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Aim <p>Prediction of posttreatment lung mean dose (LMD) during liver radioembolization (RE) work-up is essential for risk evaluation of radiation pneumonitis, especially when treating large hepatocellular carcinoma (HCC) where the chance of arteriovenous shunting is not negligible. In case of holmium-166-([<sup>166</sup>Ho])-RE, either [<sup>99m</sup>Tc]TcMAA or <sup>166</sup>Ho-microspheres can be used as scout tracers.</p> <p>Safety of use of <sup>166</sup>Ho-scout has been demonstrated previously, but, to our notice, evaluation of lung radiation dose due to <sup>166</sup>Ho-scout activity in case of significant lung shunting has not been described so far.</p> <p>Therefore, a retrospective study was conducted to evaluate the presence of pulmonary shunting in HCC patients influencing therapeutical approach and to assess lung <sup>166</sup>Ho-scout dose in these patients.</p> Materials and Methods <p>Twenty-nine HCC patients referred for RE were retrospectively evaluated. All work-ups were performed with <sup>166</sup>Ho-microspheres. Scout imaging consisted of a hybrid SPECT/CT acquisition covering the thoraco-abdominal region. As mentioned in the manufacturer’s instruction for use of <sup>166</sup>Ho-microspheres, the possibility of &gt; 30&#xa0;Gy lung radiation exposure in a single treatment is withheld as contra-indication for RE. In patients with lung shunt resulting in predicted posttreatment LMD &gt; 30&#xa0;Gy, lung <sup>166</sup>Ho-scout dose due to patient-specific injected activity was calculated, alongside two hypothetical scenarios: lung <sup>166</sup>Ho-scout dose related to patient’s lung shunt fraction (LSF) assuming administration of leaflet prescribed maximum <sup>166</sup>Ho-scout activity and in case of 100% LSF according to patient-specific injected scout activity. Afterwards, these patients were followed for 3&#xa0;months or till death.</p> Results <p>In the 29 patients, average predicted posttreatment LMD was 10.0&#xa0;Gy (range 0.1–138.9&#xa0;Gy), four of them revealing predicted LMD &gt; 30&#xa0;Gy. Based on patient-specific injected <sup>166</sup>Ho-scout activity (range 100–200&#xa0;MBq), average lung <sup>166</sup>Ho-scout dose of 0.5&#xa0;Gy (range 0.1–0.8&#xa0;Gy) was calculated in these 4 patients. Assuming administration of leaflet prescribed maximum activity of 250&#xa0;MBq, average lung <sup>166</sup>Ho-scout dose would be 0.9&#xa0;Gy (range 0.4–1.7&#xa0;Gy). In case of a 100% LSF, average lung <sup>166</sup>Ho-scout dose would be 2.2&#xa0;Gy (range 1.5–2.7&#xa0;Gy) due to patient-specific scout activity.</p> <p>In these 4 patients, RE was denied and alternative treatment was started. No pulmonary adverse events related to <sup>166</sup>Ho-scout were recorded.</p> Conclusion <p>This study supports previous reports that <sup>166</sup>Ho-scout is a safe alternative to [<sup>99m</sup>Tc]TcMAA -scout and underlines the importance of predicting posttreatment LMD when treating large HCC since 13.8% of our patient group presented arteriovenous shunting with impact on treatment planning.</p>

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Assessment and clinical relevance of pulmonary shunt on 166Ho-Scout Imaging in hepatocellular carcinoma

  • 期刊论文

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  • 发表日期：

    2025年7月14日

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  • Evelyn Vranken,
  • An De Crop,
  • Victor Nuttens,
  • Ruben Vandenbulcke,
  • Tom Dewaele,
  • Thomas Ryckaert,
  • Jochen Decaestecker,
  • Sofie De Meulder,
  • Pieter De Bondt

摘要

Aim

Prediction of posttreatment lung mean dose (LMD) during liver radioembolization (RE) work-up is essential for risk evaluation of radiation pneumonitis, especially when treating large hepatocellular carcinoma (HCC) where the chance of arteriovenous shunting is not negligible. In case of holmium-166-([166Ho])-RE, either [99mTc]TcMAA or 166Ho-microspheres can be used as scout tracers.

Safety of use of 166Ho-scout has been demonstrated previously, but, to our notice, evaluation of lung radiation dose due to 166Ho-scout activity in case of significant lung shunting has not been described so far.

Therefore, a retrospective study was conducted to evaluate the presence of pulmonary shunting in HCC patients influencing therapeutical approach and to assess lung 166Ho-scout dose in these patients.

Materials and Methods

Twenty-nine HCC patients referred for RE were retrospectively evaluated. All work-ups were performed with 166Ho-microspheres. Scout imaging consisted of a hybrid SPECT/CT acquisition covering the thoraco-abdominal region. As mentioned in the manufacturer’s instruction for use of 166Ho-microspheres, the possibility of > 30 Gy lung radiation exposure in a single treatment is withheld as contra-indication for RE. In patients with lung shunt resulting in predicted posttreatment LMD > 30 Gy, lung 166Ho-scout dose due to patient-specific injected activity was calculated, alongside two hypothetical scenarios: lung 166Ho-scout dose related to patient’s lung shunt fraction (LSF) assuming administration of leaflet prescribed maximum 166Ho-scout activity and in case of 100% LSF according to patient-specific injected scout activity. Afterwards, these patients were followed for 3 months or till death.

Results

In the 29 patients, average predicted posttreatment LMD was 10.0 Gy (range 0.1–138.9 Gy), four of them revealing predicted LMD > 30 Gy. Based on patient-specific injected 166Ho-scout activity (range 100–200 MBq), average lung 166Ho-scout dose of 0.5 Gy (range 0.1–0.8 Gy) was calculated in these 4 patients. Assuming administration of leaflet prescribed maximum activity of 250 MBq, average lung 166Ho-scout dose would be 0.9 Gy (range 0.4–1.7 Gy). In case of a 100% LSF, average lung 166Ho-scout dose would be 2.2 Gy (range 1.5–2.7 Gy) due to patient-specific scout activity.

In these 4 patients, RE was denied and alternative treatment was started. No pulmonary adverse events related to 166Ho-scout were recorded.

Conclusion

This study supports previous reports that 166Ho-scout is a safe alternative to [99mTc]TcMAA -scout and underlines the importance of predicting posttreatment LMD when treating large HCC since 13.8% of our patient group presented arteriovenous shunting with impact on treatment planning.