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328. The Basedow’s disease radiometabolic therapy: The uptake volume estimation
Abstracts / Physica Medica 56 (2018) 133–278
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328. The Basedow’s disease radiometabolic therapy: The uptake volume estimation A. Ostinelli a, M. Duchini a, M. Cacciatori a, G. Frigerio a, M. Frigerio a, S. Gelosa a, A. Vassena a, A. Corso b, I. Martinelli b, R. Posterli b a b
d Sacro Cuore Don Calabria Hospital, Nuclear Medicine Department, Negrar (VR), Italy
Purpose. We present our initial experience on transarterial radioembolization (TARE) with Yttrium-90 glass microspheres in Hepatocellular Carcinoma (HCC) patients. The first objective was to choose the procedure for defining the dose to be delivered to the patient and a first evaluation of its effectiveness. Methods. From January 2016 to October 2017, 18 consecutive patients (M = 17, F = 1, median age 73 [24–85] years) with HCC were selected. TARE was performed using 90Y glass microspheres [1]. The administration activity was defined by the MIRD method based on the uptake volume [2]. Lung and gastrointestinal tract shunts were evaluated two weeks before the TARE, by a diagnostic angiography and, respectively, scintigraphy and SPECT/CT, after hepatic perfusion with 99mTc macroaggregated albumin (MAA). 90Y dose was personalized based on the 99mTc MAA SPECT/CT dose distribution. The mean dosimetric parameters are: Lesion Volume (cm3) 144, Target/Uptake Dose (Gy) 216, Target Volume (cm3) 371, Liver Treated (%) 25, Lung Shunt (%) 7, Non Tumoral Liver Dose (Gy) 6, Total Activity Administered (GBq) 1.6. Response evaluation was performed in 17 patients. Results. Complete response occurred in 9 patients, partial response in 5 patients, while progression was seen in 3 patients. During a median clinical follow-up of 8 (3–18) months, 6 patients died. Median disease free survival and overall survival were respectively 13 and 16 months. One patient led to down-staging, allowing liver transplantation. Conclusions. The dose definition procedure adopted proved to be effective, in the reduced number of cases treated. More data need to be acquired to confirm this preliminary result.
References 1. Cremonesi M. Radioembolization of hepatic lesions from a radiobiology and dosimetric perspective. Front Oncol 2014;19(4): 210. 2. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 201;38(7):1393–406. https://doi.org/10.1016/j.ejmp.2018.04.336
ASST Lariana, UOC Fisica Sanitaria, Como, Italy ASST Lariana, UOC Medicina Nucleare, Como, Italy
Purpose. The ASST Lariana has adopted a personalized approach to treat Basedow’s hyperthyroidism, based on mathematical models describing the radioiodine uptake and the hypercaptant mass evaluation. Functional parameters are derived from the thyroid uptake of a trace activity. The target volume is generally estimated by a 99mTc-pertechnetate planar scintigraphy. The aim of this study was to investigate the contribution of SPECT/CT images, both by the analysis of the processed thyroid images with a home-made software and by a inter-operator comparison. Methods. SPECT/CT images of 46 patients with Basedow’s disease were acquired by injecting 185 MBq of 99mTc-pertechnetate. SPECT images were reconstructed using both Filtered Back Projection (FBP) and Ordered Subsets Expectation Maximization (OSEM) algorithms and varying the reconstruction parameters in order to find the optimized combination. Volumes were estimated by a in-house Matlab implementation of the Recovering Iterative Thresholding Method (see Fig.). Moreover, to assess the CT contribution, three nuclear physicians