M. G. E. H. Lam (Utrecht, NL)

University Medical Center Utrecht Radiology

Author Of 4 Presentations

401.6 - Radioembolisation: is dosimetry the key?

Learning Objectives:
1. To learn about the usefulness of pre-treatment evaluation for calculation of dosimetry
2. To understand the limitations of current methods used to calculate dosimetry
3. To learn about the evidence for new radioembolisation platforms (Holmium 166) in improving dosimetry

1902.3 - Additional hepatic 166Ho-radioembolization in patients with neuroendocrine tumours treated with 177Lu-DOTATATE: a single-center, interventional, non-randomized, non-comparative, open-label, phase II study (HEPAR PLUS trial)

Abstract

Purpose

At diagnosis 21% of the patients with a grade 1 neuroendocrine tumor (NET) and 30% with a grade 2 NET have distant metastases. The liver is the most commonly affected organ in metastatic disease and is the most incriminating factor for patient survival. Treatment with peptide receptor radionuclide therapy (PRRT) shows an 18% objective response rate and long median survival after treatment. Additional treatment of liver disease with radioembolization may improve outcome in NET patients. To investigate this hypothesis, a phase 2 study was initiated to assess effectiveness and toxicity of holmium-166 radioembolization (166Ho-RE) after PRRT with lutetium-177 (177Lu)-DOTATATE.

Material and Methods

The HEPAR PLUS trial (“Holmium Embolization Particles for Arterial Radiotherapy Plus 177Lu-DOTATATE in Salvage NET patients”) was a single centre, interventional, non-randomized, non-comparative, open label study. Recruitment is completed. Thirty patients with >3 measurable liver metastases according to RECIST 1.1 and mRECIST received additional 166Ho-RE within 20 weeks after the 4th and last cycle of PRRT with 7.4 GBq 177Lu-DOTATATE. Primary objectives: tumour response, complete and partial response according to RECIST 1.1, and toxicity, based on CTCAE v4.03, three months after 166Ho-RE. Secondary endpoints included biochemical response, quality of life, biodistribution and dosimetry.

Results

Primary endpoint expected January 2019; results to be presented at ECIO 2019.

Conclusion

This was the first prospective study to combine PRRT and additional 166Ho-RE in metastatic NET. A radiation boost on intrahepatic disease using 166Ho-RE may lead to an improved response rate without significant additional short-term side-effects.

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1902.6 - Dose-effect relationship for hepatic holmium-166 radioembolization in colorectal cancer patients

Abstract

Purpose

The aim of this study was to analyze the safety and efficacy of holmium-166 (166Ho)-microsphere radioembolization in colorectal cancer patients.

Material and Methods

Patients who underwent a post-therapy 166Ho-SPECT/CT, an FDG-PET/CT at baseline, and an FDG-PET/CT at three-months follow-up, were included for analysis. Dose-response relationship was assessed by relating the change in total lesion glycolysis (TLG) between baseline and follow-up to tumor absorbed dose. Response was categorized according to the PERCIST criteria. To define the maximum tolerable dose to the healthy liver parenchyma, liver enzymes and the presence of ascites and encephalopathy were assessed up to three months after treatment. Correlation between change in liver enzymes and parenchymal absorbed dose was assessed using linear regression analysis.

Results

In total, 35 patients with 113 lesions were included. The lesions were categorized as complete response (CR) (n=22), partial response (PR) (n=22), stable disease (SD) (n=49) and progressive disease (PD) (n=20). Mean tumor absorbed doses in the response categories were 287 Gy, 183 Gy, 172 Gy and 162 Gy (p=0.009). At a patient level, there was 1 patient with CR, 11 patients with PR, 17 patients with SD and 6 patients with PD. Overall, toxicity was mild, with new CTCAE grade 4 toxicity occurring in only 5 patients (4 GGT, 1 bilirubin). There was a significant correlation between change in ASAT, GGT and AF and parenchymal absorbed dose. A dose of 45 Gy was deemed safe.

Conclusion

Significant dose-effect relationships were established for 166Ho radioembolization in colorectal cancer patients, with a safe parenchymal absorbed dose of 45 Gy.

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Presenter Of 2 Presentations

401.6 - Radioembolisation: is dosimetry the key?

Learning Objectives:
1. To learn about the usefulness of pre-treatment evaluation for calculation of dosimetry
2. To understand the limitations of current methods used to calculate dosimetry
3. To learn about the evidence for new radioembolisation platforms (Holmium 166) in improving dosimetry

Moderator Of 1 Session

Satellite Symposium

SY 1001 - Satellite Symposium

Date
Tue, Apr 9, 2019
Time
13:00 - 13:45
Location:
Main Auditorium
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Author Of 1 Presentation

1001.1 - Introduction and objectives

Presenter Of 1 Presentation

1001.1 - Introduction and objectives

Moderator Of 1 Session

Satellite Symposium Interventional Oncology
Date
Tue, Apr 9, 2019
Time
13:00 - 13:45
Location:
Main Auditorium