Feasibility of High Activity Rhenium-188-Microsphere in Hepatic Radioembolization

• Published in: Japanese journal of clinical oncology 2007-12, Vol.37 (12), p.942-950
• Main Authors: Liepe, Knut, Brogsitter, Claudia, Leonhard, Johannes, Wunderlich, Gerd, Hliscs, Rainer, Pinkert, Joerg, Folprecht, Gunnar, Kotzerke, Joerg
• Format: Article
• Language: English
• Subjects: 188Re-microsphere; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - metabolism; Carcinoma, Hepatocellular - radiotherapy; colorectal liver metastases; Colorectal Neoplasms - pathology; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Feasibility Studies; Female; hepatocellular cancer; high activity; Humans; Liver Neoplasms - metabolism; Liver Neoplasms - radiotherapy; Liver Neoplasms - secondary; Male; Microspheres; Middle Aged; Radioisotopes - administration & dosage; Radioisotopes - adverse effects; Radioisotopes - therapeutic use; Radiotherapy Planning, Computer-Assisted; Rhenium - administration & dosage; Rhenium - adverse effects; Rhenium - therapeutic use; side effects; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome; urinary excretion rate
• ISSN: 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hym137

Background This paper describes the feasibility of intra-arterial high-activity administration of 188Re-microspheres. Methods Patients with unresectable colorectal liver metastases or hepatocellular cancer (HCC) received single treatments with 188Re-microspheres. The administered activity was calculated to give a liver dose of 100 Gy. From post-therapeutic scans and urine sampling, the dose to the liver, metastases and bladder was calculated. Toxicity was assessed up to 3 months after administration by means of the Common Terminology Criteria for Adverse Events v3.0 (Trotti et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 2003;13(3):176–81). Response was evaluated on CT. Results 13.6 ± 4.7 GBq 188Re-microspheres was administered selective in the feeding artery of the tumour to 10 patients (3 × HCC and 7 × colorectal liver metastases). There was a low urinary excretion rate of 8.9 ± 3.8% of administered activity within 96 h. The absorbed dose to the tumour, normal liver (excluding the tumour) and bladder was 10.24 ± 5.02 Gy/GBq (128 ± 47 Gy), 3.94 ± 2.52 Gy/GBq (50 ± 33 Gy) and 0.27 ± 0.20 Gy/GBq (2.4 ± 1.9 Gy), respectively. There was an acceptable rate of toxicity in 30% of grades I and II, respectively, and 10% with grade III. There was reversible in the most patients within 14 days after treatment. The response was assessed on CT: two patients had a partial response (PR), five patients had stable disease and three patients had disease progression. Conclusion Treatment of colorectal liver metastases or HCC using high activities of 188Re-microspheres was well tolerated and a PR was seen in 2 of 10 patients. The treatment represents a therapeutic option in these patients.