Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel

Morsal Samim; Linde M van Veenendaal; Manon N G J A Braat; Andor F van den Hoven; Richard Van Hillegersberg; Bruno Sangro; Yung Hsiang Kao; Dave Liu; John D. Louie; Daniel Y Sze; Steven C Rose; Daniel B Brown; Hojjat Ahmadzadehfar; Edward Kim; Maurice A A J van den Bosch; Marnix G E H Lam

doi:10.1007/s00330-017-4889-6

Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel

Morsal Samim, Linde M van Veenendaal, Manon N G J A Braat, Andor F van den Hoven, Richard Van Hillegersberg, Bruno Sangro, Yung Hsiang Kao, Dave Liu, John D. Louie, Daniel Y Sze, Steven C Rose, Daniel B Brown, Hojjat Ahmadzadehfar, Edward Kim, Maurice A A J van den Bosch, Marnix G E H Lam

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Abstract

INTRODUCTION: Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation ((90)Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres (90)Y-RE, and to draw recommendations on activity prescription based on an expert consensus.

METHODS: The variability in activity prescription between centres was investigated by a survey of international experts in the field of (90)Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients' disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated.

RESULTS: Ten experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18-55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum DTarget of 50 Gy was recommended.

CONCLUSION: With a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing (90)Y-RE exists. In consensus, DTarget ≤50 Gy is recommended.

KEY POINTS: • BSA method does not account for a decreased remnant liver volume after surgery. • In post-surgical patients, a volume-based activity determination method is recommended. • In post-surgical patients, a mean D Target of ≤ 50Gy should be aimed for.

Original language	English
Pages (from-to)	4923-4930
Number of pages	8
Journal	European Radiology
Volume	27
Issue number	12
DOIs	https://doi.org/10.1007/s00330-017-4889-6
Publication status	Published - 2017

Keywords

Dosimetry
Guidelines
Liver
Radioembolisation
Yttrium

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Samim, M., van Veenendaal, L. M., Braat, M. N. G. J. A., van den Hoven, A. F., Van Hillegersberg, R., Sangro, B., Kao, Y. H., Liu, D., Louie, J. D., Sze, D. Y., Rose, S. C., Brown, D. B., Ahmadzadehfar, H., Kim, E., van den Bosch, M. A. A. J., & Lam, M. G. E. H. (2017). Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel. European Radiology, 27(12), 4923-4930. https://doi.org/10.1007/s00330-017-4889-6

@article{276044abffcf4c5eba4c0618949057ae,

title = "Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel",

abstract = "INTRODUCTION: Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation ((90)Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres (90)Y-RE, and to draw recommendations on activity prescription based on an expert consensus.METHODS: The variability in activity prescription between centres was investigated by a survey of international experts in the field of (90)Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients' disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated.RESULTS: Ten experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18-55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum DTarget of 50 Gy was recommended.CONCLUSION: With a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing (90)Y-RE exists. In consensus, DTarget ≤50 Gy is recommended.KEY POINTS: • BSA method does not account for a decreased remnant liver volume after surgery. • In post-surgical patients, a volume-based activity determination method is recommended. • In post-surgical patients, a mean D Target of ≤ 50Gy should be aimed for.",

keywords = "Dosimetry, Guidelines, Liver, Radioembolisation, Yttrium",

author = "Morsal Samim and {van Veenendaal}, {Linde M} and Braat, {Manon N G J A} and {van den Hoven}, {Andor F} and {Van Hillegersberg}, Richard and Bruno Sangro and Kao, {Yung Hsiang} and Dave Liu and Louie, {John D.} and Sze, {Daniel Y} and Rose, {Steven C} and Brown, {Daniel B} and Hojjat Ahmadzadehfar and Edward Kim and {van den Bosch}, {Maurice A A J} and Lam, {Marnix G E H}",

note = "Publisher Copyright: {\textcopyright} 2017, The Author(s).",

year = "2017",

doi = "10.1007/s00330-017-4889-6",

language = "English",

volume = "27",

pages = "4923--4930",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer-Verlag",

number = "12",

}

Samim, M, van Veenendaal, LM, Braat, MNGJA, van den Hoven, AF, Van Hillegersberg, R, Sangro, B, Kao, YH, Liu, D, Louie, JD, Sze, DY, Rose, SC, Brown, DB, Ahmadzadehfar, H, Kim, E, van den Bosch, MAAJ & Lam, MGEH 2017, 'Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel', European Radiology, vol. 27, no. 12, pp. 4923-4930. https://doi.org/10.1007/s00330-017-4889-6

TY - JOUR

T1 - Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel

AU - Samim, Morsal

AU - van Veenendaal, Linde M

AU - Braat, Manon N G J A

AU - van den Hoven, Andor F

AU - Van Hillegersberg, Richard

AU - Sangro, Bruno

AU - Kao, Yung Hsiang

AU - Liu, Dave

AU - Louie, John D.

AU - Sze, Daniel Y

AU - Rose, Steven C

AU - Brown, Daniel B

AU - Ahmadzadehfar, Hojjat

AU - Kim, Edward

AU - van den Bosch, Maurice A A J

AU - Lam, Marnix G E H

PY - 2017

Y1 - 2017

N2 - INTRODUCTION: Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation ((90)Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres (90)Y-RE, and to draw recommendations on activity prescription based on an expert consensus.METHODS: The variability in activity prescription between centres was investigated by a survey of international experts in the field of (90)Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients' disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated.RESULTS: Ten experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18-55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum DTarget of 50 Gy was recommended.CONCLUSION: With a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing (90)Y-RE exists. In consensus, DTarget ≤50 Gy is recommended.KEY POINTS: • BSA method does not account for a decreased remnant liver volume after surgery. • In post-surgical patients, a volume-based activity determination method is recommended. • In post-surgical patients, a mean D Target of ≤ 50Gy should be aimed for.

AB - INTRODUCTION: Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation ((90)Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres (90)Y-RE, and to draw recommendations on activity prescription based on an expert consensus.METHODS: The variability in activity prescription between centres was investigated by a survey of international experts in the field of (90)Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients' disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated.RESULTS: Ten experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18-55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum DTarget of 50 Gy was recommended.CONCLUSION: With a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing (90)Y-RE exists. In consensus, DTarget ≤50 Gy is recommended.KEY POINTS: • BSA method does not account for a decreased remnant liver volume after surgery. • In post-surgical patients, a volume-based activity determination method is recommended. • In post-surgical patients, a mean D Target of ≤ 50Gy should be aimed for.

KW - Dosimetry

KW - Guidelines

KW - Liver

KW - Radioembolisation

KW - Yttrium

U2 - 10.1007/s00330-017-4889-6

DO - 10.1007/s00330-017-4889-6

M3 - Article

C2 - 28674968

SN - 0938-7994

VL - 27

SP - 4923

EP - 4930

JO - European Radiology

JF - European Radiology

IS - 12

ER -

Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel

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