Dose–response relationship after yttrium-90-radioembolization with glass microspheres in patients with neuroendocrine tumor liver metastases
Background In radioembolization, response is achieved through the irradiation and damaging of tumor DNA. For hepatic metastases of neuroendocrine tumors, a dose–response relationship has not been established yet. This study assesses whether increasing tumor-absorbed doses lead to increased response...
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| Veröffentlicht in: | European journal of nuclear medicine and molecular imaging 2022-04, Vol.49 (5), p.1700-1710 |
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| container_title | European journal of nuclear medicine and molecular imaging |
| container_volume | 49 |
| creator | Ebbers, Sander C. van Roekel, Caren Braat, Manon N. G. J. A. Barentsz, Maarten W. Lam, Marnix G. E. H. Braat, Arthur J. A. T. |
| description | Background
In radioembolization, response is achieved through the irradiation and damaging of tumor DNA. For hepatic metastases of neuroendocrine tumors, a dose–response relationship has not been established yet. This study assesses whether increasing tumor-absorbed doses lead to increased response rates.
Methods
We included all patients who underwent yttrium-90 (
90
Y) glass microspheres radioembolization in our center if both pre- and post-treatment contrast-enhanced CT and post-injection PET/CT were available. Up to five hepatic tumors and the healthy hepatic tissue were delineated, and absorbed dose was quantified using post-injection PET/CT. Response was measured according to RECIST 1.1 on patient and tumor level. Linear mixed models were used to study the relationship between absorbed dose and response on tumor level. Logistic regression analysis was used on patient level to study dose–response and hepatic dose-toxicity relationships.
Results
A total of 128 tumors in 26 patients (31 procedures) were included in the response analysis. While correcting for confounding by tumor volume, a significant effect of response on dose was found (
p
= 0.0465). Geometric mean of absorbed dose for responding tumors was 170 Gy, for stable disease 101 Gy, and for progressive disease 67 Gy. No significant dose-toxicity relationship could be identified.
Conclusion
In patients with neuroendocrine tumor liver metastases, treated with
90
Y-radioembolization, a clear dose–response relationship was found. We propose to perform
90
Y-radioembolization with an absolute minimum planned tumor-absorbed dose of 150 Gy. |
| doi_str_mv | 10.1007/s00259-021-05642-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2607597637</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2607597637</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-55b6ae6b03041b0e04ec00986841103e16f98b283f5b4751cac5fb0a46b19bc43</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhS0EoqXwAiyQJTbdGMbxT-IlKuVHqsQG1pGdO-l1ldjBdkBlxROw4Q15EnybUiQWSCPNSP7mnJEPIU85vOAA7csM0CjDoOEMlJYNE_fIMdfcsBY6c_9ubuGIPMr5CoB3TWcekiMhu1Zo0R2TH69jxl_ffybMSwwZacLJFl_HvV-oHQsmel1K8uvMDLBkdz7i7OLkv91g9Ksve3o52Zzp7IcU87LHKkZ9oEslMJS8MQHXFDHs4pB8QFrWOSY6-S_VYMZicy3Mj8mD0U4Zn9z2E_LpzfnHs3fs4sPb92evLtggWlWYUk5b1A4ESO4AQeIAYDrdSc5BINej6VzTiVE52So-2EGNDqzUjhs3SHFCTjfdJcXPK-bSzz4POE02YFxz32holWm1aCv6_B_0Kq4p1OsqJbk21UZUqtmowxfkhGO_JD_bdN1z6A9p9VtafU2rv0mrPyw9u5Ve3Yy7u5U_8VRAbECuT-ES01_v_8j-BqHTpBY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2641692833</pqid></control><display><type>article</type><title>Dose–response relationship after yttrium-90-radioembolization with glass microspheres in patients with neuroendocrine tumor liver metastases</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Ebbers, Sander C. ; van Roekel, Caren ; Braat, Manon N. G. J. A. ; Barentsz, Maarten W. ; Lam, Marnix G. E. H. ; Braat, Arthur J. A. T.</creator><creatorcontrib>Ebbers, Sander C. ; van Roekel, Caren ; Braat, Manon N. G. J. A. ; Barentsz, Maarten W. ; Lam, Marnix G. E. H. ; Braat, Arthur J. A. T.</creatorcontrib><description>Background
In radioembolization, response is achieved through the irradiation and damaging of tumor DNA. For hepatic metastases of neuroendocrine tumors, a dose–response relationship has not been established yet. This study assesses whether increasing tumor-absorbed doses lead to increased response rates.
