Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany.
J Nucl Med. 2013 Apr;54(4):516-22. doi: 10.2967/jnumed.112.112508. Epub 2013 Feb 27.
(90)Y radioembolization is a promising therapy for patients with primary and secondary liver malignancies. Pretherapeutic assessment consists of hepatic angiography and (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) perfusion scintigraphy to estimate the liver-to-lung shunt and exclude extrahepatic (99m)Tc-MAA deposition. However, the predictive value of intratumoral (99m)Tc-MAA uptake remains unclear.
One hundred four patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer were treated with (90)Y radioembolization between December 2006 and December 2010. All of the patients underwent angiographic assessment and perfusion scintigraphy with (99m)Tc-MAA before lobar (90)Y radioembolization. For inclusion, patients must have undergone pretherapeutic and follow-up MR imaging (6 wk and 3 mo after radioembolization, respectively). The degree of intratumoral (99m)Tc-MAA uptake was rated, and liver metastases were classified according to changes in tumor diameter on both an individual and a patient basis using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Response at both time points, MAA uptake, and catheter position were then statistically analyzed in a linear and generalized linear mixed model at a significance level of 0.05 (P value).
Sixty-six patients with a total of 435 colorectal liver metastases (mean number of lesions ± SD, 6.6 ± 2.8; mean lesion size ± SD, 33.8 ± 21.2 mm; lesion size range, 10-154 mm) were included in this analysis. According to the patient-based analysis, 3 patients had partial response, 49 stable disease, and 6 progressive disease after 6 wk. After 3 mo, 5 patients showed partial response, 26 stable disease, and 17 progressive disease. There was no association of patient-based tumor response with overall (99m)Tc-MAA uptake (P = 0.172) or with catheter position (P = 0.6456). Furthermore, an interaction effect of (99m)Tc-MAA uptake and catheter position in relation to tumor response was not found (P = 0.512). Moreover, in lesion-based analysis according to RECIST 1.1 there was no association of tumor response with degree of (99m)Tc-MAA uptake, catheter position, or interaction of (99m)Tc-MAA uptake and catheter position (P = 0.339, 0.593, and 0.658, respectively).
Response to (90)Y radioembolization was found to be independent of the degree of (99m)Tc-MAA uptake. Therefore, therapy should not be withheld from patients with colorectal liver metastases lacking intratumoral (99m)Tc-MAA accumulation.
（90）Y 放射性栓塞治疗是一种有前途的原发性和继发性肝恶性肿瘤的治疗方法。治疗前评估包括肝血管造影术和（99m）Tc-聚合白蛋白（（99m）Tc-MAA）灌注闪烁照相术，以评估肝-肺分流并排除肝外（99m）Tc-MAA 沉积。然而，肿瘤内（99m）Tc-MAA 摄取的预测价值仍不清楚。
2006 年 12 月至 2010 年 12 月，104 例化疗耐药的肝优势转移性结直肠癌患者接受了（90）Y 放射性栓塞治疗。所有患者在进行（90）Y 放射性栓塞前均接受血管造影评估和（99m）Tc-MAA 灌注闪烁照相术。纳入标准为患者必须在治疗前和治疗后分别进行 6 周和 3 个月的 MRI 随访（分别为 6 周和 3 个月）。评价肿瘤内（99m）Tc-MAA 摄取程度，并根据个体和患者的肿瘤直径变化，采用实体瘤反应评估标准（RECIST）1.1 对肝转移瘤进行分类。采用线性和广义线性混合模型，在 0.05 水平（P 值）对两个时间点的反应、MAA 摄取和导管位置进行统计学分析。
本研究共纳入 66 例患者的 435 个结直肠肝转移瘤（平均病灶数±标准差，6.6±2.8；平均病灶大小±标准差，33.8±21.2mm；病灶大小范围，10-154mm）。根据患者的分析，6 周后 3 例患者部分缓解，49 例稳定，6 例进展。3 个月后，5 例患者部分缓解，26 例稳定，17 例进展。患者肿瘤反应与总体（99m）Tc-MAA 摄取（P=0.172）或导管位置（P=0.6456）无关。此外，（99m）Tc-MAA 摄取与导管位置与肿瘤反应之间也没有发现交互作用（P=0.512）。此外，根据 RECIST 1.1 的病变基础分析，肿瘤反应与（99m）Tc-MAA 摄取程度、导管位置或（99m）Tc-MAA 摄取与导管位置的交互作用均无相关性（P=0.339、0.593 和 0.658）。
（90）Y 放射性栓塞治疗的反应与（99m）Tc-MAA 摄取程度无关。因此，对于缺乏肿瘤内（99m）Tc-MAA 积聚的结直肠肝转移患者，不应拒绝治疗。
