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Purpose <p>We applied a voxel-based personalized dosimetry method using multiple voxel S-values (VSVs) to assess the intratumoral dose distribution in hepatocellular carcinoma (HCC) patients treated with trans-arterial radioembolization (TARE) using glass microspheres. This study aimed to evaluate the predictive value of dose metrics for treatment response and local progression-free survival (L-PFS).</p> Methods <p>Ninety patients with HCC who underwent TARE between November 2015 and December 2019 were retrospectively analyzed. Post-treatment <sup>90</sup>Y-microsphere PET/CT images were used to generate voxel-wise absorbed dose maps via convolution with CT-derived multiple VSV kernels. Tumor volumes were manually delineated on contrast-enhanced CT co-registered with dose map. Dose-volume histogram (DVH) parameters, including V-V<sub>205</sub> (tumor volume receiving &lt; 205&#xa0;Gy) and D70, were calculated. Dose heterogeneity was assessed using the coefficient of variation (CoV) of voxel doses. The performance of dose parameters for predicting complete response (CR) and L-PFS was evaluated using logistic and Cox regression analyses.</p> Results <p>Among 90 patients, 57 (63.3%) achieved CR. PET average dose, D70, V-V<sub>205</sub>, and CoV significantly differed according to treatment response. ROC analysis showed good predictive performance for CR with D70 (AUC 0.908), V-V<sub>205</sub> (0.903), PET average dose (0.876), and CoV (0.870). In multivariate logistic regression, only small V-V<sub>205</sub> (&lt; 22.8&#xa0;mL; OR 12.50, <i>P</i> = 0.002) remained an independent predictor of CR. For L-PFS, multivariate Cox analysis identified V-V<sub>205</sub> &lt; 22.8&#xa0;mL (HR 0.07, <i>P</i> = 0.013) and CR (HR 0.29, <i>P</i> = 0.034) as independent prognostic factors.</p> Conclusion <p>Voxel-based dosimetry using multiple VSV kernels enables quantitative assessment of intratumoral dose distribution in HCC patients treated with TARE. Among voxel-level parameters, D70, V-V<sub>205</sub>, and CoV showed good performance in predicting CR, and V-V<sub>205</sub> was the only independent predictor for both treatment response and L-PFS. These findings support the added prognostic value of voxel-based dose metrics beyond average tumor absorbed dose.</p>

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Voxel-based dosimetry for predicting treatment response to transarterial radioembolization in hepatocellular carcinoma: significance of intratumoral dose distribution

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月17日

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  • Minseok Suh,
  • Keon Min Kim,
  • Jin Woo Choi,
  • Jae Sung Lee,
  • Jin Chul Paeng,
  • Hyo-Cheol Kim

摘要

Purpose

We applied a voxel-based personalized dosimetry method using multiple voxel S-values (VSVs) to assess the intratumoral dose distribution in hepatocellular carcinoma (HCC) patients treated with trans-arterial radioembolization (TARE) using glass microspheres. This study aimed to evaluate the predictive value of dose metrics for treatment response and local progression-free survival (L-PFS).

Methods

Ninety patients with HCC who underwent TARE between November 2015 and December 2019 were retrospectively analyzed. Post-treatment 90Y-microsphere PET/CT images were used to generate voxel-wise absorbed dose maps via convolution with CT-derived multiple VSV kernels. Tumor volumes were manually delineated on contrast-enhanced CT co-registered with dose map. Dose-volume histogram (DVH) parameters, including V-V205 (tumor volume receiving < 205 Gy) and D70, were calculated. Dose heterogeneity was assessed using the coefficient of variation (CoV) of voxel doses. The performance of dose parameters for predicting complete response (CR) and L-PFS was evaluated using logistic and Cox regression analyses.

Results

Among 90 patients, 57 (63.3%) achieved CR. PET average dose, D70, V-V205, and CoV significantly differed according to treatment response. ROC analysis showed good predictive performance for CR with D70 (AUC 0.908), V-V205 (0.903), PET average dose (0.876), and CoV (0.870). In multivariate logistic regression, only small V-V205 (< 22.8 mL; OR 12.50, P = 0.002) remained an independent predictor of CR. For L-PFS, multivariate Cox analysis identified V-V205 < 22.8 mL (HR 0.07, P = 0.013) and CR (HR 0.29, P = 0.034) as independent prognostic factors.

Conclusion

Voxel-based dosimetry using multiple VSV kernels enables quantitative assessment of intratumoral dose distribution in HCC patients treated with TARE. Among voxel-level parameters, D70, V-V205, and CoV showed good performance in predicting CR, and V-V205 was the only independent predictor for both treatment response and L-PFS. These findings support the added prognostic value of voxel-based dose metrics beyond average tumor absorbed dose.