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SU‐E‐T‐116: Dose Response in the Treatment of Unresectable Cholangiocarcinoma with Yttrium‐90 Microspheres
Author(s) -
Yu S,
Green G,
Sehgal V,
Samford G,
Kuo J,
Imagawa D,
Fernando D,
AlGhazi M
Publication year - 2014
Publication title -
medical physics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.473
H-Index - 180
eISSN - 2473-4209
pISSN - 0094-2405
DOI - 10.1118/1.4888446
Subject(s) - medicine , nuclear medicine , microsphere , selective internal radiation therapy , dosimetry , context (archaeology) , radiology , radiation therapy , hepatocellular carcinoma , engineering , biology , paleontology , chemical engineering
Purpose: The purpose of this study is to assess the dose response of radioembolization using yttrium‐90 (Y‐90) microspheres in patients treated for unresectable cholangiocarcinoma. This study utilized partition dosimetry model for the dose calculation. The results show survival benefit with dose escalation. Methods: Between February 2009 and March 2013, ten patients with pathology proven unresectable cholangiocarcinoma were radioembolized with Y‐90 microspheres. Patients underwent initial pre‐treatment angiographic assessment for blood flow and 99mTc‐ MAA for lung shunt evaluation. Activity of Y‐90 administration was calculated using the Body Surface Area (BSA) and target volumes which were determined by contouring the pre‐treatment MRI/CT images using a radiation therapy treatment planning system. Medical Internal Radiation Dose (MIRD) method was used to assess the dosimetric results of Y90. Partition model based on the tumor to‐liver activity uptake estimated from pretreatment 99mTc‐ MAA study was used to calculate the dose delivered to the target. The variables assessed included: administered dose, toxicity based on clinical changes, imaging based tumor response, and survival. Results: Ten patients were radioembolized with Y‐90 microspheres to either one hepatic lobe or both left and right lobes. Patients were stratified by dose. Four patients who received dose greater than 140Gy (p < 0.05) all survived. The corresponding activity they received was greater than 35 mCi. Six out of ten patients died of disease with median survival of 18 weeks (range 12–81wks). Conclusion: Given the growing body of data for Y‐90 microspheres in the context of cholangiocarcinoma, radioembolization may become an important treatment modality for an appropriately selected group of patients. Our study further substantiates past studies and shows additional evidence of a survival benefit with dose escalation