TCP post-radioembolization and TCP post-EBRT in HCC are similar and can be predicted using the in vitro radiosensitivity

Philippe d'Abadie; Stephan Walrand; Michel Hesse; Ivan Borbath; Renaud Lhommel; François Jamar

doi:10.1186/s13550-022-00911-0

TCP post-radioembolization and TCP post-EBRT in HCC are similar and can be predicted using the in vitro radiosensitivity

EJNMMI Res. 2022 Jul 8;12(1):40. doi: 10.1186/s13550-022-00911-0.

Authors

Philippe d'Abadie¹, Stephan Walrand², Michel Hesse², Ivan Borbath³, Renaud Lhommel², François Jamar²

Affiliations

¹ Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Institut Roi Albert II, 10, avenue Hippocrate, 1200, Brussels, Belgium. philippe.dabadie@saintluc.uclouvain.be.
² Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Institut Roi Albert II, 10, avenue Hippocrate, 1200, Brussels, Belgium.
³ Department of Medical Oncology, CIiniques Universitaires Saint Luc, Institut Roi Albert II, Brussels, Belgium.

Abstract

Background: Tumor equivalent uniform dose (EUD) is proposed as a predictor of patient outcome after liver radioembolization (RE) of hepatocellular carcinoma (HCC) and can be evaluated with ⁹⁰Y-TOF-PET. The aim is to evaluate the correlation between PET-based tumors EUD and the clinical response evaluated with dual molecular tracer (¹¹C-acetate and ¹⁸F-FDG) PET/CT post-RE.

Methods: 34 HCC tumors in 22 patients were prospectively evaluated. The metabolic response was characterized by the total lesion metabolism variation (ΔTLM) between baseline and follow-up. This response allowed to compute a tumor control probability (TCP) as a function of the tumor EUD.

Results: The absorbed dose response correlation was highly significant (R = 0.72, P < 0.001). With an absorbed dose threshold of 40 Gy, the metabolic response was strongly different in both groups (median response 35% versus 100%, P < 0.001). Post-RE TCP as a function of the EUD was very similar to that observed in external beam radiation therapy (EBRT), with TCP values equal to 0.5 and 0.95 for a EUD of 51 Gy and 100 Gy, respectively. The TCP was perfectly predicted by the Poisson model assuming an inter tumor radiosensitivity variation of 30% around the HCC cell in vitro value.

Conclusions: EUD-based ⁹⁰Y TOF-PET/CT predicts the metabolic response post-RE in HCC assessed using dual molecular PET tracers and provides a similar TCP curve to that observed in EBRT. In vivo and in vitro HCC radiosensitivities are similar. Both TCPs show that a EUD of 100 Gy is needed to control HCC for the three devices (resin spheres, glass spheres, EBRT). Observed absorbed doses achieving this 100 Gy-EUD ranged from 190 to 1800 Gy!

Keywords: Acetate; EUD; FDG; HCC; PET; TCP.