it has the advantage of high flexibility when there is need to impose physical constraints to the fitting. As expected, the bandwidths decrease when considering data with a larger number of points. Moreover, having our data similar time window acquisition, the RMSE itself has been observed as a good predictor of the bandwidths as computed with the present method.
has emerged as a powerful tool to better define the metabolic behavior of neoplasms. The study is meant to evaluate the relationship of texture analysis features of surgically resected NSCLC with local invasiveness and regional sublicnical diffusion. Methods. The study is a retrospective evaluation of prospectively collected data. We performed a 3D texture analysis of the PET scans on previously delineated lesion VOIs of resected stage Ia IIb NSCLC. The extraction of a list of texture analysis features was performed by an open source software package CGITA developed by Yu-Hua Dean Fang et al. [1]. We then evaluated their relationship with lymphovascular invasion, nodal upstaging and disease-free survival. Results. tumours with lymphovascular invasion displayed higher levels of SUVmax, SUV entropy, normalized entropy, SUV standard deviation; and lower level of the following: normalized homogeneity, normalized inverse different moment (IDM). Tumors with nodal upstaging displayed higher levels of the following: SUV max, SUV entropy, normalized entropy, SUV standard deviation; and lower level of the following: normalized heterogeneity and normalized IDM. ROC analysis ruled out a stronger predictive power of texture analysis indicators when compared to SUVmax. Conclusions. given its relationship with important prognostic indicators, texture analysis may provide a stratification of highly aggressive tumours from the very beginning of patient’s diagnostic path.
https://doi.org/10.1016/j.ejmp.2018.04.332
References
324. FDG-PET texture analysis in NSCLC: Metabolic-pathological correlations S. Pasetto a, A. Viti b, M. Salgarello c, V. Clementi a, F. Severi a a
Ospedale Sacro Cuore Don Calabria, Medical Physics Department, Negrar, Italy b Ospedale Sacro Cuore Don Calabria, Thoracic Surgery Department, Negrar, Italy c Ospedale Sacro Cuore Don Calabria, Nuclear Medicine Department, Negrar, Italy Purpose. in surgically resectable NSCLC prognosis is strongly affected by local invasiveness as well as unexpected lymph node diffusion found at surgery. Recently, texture analysis of PET imaging
1. Fang YH, Lin CY, Shih MJ, Wang HM, Ho TY, Liao CT, Yen TC. Development and evaluation of an open-source software package ‘‘CGITA” for quantifying tumor heterogeneity with molecular images. Biomed Res Int:1–9.. Article ID 248505. https://doi.org/10.1016/j.ejmp.2018.04.333
325. Feasibility of a combination of 90Y/177Lu-Radiopeptide Therapy (Peptide Receptor Radionuclide Therapy – PRRT) and External Beam Radiation Therapy (EBRT) in neuroendocrine tumors (NETs) S. Vitali a,b, C. Garibaldi a, M.E. Ferrari a, F. Botta a, L. Bodei c, D. Zerini a, B.A. Jereczek-Fossa a,b, C.M. Grana a, R. Orecchia a, M. Cremonesi a
260
Abstracts / Physica Medica 56 (2018) 133–278
Table 1 PRRT 90
Administered activity (GBq) Absorbed dose to OARs Kidneys Red-marrow Liver
177
Y-DOTATOC
7.4 (2.9–22.8) (Gy/GBq) 2.7 (1.0–7.8) 0.07 (0.03–0.14) 0.6 (0.10–2.5)
Lu-DOTATATE
Treatment
21.0 (3.6–40.7) (Gy/GBq) 0.6 (0.4–1.8) 0.04 (0.02–0.06) 0.05 (0.01–0.09)
(Gy) 19 (2–32) 1.0 (0.2–1.6) 2 (0.2–13)
EBRT Prescription dose (Gy) Dose per fraction (Gy)
28 (20–45) 4.6 (3–15)
a
Istituto Europeo di Oncologia, Milano, Italy Università degli Studi di Milano, Milano, Italy c Memorial Sloan Kettering Cancer Center, New York, USA b
90
Table 1 Number of iterations needed for the CTQ. No. of Sites
177
