Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [        166Ho]-Scout Over [        99mTc]MAA in a Prospective Cohort Study

Martijn E H M Wagemans; Arthur J A T Braat; Rob van Rooij; Maarten L J Smits; Rutger C G Bruijnen; Jip F Prince; Guus M Bol; Hugo W A M de Jong; Marnix G E H Lam

doi:10.1007/s00270-023-03656-y

Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [ 166Ho]-Scout Over [ 99mTc]MAA in a Prospective Cohort Study

Martijn E H M Wagemans^*, Arthur J A T Braat, Rob van Rooij, Maarten L J Smits, Rutger C G Bruijnen, Jip F Prince, Guus M Bol, Hugo W A M de Jong, Marnix G E H Lam

^*Corresponding author for this work

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Abstract

Purpose: Radiation pneumonitis is a serious complication of radioembolization. In holmium-166 ([¹⁶⁶Ho]) radioembolization, the lung mean dose (LMD) can be estimated (eLMD) using a scout dose with either technetium-99 m-macroaggregated albumin ([^99mTc]MAA) or [¹⁶⁶Ho]-microspheres. The accuracy of eLMD based on [^99mTc]MAA (eLMD_MAA) was compared to eLMD based on [¹⁶⁶Ho]-scout dose (eLMD_Ho-scout) in two prospective clinical studies. Materials and Methods: Patients were included if they received both scout doses ([^99mTc]MAA and [¹⁶⁶Ho]-scout), had a posttreatment [¹⁶⁶Ho]-SPECT/CT (gold standard) and were scanned on the same hybrid SPECT/CT system. The correlation between eLMD_MAA/eLMD_Ho-scout and LMD_Ho-treatment was assessed by Spearman’s rank correlation coefficient (r). Wilcoxon signed rank test was used to analyze paired data. Results: Thirty-seven patients with unresectable liver metastases were included. During follow-up, none developed symptoms of radiation pneumonitis. Median eLMD_MAA (1.53 Gy, range 0.09–21.33 Gy) was significantly higher than median LMD_Ho-treatment (0.00 Gy, range 0.00–1.20 Gy; p < 0.01). Median eLMD_Ho-scout (median 0.00 Gy, range 0.00–1.21 Gy) was not significantly different compared to LMD_Ho-treatment (p > 0.05). In all cases, eLMD_MAA was higher than LMD_Ho-treatment (p < 0.01). While a significant correlation was found between eLMD_Ho-scout and LMD_Ho-treatment (r = 0.43, p < 0.01), there was no correlation between eLMD_MAA and LMD_Ho-treatment (r = 0.02, p = 0.90). Conclusion: [¹⁶⁶Ho]-scout dose is superior in predicting LMD over [^99mTc]MAA, in [¹⁶⁶Ho]-radioembolization. Consequently, [¹⁶⁶Ho]-scout may limit unnecessary patient exclusions and avoid unnecessary therapeutic activity reductions in patients eligible for radioembolization. Trail registration: NCT01031784, registered December 2009. NCT01612325, registered June 2012. Graphical Abstract: (Figure presented.)

Original language	English
Pages (from-to)	443-450
Number of pages	8
Journal	Cardiovascular and Interventional Radiology
Volume	47
Issue number	4
Early online date	7 Feb 2024
DOIs	https://doi.org/10.1007/s00270-023-03656-y
Publication status	Published - Apr 2024

Keywords

Holmium-166
Lung mean dose
Radiation pneumonitis
Radioembolization
SPECT/CT

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Wagemans, M. E. H. M., Braat, A. J. A. T., van Rooij, R., Smits, M. L. J., Bruijnen, R. C. G., Prince, J. F., Bol, G. M., de Jong, H. W. A. M., & Lam, M. G. E. H. (2024). Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [ 166Ho]-Scout Over [ 99mTc]MAA in a Prospective Cohort Study. Cardiovascular and Interventional Radiology, 47(4), 443-450. https://doi.org/10.1007/s00270-023-03656-y

