Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany.
Semin Nucl Med. 2010 Mar;40(2):105-21. doi: 10.1053/j.semnuclmed.2009.11.001.
Radioembolization (RE), also termed selective internal radiation therapy (SIRT), has been gradually introduced to the clinical arsenal of cytoreductive modalities in recent years. There is growing evidence for efficiency in liver tumors of various entities, with the most prominent ones being hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors. Hepatic metastases of numerous other tumor entities including breast cancer, cholangiocarcinoma, and pancreatic cancer are treatment-sensitive, even when being refractory to other treatment modalities such as bland-embolization, regional, or systemic chemotherapy. The antitumor effect of SIRT is related to radiation rather than embolization, with extraordinary high local radiation doses obtained selectively at the site of viable tumor and little affection of the surrounding normal liver tissue. Morphologic changes after RE may pose difficulties for interpretation in conventional restaging with regard to tumor viability and true response to treatment. Therefore, functional imaging, that is, metabolic imaging with (18)F fluorodeoxyglucose positron emission tomography (computed tomography) in the majority of treated tumors, is regarded the gold standard in this respect and should be included for pre- and post-SIRT assessment. To prevent serious toxicity to be associated with the potent antitumor efficacy, meticulous pretreatment evaluation is of particular importance. Improvements in predicting dosimetry will help optimize treatment and patient selection. Nuclear medicine procedures are essential for planning, performing, and monitoring of RE. However, the interdisciplinary aspect of patient management has to be emphasized for this particular treatment form. As SIRT is moving forward from the salvage setting indication to the use in earlier stages of hepatic tumor disease and with the advent of new treatment protocols and targeted therapies, embedding SIRT into a multidisciplinary approach will become even more important. This article focuses on procedural and technical aspects for selection, preparation, and performance of treatment as well as post-therapeutic monitoring and response assessment.
放射性栓塞治疗（RE），也称为选择性内放射治疗（SIRT），近年来已逐渐被引入到减瘤治疗手段的临床武器库中。越来越多的证据表明其对各种实体肝肿瘤具有疗效，其中最为突出的是肝细胞癌、结直肠癌和神经内分泌肿瘤。许多其他肿瘤实体的肝转移灶对治疗敏感，即使对其他治疗方式如单纯栓塞、区域性或全身化疗具有耐药性也是如此。SIRT 的抗肿瘤作用与栓塞无关，而是与辐射有关，在有活力的肿瘤部位选择性地获得极高的局部辐射剂量，而周围正常肝组织几乎不受影响。RE 后的形态学变化可能会给常规的肿瘤活性和治疗反应的再分期解读带来困难。因此，功能成像，即大多数治疗肿瘤的（18）F 氟脱氧葡萄糖正电子发射断层扫描（计算机断层扫描）代谢成像，被认为是这方面的金标准，并且应该在 SIRT 前后评估中包括。为了防止与强效抗肿瘤疗效相关的严重毒性，精细的预处理评估尤为重要。改进剂量预测将有助于优化治疗和患者选择。核医学程序是规划、执行和监测 RE 的必要手段。然而，对于这种特殊的治疗形式，必须强调患者管理的跨学科方面。随着 SIRT 从挽救性治疗适应证向肝肿瘤疾病早期阶段的应用以及新的治疗方案和靶向治疗的出现，将 SIRT 纳入多学科方法将变得更加重要。本文重点介绍了治疗的选择、准备和执行以及治疗后的监测和反应评估的程序和技术方面。
