Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
Diagn Interv Radiol. 2010 Mar;16(1):70-8. doi: 10.4261/1305-3825.DIR.2693-09.1. Epub 2010 Feb 16.
Radioembolization with yttrium-90 microsphere (Y-90) therapy with SIR-Spheres (Sirtex Medical, Lane Cove, Australia) was approved by the Turkish Ministry of Health in April 2008. In this study, we present the preliminary experience at a tertiary care center with early follow-up results of Y-90 therapy, as well as a review of the related literature.
Complete evaluation for radioembolization was performed in 10 patients (8 males, 2 females; mean age, 52.3 years) during an 8-month period at a single center, of which 9 were actually treated with SIR-Spheres(R). All patients underwent meticulous pre- and post-procedural imaging studies to document the therapy response. RESULTS; In order to isolate the target hepatic arterial circulation, following branches were embolized as they were considered as potential gastrointestinal shunts: the gastroduodenal artery (n = 5), right gastric artery (n = 1), and supraduodenal artery (n = 1). Radioembolization therapy could not be performed only in one patient because of a hepatogastric shunt of unknown origin. No significant hepatopulmonary shunting was identified (maximum, 9% shunting). The body surface area method was used to calculate the Y-90 dose in all patients (mean dose, 1.24 GBq). All patients had at least partial response of the targeted liver lesions, according to RECIST (Response Evaluation Criteria in Solid Tumors).
In comparison to chemoembolization, radioembolization has less systemic toxicity and can be performed as an outpatient procedure, which makes it more attractive to both patients and physicians. From our limited experience, the radioembolization procedure is a promising first-line treatment in unresectable liver cancer; randomized controlled multi-center studies, however, are needed.
钇-90 放射性微球（Y-90）栓塞疗法于 2008 年 4 月获得土耳其卫生部批准。本研究介绍了在一家三级医疗中心进行的初步经验，以及对相关文献的回顾。
在单中心的 8 个月内，对 10 名患者（8 名男性，2 名女性；平均年龄 52.3 岁）进行了完整的放射性栓塞评估，其中 9 名患者实际接受了 SIR-Spheres（R）治疗。所有患者均进行了细致的术前和术后影像学研究，以记录治疗反应。
为了隔离目标肝动脉循环，以下分支被栓塞，因为它们被认为是潜在的胃肠道分流：胃十二指肠动脉（n=5）、胃右动脉（n=1）和十二指肠上动脉（n=1）。由于未知来源的肝胃分流，只有 1 名患者无法进行放射性栓塞治疗。未发现明显的肝肺分流（最大分流率 9%）。所有患者均采用体表面积法计算 Y-90 剂量（平均剂量 1.24GBq）。根据实体瘤反应评价标准（RECIST），所有患者的目标肝病变均至少有部分缓解。
与化疗栓塞相比，放射性栓塞的全身毒性较小，可作为门诊手术进行，因此对患者和医生都更具吸引力。根据我们的有限经验，放射性栓塞术是不可切除肝癌的一种有前途的一线治疗方法；然而，需要进行随机对照多中心研究。