@article{85172021864d445f80ef469a38a71b59,

title = "Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [ 166Ho]-Scout Over [ 99mTc]MAA in a Prospective Cohort Study",

abstract = "Purpose: Radiation pneumonitis is a serious complication of radioembolization. In holmium-166 ([166Ho]) radioembolization, the lung mean dose (LMD) can be estimated (eLMD) using a scout dose with either technetium-99 m-macroaggregated albumin ([99mTc]MAA) or [166Ho]-microspheres. The accuracy of eLMD based on [99mTc]MAA (eLMDMAA) was compared to eLMD based on [166Ho]-scout dose (eLMDHo-scout) in two prospective clinical studies. Materials and Methods: Patients were included if they received both scout doses ([99mTc]MAA and [166Ho]-scout), had a posttreatment [166Ho]-SPECT/CT (gold standard) and were scanned on the same hybrid SPECT/CT system. The correlation between eLMDMAA/eLMDHo-scout and LMDHo-treatment was assessed by Spearman{\textquoteright}s rank correlation coefficient (r). Wilcoxon signed rank test was used to analyze paired data. Results: Thirty-seven patients with unresectable liver metastases were included. During follow-up, none developed symptoms of radiation pneumonitis. Median eLMDMAA (1.53 Gy, range 0.09–21.33 Gy) was significantly higher than median LMDHo-treatment (0.00 Gy, range 0.00–1.20 Gy; p < 0.01). Median eLMDHo-scout (median 0.00 Gy, range 0.00–1.21 Gy) was not significantly different compared to LMDHo-treatment (p > 0.05). In all cases, eLMDMAA was higher than LMDHo-treatment (p < 0.01). While a significant correlation was found between eLMDHo-scout and LMDHo-treatment (r = 0.43, p < 0.01), there was no correlation between eLMDMAA and LMDHo-treatment (r = 0.02, p = 0.90). Conclusion: [166Ho]-scout dose is superior in predicting LMD over [99mTc]MAA, in [166Ho]-radioembolization. Consequently, [166Ho]-scout may limit unnecessary patient exclusions and avoid unnecessary therapeutic activity reductions in patients eligible for radioembolization. Trail registration: NCT01031784, registered December 2009. NCT01612325, registered June 2012. Graphical Abstract: (Figure presented.)",

keywords = "Holmium-166, Lung mean dose, Radiation pneumonitis, Radioembolization, SPECT/CT",

author = "Wagemans, {Martijn E H M} and Braat, {Arthur J A T} and {van Rooij}, Rob and Smits, {Maarten L J} and Bruijnen, {Rutger C G} and Prince, {Jip F} and Bol, {Guus M} and {de Jong}, {Hugo W A M} and Lam, {Marnix G E H}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = apr,

doi = "10.1007/s00270-023-03656-y",

language = "English",

volume = "47",

pages = "443--450",

journal = "Cardiovascular and Interventional Radiology",

issn = "0174-1551",

publisher = "Springer-Verlag",

number = "4",

}

Wagemans, MEHM, Braat, AJAT, van Rooij, R, Smits, MLJ, Bruijnen, RCG, Prince, JF, Bol, GM , de Jong, HWAM & Lam, MGEH 2024, 'Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [ 166Ho]-Scout Over [ 99mTc]MAA in a Prospective Cohort Study', Cardiovascular and Interventional Radiology, vol. 47, no. 4, pp. 443-450. https://doi.org/10.1007/s00270-023-03656-y

Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [ 166Ho]-Scout Over [ 99mTc]MAA in a Prospective Cohort Study. / Wagemans, Martijn E H M; Braat, Arthur J A T; van Rooij, Rob et al.
In: Cardiovascular and Interventional Radiology, Vol. 47, No. 4, 04.2024, p. 443-450.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [ 166Ho]-Scout Over [ 99mTc]MAA in a Prospective Cohort Study

