TABLE OF CONTENT Remerciements.................................................................................................................................7 Résumé........................................................................................

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TABLE OF CONTENT

Remerciements...7

Résumé...9

Summary...11

Contributing papers...13

List of abbreviations...15

Chapter I: General Introduction...19

1 Radioembolization with Yttrium-90...19

1.1 Principle...19

1.2 Products...21

1.3 Therapeutic intent...22

1.4 Treatment course...24

1.5 Estimation of the Lung-shunt fraction...27

1.6 Standard activity prescription method...27

2 Radioembolization indications...28

3 Other liver locoregional therapies...28

3.1 Surgery...28

3.2 Thermal therapies...28

3.3 Stereotactic external beam radiotherapy...28

3.4 Transarterial therapies...29

4 Radioembolization prospective randomised clinical trials...29

4.1 Negative trials...30

4.2 Positive trial...32

4.3 What have we learned form these trials...33

5 Personalised radioembolization...36

5.1 Therapeutic window of radioembolization...36

5.2 Personalised activity prescription...36

6 Thesis outline...38

7 References...40

Chapter II: Personalised radioembolization improves outcomes in refractory intrahepatic

cholangiocarcinoma: a multicentre study...47

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1 Introduction...47

2 Article: Personalised radioembolization improves outcomes in refractory intrahepatic cholangiocarcinoma: a multicentre study...48

2.1 Abstract...48

2.2 Introduction...49

2.3 Materials and Methods...50

2.4 Results...54

2.5 Discussion...61

2.6 Conclusion...64

2.7 Supplementary materials...65

2.8 References...68

Chapter III:

⁹⁰

Y-PET/CT-based dosimetry after selective internal radiation therapy predicts outcome in patients with liver metastases from colorectal cancer...73

1 Introduction...73

2 Article:

⁹⁰

Y-PET/CT-based dosimetry after selective internal radiation therapy predicts outcome in patients with liver metastases from colorectal cancer...74

2.1 Abstract...74

2.2 Introduction...75

2.3 Methods...76

2.4 Results...80

2.5 Discussion...85

2.6 Conclusions...89

2.7 References...90

Chapter IV: Combined Quality and Dose Volume Histograms for assessing the predictive value of

99m

Tc-MAA SPECT/CT simulation for personalizing radioembolization treatment in liver metastatic colorectal cancer...95

1 Introduction...95

2 Article: Combined Quality and Dose Volume Histograms for assessing the predictive value of

99m

Tc-MAA SPECT/CT simulation for personalizing radioembolization treatment in liver metastatic colorectal cancer...96

2.1 Abstract...96

2.2 Introduction...97

2.3 Materials and Methods...98

2.4 Results...104

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2.5 Discussion...110

2.6 Conclusion...115

2.7 Supplementary material...116

2.8 Reference...118

Chapter V: International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres...123

1 Introduction...123

2 Article: International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres...124

2.1 Abstract...124

2.2 Introduction...125

2.3 Methods...126

2.4 Results...127

2.5 Interventional strategy and pre-treatment 99mTc-MAA simulation...128

2.6 Individual activity-prescription methods...132

2.7 Individual activity-prescription...136

2.8 Treatment evaluation...140

2.9 Future directions...142

2.10 Conclusion...143

2.11 Supplementary material...144

2.12 References...154

Chapter VI: General Discussion...162

1 Synthesis of our results...162

2 Personalised activity prescription method...163

3 Relationship between the absorbed dose and the efficacy/safety...165

4 Predictive value of

^99m

Tc-MAA simulation...167

5 Limitations of our investigations...170

6 Conclusion and Perspectives...171

7 Reference...174