Methods
We included all patients who underwent yttrium-90 (
90
Y) glass microspheres radioembolization in our center if both pre- and post-treatment contrast-enhanced CT and post-injection PET/CT were available. Up to five hepatic tumors and the healthy hepatic tissue were delineated, and absorbed dose was quantified using post-injection PET/CT. Response was measured according to RECIST 1.1 on patient and tumor level. Linear mixed models were used to study the relationship between absorbed dose and response on tumor level. Logistic regression analysis was used on patient level to study dose–response and hepatic dose-toxicity relationships.
Results
A total of 128 tumors in 26 patients (31 procedures) were included in the response analysis. While correcting for confounding by tumor volume, a significant effect of response on dose was found (
p
= 0.0465). Geometric mean of absorbed dose for responding tumors was 170 Gy, for stable disease 101 Gy, and for progressive disease 67 Gy. No significant dose-toxicity relationship could be identified.
Conclusion
In patients with neuroendocrine tumor liver metastases, treated with
90
Y-radioembolization, a clear dose–response relationship was found. We propose to perform
90
Y-radioembolization with an absolute minimum planned tumor-absorbed dose of 150 Gy.</description><identifier>ISSN: 1619-7070</identifier><identifier>EISSN: 1619-7089</identifier><identifier>DOI: 10.1007/s00259-021-05642-3</identifier><identifier>PMID: 34873638</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Cardiology ; DNA damage ; Dosimetry ; Embolization, Therapeutic - adverse effects ; Embolization, Therapeutic - methods ; Humans ; Imaging ; Injection ; Liver ; Liver Neoplasms - drug therapy ; Liver Neoplasms - radiotherapy ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Microspheres ; Neuroendocrine tumors ; Neuroendocrine Tumors - drug therapy ; Neuroendocrine Tumors - radiotherapy ; Nuclear Medicine ; Oncology ; Original Article ; Orthopedics ; Patients ; Positron emission tomography ; Positron Emission Tomography Computed Tomography ; Radiation ; Radiation damage ; Radiology ; Regression analysis ; Retrospective Studies ; Toxicity ; Tumors ; Yttrium ; Yttrium isotopes ; Yttrium Radioisotopes - adverse effects</subject><ispartof>European journal of nuclear medicine and molecular imaging, 2022-04, Vol.49 (5), p.1700-1710</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-55b6ae6b03041b0e04ec00986841103e16f98b283f5b4751cac5fb0a46b19bc43</citedby><cites>FETCH-LOGICAL-c375t-55b6ae6b03041b0e04ec00986841103e16f98b283f5b4751cac5fb0a46b19bc43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00259-021-05642-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00259-021-05642-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27933,27934,41497,42566,51328</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34873638$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ebbers, Sander C.</creatorcontrib><creatorcontrib>van Roekel, Caren</creatorcontrib><creatorcontrib>Braat, Manon N. G. J. A.</creatorcontrib><creatorcontrib>Barentsz, Maarten W.</creatorcontrib><creatorcontrib>Lam, Marnix G. E. H.</creatorcontrib><creatorcontrib>Braat, Arthur J. A. T.</creatorcontrib><title>Dose–response relationship after yttrium-90-radioembolization with glass microspheres in patients with neuroendocrine tumor liver metastases</title><title>European journal of nuclear medicine and molecular imaging</title><addtitle>Eur J Nucl Med Mol Imaging</addtitle><addtitle>Eur J Nucl Med Mol Imaging</addtitle><description>Background
In radioembolization, response is achieved through the irradiation and damaging of tumor DNA. For hepatic metastases of neuroendocrine tumors, a dose–response relationship has not been established yet. This study assesses whether increasing tumor-absorbed doses lead to increased response rates.
Methods
We included all patients who underwent yttrium-90 (
90
Y) glass microspheres radioembolization in our center if both pre- and post-treatment contrast-enhanced CT and post-injection PET/CT were available. Up to five hepatic tumors and the healthy hepatic tissue were delineated, and absorbed dose was quantified using post-injection PET/CT. Response was measured according to RECIST 1.1 on patient and tumor level. Linear mixed models were used to study the relationship between absorbed dose and response on tumor level. Logistic regression analysis was used on patient level to study dose–response and hepatic dose-toxicity relationships.
