Liver Selective Internal Radiation Therapy with 90Y resin microspheres: Comparison between pre-treatment activity calculation methods

• Different calculation methods for Y-90 activity injectable for resin SIRT were compared.
• Lungs dose doesn't influence the injectable activity; without attenuation correction lung breakthrough is 65% overestimated.
• Lobar treatments are more effective than whole liver treatments.
• To preserve healthy liver BSA-based methods should not be employed to calculate activity, in particular when T/N < 3.
• Tumour irradiation delivered by PM activity is more efficient (>120 Gy) when T/N > 4.

Different methods to calculate 90Y resin microspheres activity for Selective Internal Radiation Therapy (SIRT) were compared. Such comparison is not yet available and is needed in clinical practice to optimize patient specific treatment planning.32 99mTc-macroagregates (MAA) evaluations were performed, followed by 26 treatments. Four methods to calculate 90Y-activity were applied retrospectively: three based on Body Surface Area and one based on MIRD formalism, partition model (PM). Relationships between calculated activities, lung breakthrough (LB), the activity concentration ratio between lesions and healthy liver (T/N) and tumour involvement were investigated, where lobar and whole liver treatments were analysed separately.Without attenuation correction, overestimation of LB was 65%. In any case, the estimated lungs' doses remained below 30 Gy. Thus, the maximal injectable activity (MIA) is not limited by lungs' irradiation. Moreover, LB was not significantly related to T/N, neither to tumour involvement nor radiochemical purity (RP).Differences in calculated activity with the four methods were extremely large, in particular they were greater between BSA-based and PM activities for lobar treatments (from −85% to 417%) compared to whole liver treatments (from −49% to 61%). Two values of T/N ratio were identified as thresholds: for BSA-based methods, healthy liver doses are much higher than 30 Gy when T/N < 3; for PM, tumour doses are higher than 120 Gy when T/N > 4.As PM accounts for uptake ratio between normal and tumour liver, this method should be employed over BSA-based methods.