Ponente
Descripción
Background and purpose: Transarterial radioembolization (TARE) procedures treat liver tumors by injecting radioactive microspheres into the hepatic artery. Currently, there is a critical need to optimize TARE towards personalized dosimetry. This is crucial to transition TARE to a first-line treatment for unresectable liver tumors. To this aim, we present a novel MIcrosphere DOSimetry (MIDOS) stochastic model to estimate the activity delivered in three compartments: the tumor(s), normal liver, and lung.
Methods: MIDOS incorporates adult male/female liver computational phantoms with the hepatic arterial, hepatic portal venous, and hepatic venous vascular trees. Tumors can be placed in both models at user discretion. The perfusion of microspheres follows cluster patterns, and a Markov Chain approach was applied to microsphere navigation, with the terminal location of microspheres determined to be in either normal hepatic parenchyma, hepatic tumor, or lung. A tumor uptake model was implemented to determine if microspheres get lodged in the tumor, and a probability was included in determining the shunt of microspheres to the lung. A sensitivity analysis of the model parameters was performed, and radiation segmentectomy/lobectomy procedures were simulated over a wide range of activity perfused. Then, the impact of using different microspheres, i.e., 90Y (SIR-Sphere®), 90Y (TheraSphere®) and166Ho (QuiremSphere®), on the tumor-to-normal ratio (TNR) and lung shunt fraction (LSF) was analyzed.
Results: Highly vascularized tumors translated into increased TNR. Treatment results (TNR and LSF) were significantly more variable for microspheres with high particle load. In our scenarios with 1.5 GBq perfusion, TNR was maximum for TheraSphere® at calibration time in segmentectomy/lobar technique, for SIR-Sphere® at 1-3 days post-calibration, and regarding QuiremSphere® at 3 days post-calibration.
Conclusion: This novel approach is a decisive step towards developing a personalized dosimetry framework for TARE. MIDOS assists in making clinical decisions in TARE treatment planning by assessing various delivery parameters and simulating different tumor uptakes. MIDOS offers evaluation of treatment outcomes, such as TNR and LSF, and quantitative scenario-specific decisions. Future steps include translating the activity-compartment map into dose distributions, accounting for patient-specific vasculature models in normal liver and tumor.
