Titre
Monte Carlo 90Y PET/CT dosimetry of unexpected focal radiation-induced lung damage after hepatic radioembolisation.
Type
étude de cas
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Auditore, L.
Auteure/Auteur
Amato, E.
Auteure/Auteur
Boughdad, S.
Auteure/Auteur
Meyer, M.
Auteure/Auteur
Testart, N.
Auteure/Auteur
Cicone, F.
Auteure/Auteur
Beigelman-Aubry, C.
Auteure/Auteur
Prior, J.O.
Auteure/Auteur
Schaefer, N.
Auteure/Auteur
Gnesin, S.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1361-6560
Statut éditorial
Publié
Date de publication
2020-11-27
Volume
65
Numéro
23
Première page
235014
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Case Reports ; Journal Article
Publication Status: epublish
Publication Status: epublish
Résumé
Transarterial radioembolization (TARE) with <sup>90</sup> Y-loaded microspheres is an established therapeutic option for inoperable hepatic tumors. Increasing knowledge regarding TARE hepatic dose-response and dose-toxicity correlation is available but few studies have investigated dose-toxicity correlation in extra-hepatic tissues. We investigated absorbed dose levels for the appearance of focal lung damage in a case of off-target deposition of <sup>90</sup> Y microspheres and compared them with the corresponding thresholds recommended to avoiding radiation induced lung injury following TARE. A 64-year-old male patient received 1.6 GBq of <sup>90</sup> Y-labelled glass microspheres for an inoperable left lobe hepatocellular carcinoma. A focal off-target accumulation of radiolabeled microspheres was detected in the left lung upper lobe at the post-treatment <sup>90</sup> Y-PET/CT, corresponding to a radiation-induced inflammatory lung lesion at the 3-months <sup>18</sup> F-FDG PET/CT follow-up. <sup>90</sup> Y-PET/CT data were used as input for Monte-Carlo based absorbed dose estimations. Dose-volume-histograms were computed to characterize the heterogeneity of absorbed dose distribution. The dose level associated with the appearance of lung tissue damage was estimated as the median absorbed dose measured at the edge of the inflammatory nodule. To account for respiratory movements and possible inaccuracy of image co-registration, three different methods were evaluated to define the irradiated off-target volume. Monte Carlo-derived absorbed dose distribution showed a highly heterogeneous absorbed dose pattern at the site of incidental microsphere deposition (volume = 2.13 ml) with a maximum dose of 630 Gy. Absorbed dose levels ranging from 119 Gy to 133 Gy, were estimated at the edge of the inflammatory nodule, depending on the procedure used to define the target volume. This report describes an original Monte Carlo based patient-specific dosimetry methodology for the study of the radiation-induced damage in a focal lung lesion after TARE. In our patient, radiation-induced focal lung damage occurred at significantly higher absorbed doses than those considered for single administration or cumulative lung dose delivered during TARE.
Sujets
PID Serval
serval:BIB_912F2E9DF2C7
PMID
Date de création
2020-10-02T10:56:30.591Z
Date de création dans IRIS
2025-05-20T21:32:37Z