Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N St Clair, Ste 800, Chicago, IL 60611, USA.
J Vasc Interv Radiol. 2009 Dec;20(12):1557-63. doi: 10.1016/j.jvir.2009.08.021. Epub 2009 Oct 24.
To evaluate the safety and efficacy of yttrium-90 ((90)Y) radioembolization with extended-shelf-life glass microspheres. We postulated that this approach, for the same planned tissue dose of 120 Gy, would increase the embolic load, improve distribution, and result in enhanced tumor response without causing additional adverse events.
Between June 2007 and September 2008, 50 patients with extensive tumor burden and/or markedly hypervascular tumors (13 hepatocellular carcinomas, and 37 liver metastases) underwent radioembolization with extended-shelf-life microspheres at a planned dose of 120 Gy. Baseline and follow-up imaging and laboratory data were obtained. Response in the target lesion was assessed with cross-sectional imaging by using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines.
The mean delivered radiation dose was 126 Gy. The mean increase in embolic load with this approach was 111%, corresponding to an increase from 3.6 to 7.3 million microspheres. Clinical toxicities included fatigue (28 patients, 56%), abdominal pain (19 patients, 38%), and nausea/vomiting (six patients, 12%). Grade 3-4 bilirubin toxicity was seen in one patient. Two gastroduodenal ulcers were observed. With cross-sectional imaging, response rates according to WHO and EASL guidelines were 51% and 69%, respectively.
The results demonstrate the safety and efficacy of extended-shelf-life (90)Y glass microspheres. The increased embolic load and lowered activity per microsphere theoretically resulted in better tumor coverage and, hence, improved response rates. This standardizable treatment paradigm provides a minimally embolic therapy for liver tumors.
评估钇-90((90)Y)放射性栓塞联合长货架期玻璃微球的安全性和有效性。我们推测，对于相同的 120Gy 计划组织剂量，这种方法会增加栓塞负荷，改善分布，从而提高肿瘤反应率，而不会导致额外的不良事件。
2007 年 6 月至 2008 年 9 月，50 例广泛肿瘤负荷和/或明显富血管肿瘤（13 例肝细胞癌，37 例肝转移瘤）患者接受了长货架期微球放射性栓塞治疗，计划剂量为 120Gy。获取基线和随访的影像学和实验室数据。采用世界卫生组织（WHO）和欧洲肝脏研究协会（EASL）指南，通过横断面成像评估靶病变的反应。
平均放射性剂量为 126Gy。该方法栓塞负荷的平均增加率为 111%，相当于从 360 万至 730 万微球的增加。临床毒性包括乏力（28 例，56%）、腹痛（19 例，38%）和恶心/呕吐（6 例，12%）。1 例患者出现 3-4 级胆红素毒性。观察到 2 例胃十二指肠溃疡。根据 WHO 和 EASL 指南，横断面成像的反应率分别为 51%和 69%。
结果表明长货架期（90）Y 玻璃微球的安全性和有效性。栓塞负荷的增加和每微球放射性活度的降低理论上会提高肿瘤的覆盖范围，从而提高反应率。这种可标准化的治疗方案为肝脏肿瘤提供了一种微创栓塞疗法。