Purpose. PRRT with Y-DOTATOC and Lu-DOTATATE showed up to 35% objective responses in NETs and acceptable toxicity. Given NET indolent behavior, multiple treatments are sequentially applied; EBRT is proposed frequently as oligometastatic/palliative setting. Our aim was to assess whether the combination of PRRT and EBRT (PRRT + EBRT) arise concerns about tolerability. Methods. Over our 807 patients receiving PRRT (1997–2014), 17% underwent also EBRT (14% after PRRT, 3% before PRRT). Among these, 25 patients had dosimetry and clinical data of PRRT + EBRT. The primary NETs were pancreas (12), lung (7), others (6), with multiple metastases in liver (13), bone (10), others (11). EBRT was adjuvant in 18 sites, palliative in 22. Bone metastases were treated with 3D conformal EBRT. Oligometastaseswere treated with image-guided IMRT or stereotactic EBRT, accounting for absorbed doses (AD) from PRRT. AD to Organs At Risk (OARs) and tumours were assessed and toxicity investigated (CTCAE v4). For PRRT, OARs were kidneys and red-marrow; AD to the liver was also evaluated. OARs for EBRT depended on the tumour site. Results. The table reports the median value (range) of administered activities and absorbed doses to OARs for the PRRT as well as doses delivered with EBRT. Individual metabolism leaded to large AD variability in PRRT (tumour: 1–42 Gy/GBq, 90Y-DOTATOC; 1–56 Gy/GBq, 177Lu-DOTATATE).No severe red-marrow toxicity was observed (14 patients grade I-II; 3 none); no kidney toxicity was shown but in 1 patient (grade I). Median (range) follow-up was 3.5 (0.2–12.3) years. 7 patients died. Conclusions. PRRT and EBRT have different OARs, with the great potential to increase AD to tumours without increasing toxicity, especially in red-marrow and liver. This opens the way to future prospective studies. However, EBRT irradiating liver metastases may (rarely) deliver non-negligible AD to kidneys once summed to AD from PRRT. PRRT + EBRT imposes multidisciplinary dosimetry discussion. https://doi.org/10.1016/j.ejmp.2018.04.334
326. PET scanner qualification for clinical trial: Comparison between Italian and worldwide experience F. Bergesio a, A. Biggi b, M. Coronado c, L. Ceriani d, S. Chauvie a a
S. Croce e Carle Hospital, Medical Physics, Cuneo, Italy S. Croce e Carle Hospital, Nuclear Medicine, Cuneo, Italy c La Paz University Hospital, Nuclear Medicine, Madrid, Spain d Oncology Institute of Southern Switzerland, Nuclear Medicine, Bellinzona, Switzerland b
Purpose. The aim of this work was to compare the results obtained by the procedure for qualifying PET/CT scanners for Clinical Trial
Italy Spain World
66 25 20
No. of Iterations 1
2
3
>3
36% 14% 65%
30% 40% 30%
17% 16% 0%
17% 20% 5%
Qualification (CTQ) adopted by the Italian Foundation on Lymphoma (FIL), the Grupo Espanol de Linfomas/Transplante Autologo de Medula Osea (GELTAMO) and the International Extranodal Lymphoma Study Group (IELSG). Methods. Uniformity (UQP) and image quality (IQ) NEMA/IEC phantoms filled with 18F and acquired by local personnel were uploaded to a central server and analyzed within the CoreLab. Background activity concentration in UQP (BACUQP), Background activity concentration (BACIQ) and sphere to background ratio (SBR) in the IQ phantom were compared to expected values. Variability of these indexes among different PET/CT scanners was estimated in term of inter-scanner variability (ISV) at 95% confidence level. Results. The number of PET/CT site qualified and the number of iteration necessary for the CTQ are summarized in Table 1. The BACUQP ISV at 95% confidence level among different scanners were 21.5%, 20.9% and 20.3% for Italian, Spanish and Worldwide PET/CT respectively. The BACIQ ISV were 63.0%, 36.4% and 40.4% and the SBR ISV were 57.9%, 57.5% and 35.5% for Italian, Spanish and Worldwide PET/CT, respectively. Conclusions. The CTQ is a robust and reproducible procedure to verify inter-scanner calibration. The BACUQP is at least two times smaller than BACIQ demonstrating that the uniformity phantom, that is used for CTQ, is more accurately prepared by local sites. SBR demonstrated a great variability (ISV from about 35.5% to 57.9%) because it accounts both for variability in phantom preparation and in reconstruction algorithm tuning. https://doi.org/10.1016/j.ejmp.2018.04.335