Results
A total of 128 tumors in 26 patients (31 procedures) were included in the response analysis. While correcting for confounding by tumor volume, a significant effect of response on dose was found (
p
= 0.0465). Geometric mean of absorbed dose for responding tumors was 170 Gy, for stable disease 101 Gy, and for progressive disease 67 Gy. No significant dose-toxicity relationship could be identified.
Conclusion
In patients with neuroendocrine tumor liver metastases, treated with
90
Y-radioembolization, a clear dose–response relationship was found. We propose to perform
90
Y-radioembolization with an absolute minimum planned tumor-absorbed dose of 150 Gy.</description><subject>Cardiology</subject><subject>DNA damage</subject><subject>Dosimetry</subject><subject>Embolization, Therapeutic - adverse effects</subject><subject>Embolization, Therapeutic - methods</subject><subject>Humans</subject><subject>Imaging</subject><subject>Injection</subject><subject>Liver</subject><subject>Liver Neoplasms - drug therapy</subject><subject>Liver Neoplasms - radiotherapy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Microspheres</subject><subject>Neuroendocrine tumors</subject><subject>Neuroendocrine Tumors - drug therapy</subject><subject>Neuroendocrine Tumors - radiotherapy</subject><subject>Nuclear Medicine</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Positron emission tomography</subject><subject>Positron Emission Tomography Computed Tomography</subject><subject>Radiation</subject><subject>Radiation damage</subject><subject>Radiology</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Toxicity</subject><subject>Tumors</subject><subject>Yttrium</subject><subject>Yttrium isotopes</subject><subject>Yttrium Radioisotopes - adverse effects</subject><issn>1619-7070</issn><issn>1619-7089</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kc1u1TAQhS0EoqXwAiyQJTbdGMbxT-IlKuVHqsQG1pGdO-l1ldjBdkBlxROw4Q15EnybUiQWSCPNSP7mnJEPIU85vOAA7csM0CjDoOEMlJYNE_fIMdfcsBY6c_9ubuGIPMr5CoB3TWcekiMhu1Zo0R2TH69jxl_ffybMSwwZacLJFl_HvV-oHQsmel1K8uvMDLBkdz7i7OLkv91g9Ksve3o52Zzp7IcU87LHKkZ9oEslMJS8MQHXFDHs4pB8QFrWOSY6-S_VYMZicy3Mj8mD0U4Zn9z2E_LpzfnHs3fs4sPb92evLtggWlWYUk5b1A4ESO4AQeIAYDrdSc5BINej6VzTiVE52So-2EGNDqzUjhs3SHFCTjfdJcXPK-bSzz4POE02YFxz32holWm1aCv6_B_0Kq4p1OsqJbk21UZUqtmowxfkhGO_JD_bdN1z6A9p9VtafU2rv0mrPyw9u5Ve3Yy7u5U_8VRAbECuT-ES01_v_8j-BqHTpBY</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Ebbers, Sander C.</creator><creator>van Roekel, Caren</creator><creator>Braat, Manon N. G. J. A.</creator><creator>Barentsz, Maarten W.</creator><creator>Lam, Marnix G. E. H.</creator><creator>Braat, Arthur J. A. T.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20220401</creationdate><title>Dose–response relationship after yttrium-90-radioembolization with glass microspheres in patients with neuroendocrine tumor liver metastases</title><author>Ebbers, Sander C. ; van Roekel, Caren ; Braat, Manon N. G. J. A. ; Barentsz, Maarten W. ; Lam, Marnix G. E. H. ; Braat, Arthur J. A. T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-55b6ae6b03041b0e04ec00986841103e16f98b283f5b4751cac5fb0a46b19bc43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cardiology</topic><topic>DNA damage</topic><topic>Dosimetry</topic><topic>Embolization, Therapeutic - adverse effects</topic><topic>Embolization, Therapeutic - methods</topic><topic>Humans</topic><topic>Imaging</topic><topic>Injection</topic><topic>Liver</topic><topic>Liver Neoplasms - drug therapy</topic><topic>Liver Neoplasms - radiotherapy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Microspheres</topic><topic>Neuroendocrine tumors</topic><topic>Neuroendocrine Tumors - drug therapy</topic><topic>Neuroendocrine Tumors - radiotherapy</topic><topic>Nuclear Medicine</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Positron emission tomography</topic><topic>Positron Emission Tomography Computed Tomography</topic><topic>Radiation</topic><topic>Radiation damage</topic><topic>Radiology</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Toxicity</topic><topic>Tumors</topic><topic>Yttrium</topic><topic>Yttrium isotopes</topic><topic>Yttrium Radioisotopes - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ebbers, Sander C.