calculated the target volume of 20 patients, approximating the volume with a rotational ellipsoid. The statistical analysis was performed by IBM-SPSS Statistics 20 software (Kolmogorov–Smirnov test, T-test and ANOVA for paired data and interclass correlation coefficient (ICC)). Results. For the OSEM 3D algorithm a range of parameters was found within which volume estimation showed no statistically significant differences (3–6 subset range requires >12 iterations, subset >6 requires >4 iterations). For SPECT images only, the volumes Interclass Correlation Coefficient (ICC) was 0.43, while for SPECT/CT was 0.54, evidencing an increasing correlation degree. Conclusions. Firstly, this study identified the optimal reconstruction parameter range. Secondly, it demonstrated that SPECT/CT images allowed to integrate functional and morphological information, enhancing both the functional mass localization and the corrections for scattering and attenuation. Moreover, SPECT/CT images
262
Abstracts / Physica Medica 56 (2018) 133–278
improved the nuclear physician ability in the functional volume estimation, increasing the inter-operator correlation. https://doi.org/10.1016/j.ejmp.2018.04.337
329. Personalized dosimetric approach in advanced HCC patients treated with 90Y resin microspheres C. Cutaia a, E. Richetta a, M. Poli a, M. Pasquino a, B. Peiretti Paradisi b, L. Sacco c, P. Carbonatto d, A. Calvo d, M. Tabone e, R.E. Pellerito c, M. Stasi a a
A.O. Ordine Mauriziano, Medical Physics Department, Turin, Italy Politecnico di Torino, Energy Department, Turin, Italy c A.O. Ordine Mauriziano, Nuclear Medicine Department, Turin, Italy d A.O. Ordine Mauriziano, Vascular Radiology Department, Turin, Italy e A.O. Ordine Mauriziano, Gastroenterology Department, Turin, Italy b
Purpose. Radioembolization with 90Y resin microspheres is becoming an effective therapeutic option for advanced HCC patients. Dosimetric methods are compared to standard ones to highlight the relevance of a personalized approach. Methods. The study was conducted on 42 HCC patients undergoing 90 Y resin-microspheres radioembolization. The optimal activity was calculated on pre-treatment 99mTc-MAA CT-SPECT images with dosimetric approaches (Voxel and MIRD methods with the following dose treatment’s goals: whole healthy liver (NL) <30–40 Gy and tumour (T) >120 Gy) and it was compared to the activity obtained with standard methods (BSA, fixed method). On 10 SPECT-CT images (IT_AC or IT_NOAC) the influence of CT attenuation correction was investigated: mean doses (T, NL) as well as DVH curves (D100, D95, D20, D2) were compared (using t-test). Results. 77% of patients received a mean administered activity (1.42 ± 0.52, range 0.70 2.63 GBq) lower than the BSA activity (up to 1.3 GBq) and only in 23% of cases the activity was higher (+0.8 GBq). Similar results with bigger discrepancies were observed comparing the activity calculated with dosimetric and fixed method: 84% of patients received a lower activity than the one suggested by the fixed method (up to 1.7 GBq), 16% were administered with higher activity (up to 0.8 GBq). If the doses to NL were rescaled to BSA and fixed activity values, they would be significantly higher, exceeding the 30 Gy constraint in 54.2% of patients (BSA) and 70.8% (fixed). Mean T doses were 172 ± 145 Gy (IT_AC) and 181 ± 168 Gy (IT_NOAC) and mean scintigraphic NL doses 38 ± 23 Gy (IT_AC) and 30 ± 12 Gy (IT_NOAC) without statistical differences as well as in DVHs comparisons. NL IT_NOAC DVH points were in mean lower than IT_AC while higher discrepancies between the reconstructions were found in doses calculated to tumours. The results are shown in Fig. 1.