327. Radioembolization with Yttrium-90 Microspheres in Hepatocellular Carcinoma: Initial Experience F. Severi a, S. Pasetto a, V. Clementi a, G. Taddei b, A. Masotto c, E. Oliboni b, A. Massella c, M. Salgarello d a
Sacro Cuore Don Calabria Hospital, Medical Physics Department, Negrar (VR), Italy b Sacro Cuore Don Calabria Hospital, Radiology Department, Negrar (VR), Italy c Sacro Cuore Don Calabria Hospital, Gastroenterology Department, Negrar (VR), Italy
259
Figure 1: results of EARL image quality acquisition varying reconstruction parameters.
a methodology which is able to estimate the error associated to Time-Integrated Activity Coefficient (TIAC). Methods. The Monte Carlo method is implemented in matlab and relied on the generation of a large number of data-set based on root mean square error (RMSE) associated to the fit model. Biokinetic data (time acquisition window of about 50 h) of 35 patients affected by metastatic differentiated thyroid cancer and administered with two different radionuclides (123I and 131I) were analysed, by fitting all data sets. Two classes of data sets were considered: Low Number of Points (LNP) and High Number of Points (HNP) time-activity data, consisting of 4 and 20 points respectively. The correlation between RMSE and bandwidths was also investigated. Results. The bandwidths assessed ([mean-lower, mean-upper]) was [ 14.3, +17.1]% for LNP and [ 9.3, +10.6]% for HNP. The RMSE is demonstrated to be correlated to the bandwidths with two different power laws for LNP and HNP. For LNP the R2 was 0.98 and 0.97 for lower and upper band respectively while for HNP the R2 was 0.94 and 0.97 for lower and upper band. Conclusion. The method is very simple to be implemented and it has the advantage of high flexibility when there is need to impose physical constraints to the fitting. As expected, the bandwidths decrease when considering data with a larger number of points. Moreover, having our data similar time window acquisition, the RMSE itself has been observed as a good predictor of the bandwidths as computed with the present method.
has emerged as a powerful tool to better define the metabolic behavior of neoplasms. The study is meant to evaluate the relationship of texture analysis features of surgically resected NSCLC with local invasiveness and regional sublicnical diffusion. Methods. The study is a retrospective evaluation of prospectively collected data. We performed a 3D texture analysis of the PET scans on previously delineated lesion VOIs of resected stage Ia IIb NSCLC. The extraction of a list of texture analysis features was performed by an open source software package CGITA developed by Yu-Hua Dean Fang et al. [1]. We then evaluated their relationship with lymphovascular invasion, nodal upstaging and disease-free survival. Results. tumours with lymphovascular invasion displayed higher levels of SUVmax, SUV entropy, normalized entropy, SUV standard deviation; and lower level of the following: normalized homogeneity, normalized inverse different moment (IDM). Tumors with nodal upstaging displayed higher levels of the following: SUV max, SUV entropy, normalized entropy, SUV standard deviation; and lower level of the following: normalized heterogeneity and normalized IDM. ROC analysis ruled out a stronger predictive power of texture analysis indicators when compared to SUVmax. Conclusions. given its relationship with important prognostic indicators, texture analysis may provide a stratification of highly aggressive tumours from the very beginning of patient’s diagnostic path.