</creatorcontrib><creatorcontrib>van Roekel, Caren</creatorcontrib><creatorcontrib>Braat, Manon N. G. J. A.</creatorcontrib><creatorcontrib>Barentsz, Maarten W.</creatorcontrib><creatorcontrib>Lam, Marnix G. E. H.</creatorcontrib><creatorcontrib>Braat, Arthur J. A. T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Biological Sciences</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of nuclear medicine and molecular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ebbers, Sander C.</au><au>van Roekel, Caren</au><au>Braat, Manon N. G. J. A.</au><au>Barentsz, Maarten W.</au><au>Lam, Marnix G. E. H.</au><au>Braat, Arthur J. A. T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dose–response relationship after yttrium-90-radioembolization with glass microspheres in patients with neuroendocrine tumor liver metastases</atitle><jtitle>European journal of nuclear medicine and molecular imaging</jtitle><stitle>Eur J Nucl Med Mol Imaging</stitle><addtitle>Eur J Nucl Med Mol Imaging</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>49</volume><issue>5</issue><spage>1700</spage><epage>1710</epage><pages>1700-1710</pages><issn>1619-7070</issn><eissn>1619-7089</eissn><abstract>Background
In radioembolization, response is achieved through the irradiation and damaging of tumor DNA. For hepatic metastases of neuroendocrine tumors, a dose–response relationship has not been established yet. This study assesses whether increasing tumor-absorbed doses lead to increased response rates.
Methods
We included all patients who underwent yttrium-90 (
90
Y) glass microspheres radioembolization in our center if both pre- and post-treatment contrast-enhanced CT and post-injection PET/CT were available. Up to five hepatic tumors and the healthy hepatic tissue were delineated, and absorbed dose was quantified using post-injection PET/CT. Response was measured according to RECIST 1.1 on patient and tumor level. Linear mixed models were used to study the relationship between absorbed dose and response on tumor level. Logistic regression analysis was used on patient level to study dose–response and hepatic dose-toxicity relationships.
Results
A total of 128 tumors in 26 patients (31 procedures) were included in the response analysis. While correcting for confounding by tumor volume, a significant effect of response on dose was found (
p
= 0.0465). Geometric mean of absorbed dose for responding tumors was 170 Gy, for stable disease 101 Gy, and for progressive disease 67 Gy. No significant dose-toxicity relationship could be identified.
Conclusion
In patients with neuroendocrine tumor liver metastases, treated with
90
Y-radioembolization, a clear dose–response relationship was found. We propose to perform
90
Y-radioembolization with an absolute minimum planned tumor-absorbed dose of 150 Gy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34873638</pmid><doi>10.1007/s00259-021-05642-3</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1619-7070 |
| ispartof | European journal of nuclear medicine and molecular imaging, 2022-04, Vol.49 (5), p.1700-1710 |
| issn | 1619-7070 1619-7089 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Cardiology DNA damage Dosimetry Embolization, Therapeutic - adverse effects Embolization, Therapeutic - methods Humans Imaging Injection Liver Liver Neoplasms - drug therapy Liver Neoplasms - radiotherapy Medicine Medicine & Public Health Metastases Metastasis Microspheres Neuroendocrine tumors Neuroendocrine Tumors - drug therapy Neuroendocrine Tumors - radiotherapy Nuclear Medicine Oncology Original Article Orthopedics Patients Positron emission tomography Positron Emission Tomography Computed Tomography Radiation Radiation damage Radiology Regression analysis Retrospective Studies Toxicity Tumors Yttrium Yttrium isotopes Yttrium Radioisotopes - adverse effects |
| title | Dose–response relationship after yttrium-90-radioembolization with glass microspheres in patients with neuroendocrine tumor liver metastases |
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