Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA.
J Surg Res. 2011 Apr;166(2):236-40. doi: 10.1016/j.jss.2009.05.021. Epub 2009 Jun 12.
Unresectable hepatic metastases from aerodigestive cancers are common and in most cases herald a poor prognosis. A small percentage of patients maybe amenable to surgical resection or ablation once the biology of the disease and the burden of hepatic disease are better understood. The use of hepatic arterial resin microspheres containing the β emitter, yttrium-90, has been reported in the treatment of unresectable hepatic metastases. The goal of this review was to evaluate the use of yttrium-90 hepatic arterial therapy in the management of hepatic metastases and surgical downstaging.
We reviewed our prospective hepatic arterial therapy registry and found 44 patients who had received Sir Sphere treatment for unresectable hepatic malignancies from 11/06 to 7/08. Response was assessed by using CT-imaging and characterized using modified response evaluation criteria in solid tumors (RECIST). All patients were managed in a multidisciplinary tertiary referral center specializing in hepatic malignancies.
A total of 44 patients, 34 men and 10 women, with a median age of 60 y (range 44-8), received 67 treatments. The disease types treated were one adenosquamous tongue, one adrenal, nine carcinoid, three cholangiocarcinoma, four esophageal, one gastric, one gastrinoma, one GIST, four HCC, 15 colorectal, one melanoma, one non-small-cell lung, one occular, and one sarcoma. Four patients treated proceeded to resection because of downstaging of disease or no evidence of extrahepatic progression. The median age in these patients was 61 y (range 49-62). All of the patients had less than 25% tumor burden in the liver. Surgical therapy consisted of two patients undergoing right hepatic lobectomy, one patient who also underwent two wedge resections of segment 3, and one patient who had a left lateral hepatectomy with right lobe microwave ablation. The median length of postoperative stay was 7 d. There was no evidence of liver dysfunction following resection in any of the patients. None of the patients show evidence of recurrence in the liver following resection. One patient has had progression of disease in the lungs following resection, histologically confirmed as metastatic rectal carcinoma. All of the patients are currently alive with a median survival of 2 y.
Hepatic directed yttrium-90 is a minimally invasive, highly effective therapy that can be utilized to downstage the hepatic burden and/or assess the biology of the disease to allow for appropriate treatment. The use of yttrium-90 microspheres for radio-embolization of metastases in the liver can successfully downstage the lesions to allow for surgical resection in patients with amenable predictors, and can provide a significantly better prognosis in these patients. This form of therapy for the purposes of downstaging tumors for resection merits more extensive study in order to provide the best possible outcomes for patients with metastatic liver disease.
来自消化呼吸道癌症的不可切除肝转移瘤很常见，且在大多数情况下预示预后不良。一小部分患者在更好地了解疾病的生物学特性和肝脏疾病的负担后，可能适合手术切除或消融治疗。含有β发射体钇-90 的肝动脉树脂微球的应用已在不可切除的肝转移瘤的治疗中得到报道。本综述的目的是评估钇-90 肝动脉治疗在管理肝转移瘤和手术降级中的应用。
我们回顾了我们的前瞻性肝动脉治疗登记处，发现 11/06 至 7/08 期间有 44 例接受 SirSphere 治疗不可切除肝恶性肿瘤的患者。通过 CT 成像评估反应，并使用实体瘤反应评估标准（RECIST）进行特征描述。所有患者均在专门治疗肝恶性肿瘤的多学科三级转诊中心进行管理。
共有 44 名患者，34 名男性和 10 名女性，中位年龄为 60 岁（范围 44-8），接受了 67 次治疗。治疗的疾病类型包括 1 例舌鳞腺癌、1 例肾上腺癌、9 例类癌、3 例胆管癌、4 例食管癌、1 例胃癌、1 例胃泌素瘤、1 例 GIST、4 例 HCC、15 例结直肠癌、1 例黑色素瘤、1 例非小细胞肺癌、1 例眼癌和 1 例肉瘤。有 4 例因疾病降级或无肝外进展而行手术切除的患者。这些患者的中位年龄为 61 岁（范围 49-62）。所有患者肝脏肿瘤负荷均小于 25%。手术治疗包括 2 例右半肝切除术、1 例同时行 3 段楔形切除术、1 例左外侧肝切除术联合右叶微波消融术。术后平均住院时间为 7 天。无患者出现肝切除术后肝功能障碍。所有患者在肝切除术后均未见肿瘤复发。1 例患者在肺内有疾病进展，组织学证实为转移性直肠癌。所有患者目前均存活，中位生存时间为 2 年。
肝脏靶向钇-90 是一种微创、高效的治疗方法，可用于降级肝脏负担和/或评估疾病生物学特性，以进行适当的治疗。钇-90 微球用于治疗肝脏转移瘤的放射性栓塞可成功降级肿瘤，使可预测的患者能够进行手术切除，并为这些患者提供显著更好的预后。为了为转移性肝疾病患者提供最佳治疗效果，这种用于肿瘤降级的治疗方法值得进行更广泛的研究。