https://doi.org/10.1016/j.ejmp.2018.04.332
References
324. FDG-PET texture analysis in NSCLC: Metabolic-pathological correlations S. Pasetto a, A. Viti b, M. Salgarello c, V. Clementi a, F. Severi a a
Ospedale Sacro Cuore Don Calabria, Medical Physics Department, Negrar, Italy b Ospedale Sacro Cuore Don Calabria, Thoracic Surgery Department, Negrar, Italy c Ospedale Sacro Cuore Don Calabria, Nuclear Medicine Department, Negrar, Italy Purpose. in surgically resectable NSCLC prognosis is strongly affected by local invasiveness as well as unexpected lymph node diffusion found at surgery. Recently, texture analysis of PET imaging
1. Fang YH, Lin CY, Shih MJ, Wang HM, Ho TY, Liao CT, Yen TC. Development and evaluation of an open-source software package ‘‘CGITA” for quantifying tumor heterogeneity with molecular images. Biomed Res Int:1–9.. Article ID 248505. https://doi.org/10.1016/j.ejmp.2018.04.333
325. Feasibility of a combination of 90Y/177Lu-Radiopeptide Therapy (Peptide Receptor Radionuclide Therapy – PRRT) and External Beam Radiation Therapy (EBRT) in neuroendocrine tumors (NETs) S. Vitali a,b, C. Garibaldi a, M.E. Ferrari a, F. Botta a, L. Bodei c, D. Zerini a, B.A. Jereczek-Fossa a,b, C.M. Grana a, R. Orecchia a, M. Cremonesi a
260
Abstracts / Physica Medica 56 (2018) 133–278
Table 1 PRRT 90
Administered activity (GBq) Absorbed dose to OARs Kidneys Red-marrow Liver
177
Y-DOTATOC
7.4 (2.9–22.8) (Gy/GBq) 2.7 (1.0–7.8) 0.07 (0.03–0.14) 0.6 (0.10–2.5)
Lu-DOTATATE
Treatment
21.0 (3.6–40.7) (Gy/GBq) 0.6 (0.4–1.8) 0.04 (0.02–0.06) 0.05 (0.01–0.09)
(Gy) 19 (2–32) 1.0 (0.2–1.6) 2 (0.2–13)
EBRT Prescription dose (Gy) Dose per fraction (Gy)
28 (20–45) 4.6 (3–15)
a
Istituto Europeo di Oncologia, Milano, Italy Università degli Studi di Milano, Milano, Italy c Memorial Sloan Kettering Cancer Center, New York, USA b
90
Table 1 Number of iterations needed for the CTQ. No. of Sites
177
Purpose. PRRT with Y-DOTATOC and Lu-DOTATATE showed up to 35% objective responses in NETs and acceptable toxicity. Given NET indolent behavior, multiple treatments are sequentially applied; EBRT is proposed frequently as oligometastatic/palliative setting. Our aim was to assess whether the combination of PRRT and EBRT (PRRT + EBRT) arise concerns about tolerability. Methods. Over our 807 patients receiving PRRT (1997–2014), 17% underwent also EBRT (14% after PRRT, 3% before PRRT). Among these, 25 patients had dosimetry and clinical data of PRRT + EBRT. The primary NETs were pancreas (12), lung (7), others (6), with multiple metastases in liver (13), bone (10), others (11). EBRT was adjuvant in 18 sites, palliative in 22. Bone metastases were treated with 3D conformal EBRT. Oligometastaseswere treated with image-guided IMRT or stereotactic EBRT, accounting for absorbed doses (AD) from PRRT. AD to Organs At Risk (OARs) and tumours were assessed and toxicity investigated (CTCAE v4). For PRRT, OARs were kidneys and red-marrow; AD to the liver was also evaluated. OARs for EBRT depended on the tumour site. Results. The table reports the median value (range) of administered activities and absorbed doses to OARs for the PRRT as well as doses delivered with EBRT. Individual metabolism leaded to large AD variability in PRRT (tumour: 1–42 Gy/GBq, 90Y-DOTATOC; 1–56 Gy/GBq, 177Lu-DOTATATE).No severe red-marrow toxicity was observed (14 patients grade I-II; 3 none); no kidney toxicity was shown but in 1 patient (grade I). Median (range) follow-up was 3.5 (0.2–12.3) years. 