Conclusions. A dosimetric approach is mandatory in 90Y radioembolization because it is required by EU 2013/59 Directive but also to avoid under or over treatments; an accurate dosimetry can also be achieved on SPECT images without CT correction, which is useful, however, for volumes definition. https://doi.org/10.1016/j.ejmp.2018.04.338
330. 223Ra therapy of bone metastases for castration-resistant prostate cancer (CRPC): Lesion dosimetry and follow-up for a large group of patients M. Pacilio a, G. Ventroni b, V. Frantellizzi c, B. Cassano d, T. Montesano c, C. Borrazzo c,e, C. Basile e, L. Mango b, G. De Vincentis c, M. Pacilio a, V. Frantellizzi b, E. Verdolino c, C. Borrazzo b,d, B. Cassano c, G. Ventroni e, L. Mango e, G. De Vincentis b a Azienda Ospedaliera Universitaria Policlinico Umberto I, Medical Physics Division, Rome, Italy b ‘‘Sapienza” University of Rome, Department of Radiological, Oncological and Anatomo Pathological Sciences, Rome, Italy c ‘‘Sapienza” University of Rome, Postgraduate School of Medical Physics, Rome, Italy d ‘‘Sapienza” University of Rome, Department of Public Health and Infectious Disease, Rome, Italy e Azienda Ospedaliera San Camillo Forlanini, Department of Nuclear Medicine, Rome, Italy
Purpose. Dosimetric treatment optimization is recommended for radioiodine therapy of hyperthyroidism. However, many clinicians still claim that fixed activity administrations yield analogous effectiveness, sparing time-consuming pretherapeutic studies. The possibility to establish a dose-response correlation was here investigated, highlighting the added value of patient-specific dosimetry. Methods. 374 patients affected by autonomous thyroid nodule, or multinodular goitre – presenting abnormal blood tests (TSH, and/or FT3, FT4) – were treated. Post-therapy follow-up lasted for at least 1 year. 187 patients were treated with an empiric methodology (not basing on a pre-treatment dosimetric study). 187 patients underwent dosimetry-based treatments (collecting just three biokinetics points), including also 67 treatments based on a biologically effective dose (BED) prescription. The normality of blood tests at 1 year from the therapy, after the first treatment, was evaluated. The BED was also used in the result analysis for all dosimetry-based treatments. Statistical analysis was performed by Mann-Withney and Chisquared test, univariate receiver operating characteristics (ROC) analysis, and interpolation of dose-response data by a logistic model. Results. Dosimetric differences between the unhealed and the healed group (p = 0.0067) resulted from the 120 treatments based on absorbed dose prescriptions, also after conversion of the absorbed
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328. The Basedow’s disease radiometabolic therapy: The uptake volume estimation A. Ostinelli a, M. Duchini a, M. Cacciatori a, G. Frigerio a, M. Frigerio a, S. Gelosa a, A. Vassena a, A. Corso b, I. Martinelli b, R. Posterli b a b
d Sacro Cuore Don Calabria Hospital, Nuclear Medicine Department, Negrar (VR), Italy
Purpose. We present our initial experience on transarterial radioembolization (TARE) with Yttrium-90 glass microspheres in Hepatocellular Carcinoma (HCC) patients. The first objective was to choose the procedure for defining the dose to be delivered to the patient and a first evaluation of its effectiveness. Methods. From January 2016 to October 2017, 18 consecutive patients (M = 17, F = 1, median age 73 [24–85] years) with HCC were selected. TARE was performed using 90Y glass microspheres [1]. The administration activity was defined by the MIRD method based on the uptake volume [2]. Lung and gastrointestinal tract shunts were evaluated two weeks before the TARE, by a diagnostic angiography and, respectively, scintigraphy and SPECT/CT, after hepatic perfusion with 99mTc macroaggregated albumin (MAA). 90Y dose was personalized based on the 99mTc MAA SPECT/CT dose distribution. The mean dosimetric parameters are: Lesion Volume (cm3) 144, Target/Uptake Dose (Gy) 216, Target Volume (cm3) 371, Liver Treated (%) 25, Lung Shunt (%) 7, Non Tumoral Liver Dose (Gy) 6, Total Activity Administered (GBq) 1.6. Response evaluation was performed in 17 patients. Results. Complete response occurred in 9 patients, partial response in 5 patients, while progression was seen in 3 patients. During a median clinical follow-up of 8 (3–18) months, 6 patients died. Median disease free survival and overall survival were respectively 13 and 16 months. One patient led to down-staging, allowing liver transplantation. Conclusions. The dose definition procedure adopted proved to be effective, in the reduced number of cases treated. More data need to be acquired to confirm this preliminary result.
