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Dose–effect relationships in neuroendocrine tumour liver metastases treated with [166Ho]-radioembolization

Purpose Aim of this study was to investigate a dose-response relationship, dose-toxicity relationship, progression free survival (PFS) and overall survival (OS) in neuroendocrine tumour liver metastases (NELM) treated with holmium-166-microspheres radioembolization ([ 166 Ho]-radioembolization). Mat...

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Published in:European journal of nuclear medicine and molecular imaging 2024-06, Vol.51 (7), p.2114-2123
Main Authors: Ramdhani, K., Beijer-Verduin, J., Ebbers, S. C., van Rooij, R., Smits, M. L. J., Bruijnen, R. C. G., de Jong, H. W. A. M., Lam, M. G. E. H., Braat, A. J. A. T.
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Language:English
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Summary:Purpose Aim of this study was to investigate a dose-response relationship, dose-toxicity relationship, progression free survival (PFS) and overall survival (OS) in neuroendocrine tumour liver metastases (NELM) treated with holmium-166-microspheres radioembolization ([ 166 Ho]-radioembolization). Materials and methods Single center, retrospective study included patients with NELM that received [ 166 Ho]-radioembolization with post-treatment SPECT/CT and CECT or MRI imaging for 3 months follow-up. Post-treatment SPECT/CT was used to calculate tumour (D t ) and whole liver healthy tissue (D h ) absorbed dose. Clinical and laboratory toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE), version 5 at baseline and three-months follow-up. Response was determined according to RECIST 1.1. The tumour and healthy doses was correlated to lesion-based objective response and patient-based toxicity. Kaplan Meier analyses were performed for progression free survival (PFS) and overall survival (OS). Results Twenty-seven treatments in 25 patients were included, with a total of 114 tumours. Median follow-up was 14 months (3 – 82 months). Mean D t in non-responders was 68 Gy versus 118 Gy in responders, p  = 0.01. ROC analysis determined 86 Gy to have the highest sensitivity and specificity, resp. 83% and 81%. Achieving a D t of ≥ 120 Gy provided the highest likelihood of response (90%) for obtaining response. Sixteen patients had grade 1–2 clinical toxicity and only one patient grade 3. No clear healthy liver dose-toxicity relationship was found. The median PFS was 15 months (95% CI [10.2;19.8]) and median OS was not reached. Conclusion This study confirms the safety and efficacy of [ 166 Ho]-radioembolization in NELM in a real-world setting. A clear dose–response relationship was demonstrated and future studies should aim at a D t of ≥ 120 Gy, being predictive of response. No dose-toxicity relationship could be established.
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-024-06645-6