Japanese Journal of Clinical Oncology Advance Access published online on December 19, 2007
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hym137
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© 2007 Foundation for Promotion of Cancer Research
Feasibility of High Activity Rhenium-188-Microsphere in Hepatic Radioembolization
1 Department of Nuclear Medicine
2 Radiological Department
3 Medical Department, University Hospital Dresden, Fetscherstr. 74, 01307 Dresden, Germany
For reprints and all correspondence: Knut Liepe, Department of Nuclear Medicine, Hospital Kassel, Mönchebergstr. 41-43, 34125 Kassel, Germany. E-mail: knut.liepe{at}klinikum-kassel.de
Received May 10, 2007; accepted July 2, 2007
Background: This paper describes the feasibility of intra-arterial high-activity administration of 188Re-microspheres.
Methods: Patients with unresectable colorectal liver metastases or hepatocellular cancer (HCC) received single treatments with 188Re-microspheres. The administered activity was calculated to give a liver dose of 100 Gy. From post-therapeutic scans and urine sampling, the dose to the liver, metastases and bladder was calculated. Toxicity was assessed up to 3 months after administration by means of the Common Terminology Criteria for Adverse Events v3.0 (Trotti et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 2003;13(3):176–81). Response was evaluated on CT.
Results: 13.6 ± 4.7 GBq 188Re-microspheres was administered selective in the feeding artery of the tumour to 10 patients (3 x HCC and 7 x colorectal liver metastases). There was a low urinary excretion rate of 8.9 ± 3.8% of administered activity within 96 h. The absorbed dose to the tumour, normal liver (excluding the tumour) and bladder was 10.24 ± 5.02 Gy/GBq (128 ± 47 Gy), 3.94 ± 2.52 Gy/GBq (50 ± 33 Gy) and 0.27 ± 0.20 Gy/GBq (2.4 ± 1.9 Gy), respectively. There was an acceptable rate of toxicity in 30% of grades I and II, respectively, and 10% with grade III. There was reversible in the most patients within 14 days after treatment. The response was assessed on CT: two patients had a partial response (PR), five patients had stable disease and three patients had disease progression.
Conclusion: Treatment of colorectal liver metastases or HCC using high activities of 188Re-microspheres was well tolerated and a PR was seen in 2 of 10 patients. The treatment represents a therapeutic option in these patients.
Key Words: 188Re-microsphere • colorectal liver metastases • hepatocellular cancer • side effects • urinary excretion rate • high activity