References 1. Cremonesi M. Radioembolization of hepatic lesions from a radiobiology and dosimetric perspective. Front Oncol 2014;19(4): 210. 2. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 201;38(7):1393–406. https://doi.org/10.1016/j.ejmp.2018.04.336
ASST Lariana, UOC Fisica Sanitaria, Como, Italy ASST Lariana, UOC Medicina Nucleare, Como, Italy
Purpose. The ASST Lariana has adopted a personalized approach to treat Basedow’s hyperthyroidism, based on mathematical models describing the radioiodine uptake and the hypercaptant mass evaluation. Functional parameters are derived from the thyroid uptake of a trace activity. The target volume is generally estimated by a 99mTc-pertechnetate planar scintigraphy. The aim of this study was to investigate the contribution of SPECT/CT images, both by the analysis of the processed thyroid images with a home-made software and by a inter-operator comparison. Methods. SPECT/CT images of 46 patients with Basedow’s disease were acquired by injecting 185 MBq of 99mTc-pertechnetate. SPECT images were reconstructed using both Filtered Back Projection (FBP) and Ordered Subsets Expectation Maximization (OSEM) algorithms and varying the reconstruction parameters in order to find the optimized combination. Volumes were estimated by a in-house Matlab implementation of the Recovering Iterative Thresholding Method (see Fig.). Moreover, to assess the CT contribution, three nuclear physicians calculated the target volume of 20 patients, approximating the volume with a rotational ellipsoid. The statistical analysis was performed by IBM-SPSS Statistics 20 software (Kolmogorov–Smirnov test, T-test and ANOVA for paired data and interclass correlation coefficient (ICC)). Results. For the OSEM 3D algorithm a range of parameters was found within which volume estimation showed no statistically significant differences (3–6 subset range requires >12 iterations, subset >6 requires >4 iterations). For SPECT images only, the volumes Interclass Correlation Coefficient (ICC) was 0.43, while for SPECT/CT was 0.54, evidencing an increasing correlation degree. Conclusions. Firstly, this study identified the optimal reconstruction parameter range. Secondly, it demonstrated that SPECT/CT images allowed to integrate functional and morphological information, enhancing both the functional mass localization and the corrections for scattering and attenuation. Moreover, SPECT/CT images
262
Abstracts / Physica Medica 56 (2018) 133–278
improved the nuclear physician ability in the functional volume estimation, increasing the inter-operator correlation. https://doi.org/10.1016/j.ejmp.2018.04.337
329. Personalized dosimetric approach in advanced HCC patients treated with 90Y resin microspheres C. Cutaia a, E. Richetta a, M. Poli a, M. Pasquino a, B. Peiretti Paradisi b, L. Sacco c, P. Carbonatto d, A. Calvo d, M. Tabone e, R.E. Pellerito c, M. Stasi a a
A.O. Ordine Mauriziano, Medical Physics Department, Turin, Italy Politecnico di Torino, Energy Department, Turin, Italy c A.O. Ordine Mauriziano, Nuclear Medicine Department, Turin, Italy d A.O. Ordine Mauriziano, Vascular Radiology Department, Turin, Italy e A.O. Ordine Mauriziano, Gastroenterology Department, Turin, Italy b
Purpose. Radioembolization with 90Y resin microspheres is becoming an effective therapeutic option for advanced HCC patients. Dosimetric methods are compared to standard ones to highlight the relevance of a personalized approach. Methods. The study was conducted on 42 HCC patients undergoing 90 Y resin-microspheres radioembolization. The optimal activity was calculated on pre-treatment 99mTc-MAA CT-SPECT images with dosimetric approaches (Voxel and MIRD methods with the following dose treatment’s goals: whole healthy liver (NL) <30–40 Gy and tumour (T) >120 Gy) and it was compared to the activity obtained with standard methods (BSA, fixed method). On 10 SPECT-CT images (IT_AC or IT_NOAC) the influence of CT attenuation correction was investigated: mean doses (T, NL) as well as DVH curves (D100, D95, D20, D2) were compared (using t-test). Results. 