Bester Lourens, Feitelson Samantha, Milner Brad, Chua Terence C, Morris David L
*Department of Medical Imaging, St Vincent's Hospital ‡Department of Surgery, St George Hospital †Faculty of Medicine, University of New South Wales, Sydney, NSW Australia.
Am J Clin Oncol. 2014 Oct;37(5):454-60. doi: 10.1097/COC.0b013e31827deea1.
Yttrium-90 (Y) radioembolization is increasingly used as a minimally invasive therapy for unresectable liver tumors; however, previous hepatectomy must be considered to avoid excessive hepatic insult. A retrospective analysis was undertaken to investigate the viability of performing radioembolization on a remnant liver.
A retrospective analysis was performed on data collected from December 2005 to August 2011 to identify the effect of prior hepatectomy on radioembolization outcomes. Survival and complications were reviewed for up to 3 months after radioembolization.
Of 427 patients eligible for analysis, 89 underwent previous hepatectomy. Immediate adverse events included abdominal pain (7.9% of hepatectomy patients vs. 18.0% of non-hepatectomy patients; P = 0.02), nausea (4.5% vs. 8.0%; P > 0.05), and emesis (0.0% vs. 0.9%; P > 0.05). The prevalence of intermediate complications 1 month after radioembolization was low. Late complications included radiation-induced liver disease (3.4% vs. 1.5%; P > 0.05), ulceration (2.2% vs. 2.7%; P > 0.05), and gallbladder and biliary tree-related outcomes (2.2% vs. 1.8%; P > 0.05). Imaging analysis demonstrated a significant relationship between prior hepatectomy patients and a partial response to radioembolization, as well as progressive disease. The median overall survival after radioembolization for hepatectomy patients was 7.8 months, versus 5.8 months for non-hepatectomy patients (P = 0.108).
Our results indicate that radioembolization is safe to be performed on a remnant liver. Although imaging analysis demonstrated varying responses to radioembolization when comparing hepatectomy patients to non-hepatectomy patients, overall survival was shown to be similar between the 2 groups.
钇-90（Y）放射性栓塞术越来越多地被用作不可切除肝肿瘤的微创治疗方法；然而，必须考虑先前的肝切除术以避免对肝脏造成过度损伤。进行了一项回顾性分析，以研究在残余肝脏上进行放射性栓塞术的可行性。
对2005年12月至2011年8月收集的数据进行回顾性分析，以确定先前肝切除术对放射性栓塞术结果的影响。对放射性栓塞术后长达3个月的生存率和并发症进行了评估。
在427例符合分析条件的患者中，89例曾接受过肝切除术。即刻不良事件包括腹痛（肝切除患者中的7.9% vs. 非肝切除患者中的18.0%；P = 0.02）、恶心（4.5% vs. 8.0%；P > 0.05）和呕吐（0.0% vs. 0.9%；P > 0.05）。放射性栓塞术后1个月的中度并发症发生率较低。晚期并发症包括放射性肝病（3.4% vs. 1.5%；P > 0.05）、溃疡（2.2% vs. 2.7%；P > 0.05）以及胆囊和胆道相关结果（2.2% vs. 1.8%；P > 0.05）。影像学分析显示，先前接受肝切除术的患者与放射性栓塞术的部分缓解以及疾病进展之间存在显著关系。肝切除患者放射性栓塞术后的中位总生存期为7.8个月，而非肝切除患者为5.8个月（P = 0.108）。
我们的结果表明，在残余肝脏上进行放射性栓塞术是安全的。尽管影像学分析显示，将肝切除患者与非肝切除患者进行比较时，对放射性栓塞术的反应有所不同，但两组的总生存期相似。
