选择性动脉内放射性核素治疗用钇-90（Y-90）微球治疗不可切除的原发性和转移性肝肿瘤。
Selective intraarterial radionuclide therapy with Yttrium-90 (Y-90) microspheres for unresectable primary and metastatic liver tumors.
机构信息
Department of Nuclear Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey.
出版信息
World J Surg Oncol. 2011 Aug 6;9:86. doi: 10.1186/1477-7819-9-86.
BACKGROUND
The aim of this study was to evaluate the success of selective intraarterial radionuclide therapy (SIRT) with Yttrium-90 (Y-90) microspheres in liver metastases of different tumors. We also interpreted the contribution of SIRT to survival times according to responder- non responder and hepatic- extra hepatic disease.
METHODS
The clinical and follow-up data of 124 patients who were referred to our department for SIRT between June 2008 [corrected] and October 2010 were evaluated retrospectively. SIRT has been applied to 78 patients who were suitable for treatment. All the patients had primary liver tumor or unresectable liver metastasis of different malignancies. The treatment was repeated at least one more time in 5 patients to the same or other lobes. Metabolic treatment response evaluated by fluorine-18 fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) in the 6th week after treatment. F18-FDG PET/CT was repeated in per six weeks periods. The response criterion had been described as at least 20% decrease of SUV value. Also in patients with neuroendocrine tumor serial Gallium-68 (Ga-68) PET/CT was used for evaluation of response. Patients were divided into 2 groups according to their treatment response.
RESULTS
68 patients received treatment for the right lobe, seven patients received treatment for the left lobe and 3 patients for both lobes. The mean treatment dose was estimated at 1.62 GBq. In the evaluation of treatment response; 43(55%) patients were responder (R) and 35 (45%) patients were non-responder (NR) in the sixth week F18-FDG PET/CT. Mean pretreatment SUVmax value of R group was 11.6 and NR group was 10.7. While only 11 (31%) out of 35 NR patients had H disease, 30 (69%) out of 43 R patients had H disease (p < 0.05). The mean overall survival time of R group was calculated as 25.63 ± 1.52 months and NR group's 20.45 ± 2.11 (p = 0.04). The mean overall survival time of H group was computed as 25.66 ± 1.52 months and EH group's 20.76 ± 1.97 (p = 0.09).
CONCLUSIONS
SIRT is a useful treatment method which can contribute to the lengthening of survival times in patients with primary or metastatic unresectable liver malignancies. Also F18-FDG PET/CT is seen to be a successful imaging method in evaluating treatment response for predicting survival times in this patient group.
背景
本研究旨在评估钇-90（Y-90）微球选择性经动脉放射性核素治疗（SIRT）在不同肿瘤肝转移中的疗效。我们还根据应答者-非应答者和肝内-肝外疾病来解释 SIRT 对生存时间的贡献。
方法
回顾性分析 2008 年 6 月至 2010 年 10 月期间因 SIRT 而被转诊至我科的 124 例患者的临床和随访数据。对 78 例适合治疗的患者进行了 SIRT 治疗。所有患者均有原发性肝癌或不可切除的肝转移癌。在 5 例患者中，将相同或其他叶进行了至少一次重复治疗。治疗后第 6 周，通过氟-18 氟脱氧葡萄糖（F18-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）评估代谢治疗反应。每六周重复进行 F18-FDG PET/CT 检查。反应标准描述为 SUV 值至少降低 20%。在神经内分泌肿瘤患者中，还使用镓-68（Ga-68）PET/CT 对反应进行评估。根据治疗反应，患者分为 2 组。
结果
68 例患者接受右叶治疗，7 例患者接受左叶治疗，3 例患者接受双叶治疗。平均治疗剂量估计为 1.62GBq。在 F18-FDG PET/CT 第六周的治疗反应评估中，43 例（55%）患者为应答者（R），35 例（45%）患者为无应答者（NR）。R 组治疗前 SUVmax 值的平均值为 11.6，NR 组为 10.7。尽管只有 35 例 NR 患者中的 11 例（31%）患有 H 疾病，但 43 例 R 患者中有 30 例（69%）患有 H 疾病（p<0.05）。R 组的总生存时间平均值为 25.63±1.52 个月，NR 组为 20.45±2.11（p=0.04）。H 组的总生存时间平均值为 25.66±1.52 个月，EH 组的总生存时间平均值为 20.76±1.97（p=0.09）。
结论
SIRT 是一种有用的治疗方法，可延长原发性或转移性不可切除肝恶性肿瘤患者的生存时间。此外，F18-FDG PET/CT 是一种成功的成像方法，可用于评估该患者群体的治疗反应，从而预测生存时间。
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