77% of patients received a mean administered activity (1.42 ± 0.52, range 0.70 2.63 GBq) lower than the BSA activity (up to 1.3 GBq) and only in 23% of cases the activity was higher (+0.8 GBq). Similar results with bigger discrepancies were observed comparing the activity calculated with dosimetric and fixed method: 84% of patients received a lower activity than the one suggested by the fixed method (up to 1.7 GBq), 16% were administered with higher activity (up to 0.8 GBq). If the doses to NL were rescaled to BSA and fixed activity values, they would be significantly higher, exceeding the 30 Gy constraint in 54.2% of patients (BSA) and 70.8% (fixed). Mean T doses were 172 ± 145 Gy (IT_AC) and 181 ± 168 Gy (IT_NOAC) and mean scintigraphic NL doses 38 ± 23 Gy (IT_AC) and 30 ± 12 Gy (IT_NOAC) without statistical differences as well as in DVHs comparisons. NL IT_NOAC DVH points were in mean lower than IT_AC while higher discrepancies between the reconstructions were found in doses calculated to tumours. The results are shown in Fig. 1.
Conclusions. A dosimetric approach is mandatory in 90Y radioembolization because it is required by EU 2013/59 Directive but also to avoid under or over treatments; an accurate dosimetry can also be achieved on SPECT images without CT correction, which is useful, however, for volumes definition. https://doi.org/10.1016/j.ejmp.2018.04.338
330. 223Ra therapy of bone metastases for castration-resistant prostate cancer (CRPC): Lesion dosimetry and follow-up for a large group of patients M. Pacilio a, G. Ventroni b, V. Frantellizzi c, B. Cassano d, T. Montesano c, C. Borrazzo c,e, C. Basile e, L. Mango b, G. De Vincentis c, M. Pacilio a, V. Frantellizzi b, E. Verdolino c, C. Borrazzo b,d, B. Cassano c, G. Ventroni e, L. Mango e, G. De Vincentis b a Azienda Ospedaliera Universitaria Policlinico Umberto I, Medical Physics Division, Rome, Italy b ‘‘Sapienza” University of Rome, Department of Radiological, Oncological and Anatomo Pathological Sciences, Rome, Italy c ‘‘Sapienza” University of Rome, Postgraduate School of Medical Physics, Rome, Italy d ‘‘Sapienza” University of Rome, Department of Public Health and Infectious Disease, Rome, Italy e Azienda Ospedaliera San Camillo Forlanini, Department of Nuclear Medicine, Rome, Italy
Purpose. Dosimetric treatment optimization is recommended for radioiodine therapy of hyperthyroidism. However, many clinicians still claim that fixed activity administrations yield analogous effectiveness, sparing time-consuming pretherapeutic studies. The possibility to establish a dose-response correlation was here investigated, highlighting the added value of patient-specific dosimetry. Methods. 374 patients affected by autonomous thyroid nodule, or multinodular goitre – presenting abnormal blood tests (TSH, and/or FT3, FT4) – were treated. Post-therapy follow-up lasted for at least 1 year. 187 patients were treated with an empiric methodology (not basing on a pre-treatment dosimetric study). 187 patients underwent dosimetry-based treatments (collecting just three biokinetics points), including also 67 treatments based on a biologically effective dose (BED) prescription. The normality of blood tests at 1 year from the therapy, after the first treatment, was evaluated. The BED was also used in the result analysis for all dosimetry-based treatments. Statistical analysis was performed by Mann-Withney and Chisquared test, univariate receiver operating characteristics (ROC) analysis, and interpolation of dose-response data by a logistic model. Results. Dosimetric differences between the unhealed and the healed group (p = 0.0067) resulted from the 120 treatments based on absorbed dose prescriptions, also after conversion of the absorbed