AU - Wagemans, Martijn E H M

AU - Braat, Arthur J A T

AU - van Rooij, Rob

AU - Smits, Maarten L J

AU - Bruijnen, Rutger C G

AU - Prince, Jip F

AU - Bol, Guus M

AU - de Jong, Hugo W A M

AU - Lam, Marnix G E H

PY - 2024/4

Y1 - 2024/4

N2 - Purpose: Radiation pneumonitis is a serious complication of radioembolization. In holmium-166 ([166Ho]) radioembolization, the lung mean dose (LMD) can be estimated (eLMD) using a scout dose with either technetium-99 m-macroaggregated albumin ([99mTc]MAA) or [166Ho]-microspheres. The accuracy of eLMD based on [99mTc]MAA (eLMDMAA) was compared to eLMD based on [166Ho]-scout dose (eLMDHo-scout) in two prospective clinical studies. Materials and Methods: Patients were included if they received both scout doses ([99mTc]MAA and [166Ho]-scout), had a posttreatment [166Ho]-SPECT/CT (gold standard) and were scanned on the same hybrid SPECT/CT system. The correlation between eLMDMAA/eLMDHo-scout and LMDHo-treatment was assessed by Spearman’s rank correlation coefficient (r). Wilcoxon signed rank test was used to analyze paired data. Results: Thirty-seven patients with unresectable liver metastases were included. During follow-up, none developed symptoms of radiation pneumonitis. Median eLMDMAA (1.53 Gy, range 0.09–21.33 Gy) was significantly higher than median LMDHo-treatment (0.00 Gy, range 0.00–1.20 Gy; p < 0.01). Median eLMDHo-scout (median 0.00 Gy, range 0.00–1.21 Gy) was not significantly different compared to LMDHo-treatment (p > 0.05). In all cases, eLMDMAA was higher than LMDHo-treatment (p < 0.01). While a significant correlation was found between eLMDHo-scout and LMDHo-treatment (r = 0.43, p < 0.01), there was no correlation between eLMDMAA and LMDHo-treatment (r = 0.02, p = 0.90). Conclusion: [166Ho]-scout dose is superior in predicting LMD over [99mTc]MAA, in [166Ho]-radioembolization. Consequently, [166Ho]-scout may limit unnecessary patient exclusions and avoid unnecessary therapeutic activity reductions in patients eligible for radioembolization. Trail registration: NCT01031784, registered December 2009. NCT01612325, registered June 2012. Graphical Abstract: (Figure presented.)

AB - Purpose: Radiation pneumonitis is a serious complication of radioembolization. In holmium-166 ([166Ho]) radioembolization, the lung mean dose (LMD) can be estimated (eLMD) using a scout dose with either technetium-99 m-macroaggregated albumin ([99mTc]MAA) or [166Ho]-microspheres. The accuracy of eLMD based on [99mTc]MAA (eLMDMAA) was compared to eLMD based on [166Ho]-scout dose (eLMDHo-scout) in two prospective clinical studies. Materials and Methods: Patients were included if they received both scout doses ([99mTc]MAA and [166Ho]-scout), had a posttreatment [166Ho]-SPECT/CT (gold standard) and were scanned on the same hybrid SPECT/CT system. The correlation between eLMDMAA/eLMDHo-scout and LMDHo-treatment was assessed by Spearman’s rank correlation coefficient (r). Wilcoxon signed rank test was used to analyze paired data. Results: Thirty-seven patients with unresectable liver metastases were included. During follow-up, none developed symptoms of radiation pneumonitis. Median eLMDMAA (1.53 Gy, range 0.09–21.33 Gy) was significantly higher than median LMDHo-treatment (0.00 Gy, range 0.00–1.20 Gy; p < 0.01). Median eLMDHo-scout (median 0.00 Gy, range 0.00–1.21 Gy) was not significantly different compared to LMDHo-treatment (p > 0.05). In all cases, eLMDMAA was higher than LMDHo-treatment (p < 0.01). While a significant correlation was found between eLMDHo-scout and LMDHo-treatment (r = 0.43, p < 0.01), there was no correlation between eLMDMAA and LMDHo-treatment (r = 0.02, p = 0.90). Conclusion: [166Ho]-scout dose is superior in predicting LMD over [99mTc]MAA, in [166Ho]-radioembolization. Consequently, [166Ho]-scout may limit unnecessary patient exclusions and avoid unnecessary therapeutic activity reductions in patients eligible for radioembolization. Trail registration: NCT01031784, registered December 2009. NCT01612325, registered June 2012. Graphical Abstract: (Figure presented.)

KW - Holmium-166

KW - Lung mean dose

KW - Radiation pneumonitis

KW - Radioembolization

KW - SPECT/CT

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U2 - 10.1007/s00270-023-03656-y

DO - 10.1007/s00270-023-03656-y

M3 - Article

C2 - 38326577

SN - 0174-1551

VL - 47

SP - 443

EP - 450

JO - Cardiovascular and Interventional Radiology

JF - Cardiovascular and Interventional Radiology

IS - 4

ER -

Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [ 166Ho]-Scout Over [ 99mTc]MAA in a Prospective Cohort Study

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