International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

Abstract Purpose A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 ( 90 Y)-resin microspheres. Methods steering committee 23 international experts representing all participating specialties formulated SIRT Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches the responses a 61-question survey that was completed by 43 leading (including members). The validated anonymously. In face-to-face meeting, results were presented discussed. Recommendations derived level agreement defined (strong ≥ 80%, moderate 50%–79%, no ≤ 49%). Results Forty-seven established, including guidance such as team should define treatment strategy therapeutic intent agreement); 3D imaging CT an angiography cone-beam-CT, if available, 99m Tc-MAA SPECT/CT are recommended extrahepatic/intrahepatic deposition assessment, field definition calculation needed (moderate/strong agreement). personalised approach, using dosimetry (partition model and/or voxel-based) is prescription, when either whole liver or selective, non-ablative ablative planned mean absorbed dose non-tumoural 40 Gy less considered safe minimum target-absorbed tumour 100–120 hepatocellular carcinoma, metastatic colorectal cancer cholangiocarcinoma Post-SIRT verification Y-PET/CT also Conclusion Practitioners encouraged work towards adoption these recommendations.