Hospices Civils de Lyon, Service de Médecine Nucléaire, Centre Hospitalier Lyon-Sud and Université Claude Bernard Lyon 1, EA 3738 Lyon, France.
Eur J Nucl Med Mol Imaging. 2011 Jul;38(7):1393-406. doi: 10.1007/s00259-011-1812-2.
Primary liver cancers (i.e. hepatocellular carcinoma or cholangiocarcinoma) are worldwide some of the most frequent cancers, with rapidly fatal liver failure in a large majority of patients. Curative therapy consists of surgery (i.e. resection or liver transplantation), but only 10-20% of patients are candidates for this. In other patients, a variety of palliative treatments can be given, such as chemoembolization, radiofrequency ablation or recently introduced tyrosine kinase inhibitors, e.g. sorafenib. Colorectal cancer is the second most lethal cancer in Europe and liver metastases are prevalent either at diagnosis or in follow-up. These patients are usually treated by a sequence of surgery, chemotherapy and antibody therapy [Okuda et al. (Cancer 56:918-928, 1985); Schafer and Sorrell (Lancet 353:1253-1257, 1999); Leong et al. (Arnold, London, 1999)]. Radioembolization is an innovative therapeutic approach defined as the injection of micron-sized embolic particles loaded with a radioisotope by use of percutaneous intra-arterial techniques. Advantages of the use of these intra-arterial radioactive compounds are the ability to deliver high doses of radiation to small target volumes, the relatively low toxicity profile, the possibility to treat the whole liver including microscopic disease and the feasibility of combination with other therapy modalities. Disadvantages are mainly due to radioprotection constraints mainly for (131)I-labelled agents, logistics and the possibility of inadvertent delivery or shunting [Novell et al. (Br J Surg 78:901-906, 1991)]. The Therapy, Oncology and Dosimetry Committees have worked together in order to revise the European Association of Nuclear Medicine (EANM) guidelines on the use of the radiopharmaceutical (131)I-Lipiodol (Lipiocis®, IBA, Brussels, Belgium) and include the newer medical devices with (90)Y-microspheres. (90)Y is either bound to resin (SIR-Spheres®, Sirtex Medical, Lane Cove, Australia) or embedded in a glass matrix (TheraSphere®, MDS Nordion, Kanata, ON, Canada). Since (90)Y-microspheres are not metabolized, they are not registered as unsealed sources. However, the microspheres are delivered in aqueous solution: radioactive contamination is a concern and microspheres should be handled, like other radiopharmaceuticals, as open sources. The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients undergoing such treatment.
原发性肝癌（即肝细胞癌或胆管细胞癌）是全球最常见的癌症之一，大多数患者会迅速因肝衰竭而死亡。根治性治疗包括手术（即切除术或肝移植），但只有 10-20%的患者适合这种治疗。在其他患者中，可以给予各种姑息治疗，如化疗栓塞、射频消融或最近引入的酪氨酸激酶抑制剂，如索拉非尼。结直肠癌是欧洲第二大致命癌症，肝转移在诊断时或随访时很常见。这些患者通常通过手术、化疗和抗体治疗的序贯治疗[Okuda 等人，（癌症 56:918-928，1985）；Schafer 和 Sorrell，（柳叶刀 353:1253-1257，1999）；Leong 等人，（Arnold，London，1999）]。放射性栓塞是一种新的治疗方法，定义为通过经皮动脉内技术注射负载放射性同位素的微米级栓塞颗粒。使用这些动脉内放射性化合物的优点是能够将高剂量的辐射输送到小靶体积，相对较低的毒性谱，治疗整个肝脏（包括显微镜下疾病）的可能性以及与其他治疗方式联合的可行性。缺点主要是由于辐射防护限制，主要针对（131）I 标记的药物、物流以及意外输送或分流的可能性[Novell 等人，（英国外科学杂志 78:901-906，1991）]。治疗、肿瘤学和剂量学委员会共同努力，修订了欧洲核医学协会（EANM）关于放射性药物（131）I-Lipiodol（Lipiocis®，IBA，布鲁塞尔，比利时）使用的指南，并纳入了带有（90）Y 微球的新型医疗器械。（90）Y 要么与树脂结合（SIR-Spheres®，Sirtex Medical，Lane Cove，澳大利亚），要么嵌入玻璃基质（TheraSphere®，MDS Nordion，Kanata，ON，加拿大）。由于（90）Y 微球不能代谢，因此它们不作为未密封源注册。然而，微球是在水溶液中输送的：放射性污染是一个问题，微球应像其他放射性药物一样作为开放源进行处理。本指南的目的是协助核医学医师对接受此类治疗的患者进行治疗和管理。
