The Pipeline

How PET imaging will enable more personalized interventional oncology treatment

David Gaffin and Cameron Ferrey, Technology Insights

This is the third in a series of posts covering the latest clinical technology news from the 2014 Symposium on Clinical Interventional Oncology (CIO). Our coverage again centers on novel oncologic applications for imaging modalities, a theme from our previous post on using intravascular ultrasound to better assess vascular invasion in cancer patients.

New evidence suggests that positron emission tomography/computed tomography (PET/CT) is superior to conventional single-photon emission computed tomography (SPECT) for post-radioembolization imaging. If confirmed, this finding could contribute to the displacement of SPECT in the interventional oncology sector.

High-dose yttrium-90 (Y-90) microsphere radioembolization has been documented as a viable alternative to conventional bland embolization in patients with initially non-resectable hepatocellular carcinoma (HCC) due to concerns over future liver remnant (FLR) volume. As adoption of Y-90 radioembolization has grown, efforts to improve the safety and efficacy of the procedure have followed suit.

Some efforts to improve safety and efficacy have focused on the post-procedural imaging phase of the radioembolization treatment process. As a result, Y-90 PET/CT imaging has recently gained favor over conventional SPECT as a superior post-procedural technique for assessing Y-90 microsphere distribution and the extent of non-target embolization. This change is due to two key advantages of PET/CT over SPECT, which are detailed in a new study presented at CIO 2014 last month.

Improved imaging technique enables patient-specific radioembolisation dosimetry

First, PET/CT imaging provides more accurate spatial resolution than SPECT scans. Second, Y-90 PET/CT imaging enables the creation of 3-dimensional absorbed-dose maps following radioembolization. 

These maps help evaluate the technical success of the procedure, but also allow for novel methods of dose modification, representing a large step forward in the development of patient-specific radioembolization dosimetry models. More accurate, patient-tailored dosimetry could improve the effectiveness of radioembolization procedures, reducing the need for follow-up treatments and mitigating associated costs.

If conclusive, these findings on the application of PET/CT for patient-specific radioembolization dosimetry calibration could also serve as another driver of oncologic PET/CT utilization, which The Advisory Board Company estimates will increase 88% in the hospital outpatient setting between 2012 and 2022.


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