Medical Oncology Clinic, Digestive Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Rue Heger-Bordet 1, B-1000 Brussels, Belgium.
Expert Opin Pharmacother. 2010 Mar;11(4):579-86. doi: 10.1517/14656560903520916.
Metastatic tumours of the liver are responsible for significant morbidity and mortality, and only a small percentage is resectable with curative intent. Hepatic artery radioembolization (RE) with yttrium-90 ((90)Y)-loaded microspheres is an alternative treatment for patients with unresectable primary or secondary liver tumours, especially in cases of metastatic colorectal cancer (mCRC) and hepatocellular carcinoma (HCC).
Data from recent relevant clinical trials with (90)Y-RE are discussed, focusing on response rate assessments and treatment outcome.
Current data show that (90)Y-RE combined with radiosensitizing chemotherapy is a safe and efficient modality that extends the time to progression in liver mCRC and unresectable HCC, although no survival benefits have been demonstrated. The treatment response after (90)Y-RE seems to be better assessed using metabolic response assessments with serial fluorodeoxyglucose positron emission tomography (FDG-PET) in cases of FDG-avid tumours than with morphological criteria measured on computed tomography or magnetic resonance imaging (RECIST or WHO trials). Predictive models using multimodality imaging approaches (PET-SPECT-CT image fusion algorithms) have been proposed to better select patients for (90)Y-RE. The optimal routine role of radioembolization remains to be defined; the complexity and wide availability of available therapeutic alternatives confuses the role of a locoregional treatment in a generalized disease.
(90)Y-RE is a safe and efficient treatment modality in salvage therapy of colorectal cancer metastatic to the liver and in unresectable HCC. However, it has still to find its place as a first- or second-line treatment of mCRC in combination with or as an alternative to available biological agents. The role of (90)Y-RE in other solid tumour types metastatic to the liver is much more uncertain and investigations in clinical situations in which disease is strictly limited to the liver are required. Pretherapeutic work-up, initially developed to explore hepatic vasculature and to assess lung shunting, might be able to predict treatment outcome, allowing a better patient selection.
转移性肝脏肿瘤是导致重大发病率和死亡率的原因，只有一小部分具有治愈意图的肿瘤是可切除的。对于无法切除的原发性或继发性肝脏肿瘤患者，肝动脉放射栓塞 (RE) 联合钇-90 ((90)Y)-载微球是一种替代治疗方法，特别是对于转移性结直肠癌 (mCRC) 和肝细胞癌 (HCC) 患者。
讨论了最近与 (90)Y-RE 相关的临床试验数据，重点关注反应率评估和治疗结果。
目前的数据表明，(90)Y-RE 联合放射增敏化疗是一种安全有效的方法，可延长肝 mCRC 和不可切除 HCC 的无进展时间，尽管尚未证明有生存获益。与使用计算机断层扫描或磁共振成像 (RECIST 或 WHO 试验) 测量的形态学标准相比，在 FDG 摄取肿瘤中，使用代谢反应评估 (连续氟脱氧葡萄糖正电子发射断层扫描 [FDG-PET]) 似乎可以更好地评估 (90)Y-RE 后的治疗反应。已经提出了使用多模态成像方法 (PET-SPECT-CT 图像融合算法) 的预测模型，以更好地选择接受 (90)Y-RE 的患者。放射栓塞的最佳常规作用仍有待确定；可用治疗选择的复杂性和广泛可用性使局部治疗在全身性疾病中的作用变得复杂。
(90)Y-RE 是转移性结直肠癌肝转移和不可切除 HCC 的挽救性治疗的一种安全有效的治疗方法。然而，它仍需在联合或替代现有生物制剂的情况下，在 mCRC 的一线或二线治疗中找到自己的位置。(90)Y-RE 在转移性至肝脏的其他实体瘤类型中的作用更加不确定，需要在疾病严格局限于肝脏的临床情况下进行研究。治疗前评估最初是为了探索肝血管并评估肺分流而开发的，它可能能够预测治疗结果，从而更好地选择患者。
