Abstract
IntroductionGuidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation (90Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres 90Y-RE, and to draw recommendations on activity prescription based on an expert consensus.MethodsThe variability in activity prescription between centres was investigated by a survey of international experts in the field of 90Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients’ disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated.ResultsTen experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18–55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum DTarget of 50 Gy was recommended.ConclusionWith a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing 90Y-RE exists. In consensus, DTarget ≤50 Gy is recommended.Key points• BSA method does not account for a decreased remnant liver volume after surgery.• In post-surgical patients, a volume-based activity determination method is recommended.• In post-surgical patients, a mean DTargetof ≤ 50Gy should be aimed for.
Highlights
Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation (90Y-RE) are lacking
Primary curative liver resection is only feasible in a small minority of patients [1], and intrahepatic recurrence is commonly seen during follow-up [2]
The primary aim of this study was to study the variability in activity prescription in patients with a history of liver surgery between centres with extensive experience using resin microspheres 90Y-RE, and to draw recommendations on activity prescription based on an expert panel survey
Summary
Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation (90Y-RE) are lacking. Liver surgery is often the preferred treatment option for patients with primary or secondary liver malignancies [1]. Hepatic 90Y radioembolisation (RE) with resin microspheres (SIR-Spheres®, Sirtex, Sydney, Australia) is an established treatment modality for both primary and secondary liver malignancies, and is considered to be safe and effective in patients with non-resectable hepatic malignancies [3]. When using 90Y resin microspheres, international guidelines have historically recommended the simple and semi-empirical body surface area (BSA) method for activity prescription [5,6,7]
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