7 patients died. Conclusions. PRRT and EBRT have different OARs, with the great potential to increase AD to tumours without increasing toxicity, especially in red-marrow and liver. This opens the way to future prospective studies. However, EBRT irradiating liver metastases may (rarely) deliver non-negligible AD to kidneys once summed to AD from PRRT. PRRT + EBRT imposes multidisciplinary dosimetry discussion. https://doi.org/10.1016/j.ejmp.2018.04.334
326. PET scanner qualification for clinical trial: Comparison between Italian and worldwide experience F. Bergesio a, A. Biggi b, M. Coronado c, L. Ceriani d, S. Chauvie a a
S. Croce e Carle Hospital, Medical Physics, Cuneo, Italy S. Croce e Carle Hospital, Nuclear Medicine, Cuneo, Italy c La Paz University Hospital, Nuclear Medicine, Madrid, Spain d Oncology Institute of Southern Switzerland, Nuclear Medicine, Bellinzona, Switzerland b
Purpose. The aim of this work was to compare the results obtained by the procedure for qualifying PET/CT scanners for Clinical Trial
Italy Spain World
66 25 20
No. of Iterations 1
2
3
>3
36% 14% 65%
30% 40% 30%
17% 16% 0%
17% 20% 5%
Qualification (CTQ) adopted by the Italian Foundation on Lymphoma (FIL), the Grupo Espanol de Linfomas/Transplante Autologo de Medula Osea (GELTAMO) and the International Extranodal Lymphoma Study Group (IELSG). Methods. Uniformity (UQP) and image quality (IQ) NEMA/IEC phantoms filled with 18F and acquired by local personnel were uploaded to a central server and analyzed within the CoreLab. Background activity concentration in UQP (BACUQP), Background activity concentration (BACIQ) and sphere to background ratio (SBR) in the IQ phantom were compared to expected values. Variability of these indexes among different PET/CT scanners was estimated in term of inter-scanner variability (ISV) at 95% confidence level. Results. The number of PET/CT site qualified and the number of iteration necessary for the CTQ are summarized in Table 1. The BACUQP ISV at 95% confidence level among different scanners were 21.5%, 20.9% and 20.3% for Italian, Spanish and Worldwide PET/CT respectively. The BACIQ ISV were 63.0%, 36.4% and 40.4% and the SBR ISV were 57.9%, 57.5% and 35.5% for Italian, Spanish and Worldwide PET/CT, respectively. Conclusions. The CTQ is a robust and reproducible procedure to verify inter-scanner calibration. The BACUQP is at least two times smaller than BACIQ demonstrating that the uniformity phantom, that is used for CTQ, is more accurately prepared by local sites. SBR demonstrated a great variability (ISV from about 35.5% to 57.9%) because it accounts both for variability in phantom preparation and in reconstruction algorithm tuning. https://doi.org/10.1016/j.ejmp.2018.04.335
327. Radioembolization with Yttrium-90 Microspheres in Hepatocellular Carcinoma: Initial Experience F. Severi a, S. Pasetto a, V. Clementi a, G. Taddei b, A. Masotto c, E. Oliboni b, A. Massella c, M. Salgarello d a
Sacro Cuore Don Calabria Hospital, Medical Physics Department, Negrar (VR), Italy b Sacro Cuore Don Calabria Hospital, Radiology Department, Negrar (VR), Italy c Sacro Cuore Don Calabria Hospital, Gastroenterology Department, Negrar (VR), Italy