Response to 'patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres.' (int j radiat oncol biol phys 2010;oct 13).

摘要

To the Editor: We congratulate the expert panel for the activity planning consensus guideline for Yttrium-90 resin microsphere selective internal radiotherapy (1). However, some issues in the article require clarification: In Fig. 2, Infuse to flow stasis for radiation segmentectomy, no further details or references were provided. Do the authors suggest intermittent checks by contrast injection interrupting microsphere infusion to determine the point of flow stasis? If so, how should the desired particle load be predetermined? The article contradicts by stating that Body Surface Area (BSA) method BSA activity planning is "suited for small lesions with diffuse margins" when earlier in the article it is mentioned that "[BSA] calculation requires the liver and tumor volume from the computed tomography scan or magnetic resonance imaging." It is not possible for small lesions with diffuse margins to be clearly delineated on sectional imaging. Our recommendation in these situations is to use the BSA method with visual estimation of tumor involvement.