Lam Marnix G E H, Louie John D, Abdelmaksoud Mohamed H K, Fisher George A, Cho-Phan Cheryl D, Sze Daniel Y
Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5642; Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands.
Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5642.
J Vasc Interv Radiol. 2014 Jul;25(7):1085-93. doi: 10.1016/j.jvir.2013.11.018. Epub 2014 Jan 21.
To calculate absorbed radiation doses in patients treated with resin microspheres prescribed by the body surface area (BSA) method and to analyze dose-response and toxicity relationships.
A retrospective review was performed of 45 patients with colorectal carcinoma metastases who received single-session whole-liver resin microsphere radioembolization. Prescribed treatment activity was calculated using the BSA method. Liver volumes and whole-liver absorbed doses (D(WL)) were calculated. D(WL) was correlated with toxicity and radiographic and biochemical response.
The standard BSA-based administered activity (range, 0.85-2.58 GBq) did not correlate with D(WL) (mean, 50.4 Gy; range, 29.8-74.7 Gy; r = -0.037; P = .809) because liver weight was highly variable (mean, 1.89 kg; range, 0.94-3.42 kg) and strongly correlated with D(WL) (r = -0.724; P < .001) but was not accounted for in the BSA method. Patients with larger livers were relatively underdosed, and patients with smaller livers were relatively overdosed. Patients who received D(WL) > 50 Gy experienced more toxicity and adverse events (> grade 2 liver toxicity, 46% vs 17%; P < .05) but also responded better to the treatment than patients who received D(WL)< 50 Gy (disease control, 88% vs 24%; P < .01).
Using the standard BSA formula, the administered activity did not correlate with D(WL). Based on this short-term follow-up after salvage therapy in patients with late stage metastatic colorectal carcinoma, dose-response and dose-toxicity relationships support using a protocol based on liver volume rather than BSA to prescribe the administered activity.
计算采用体表面积（BSA）法开具处方接受树脂微球治疗的患者所吸收的辐射剂量，并分析剂量反应和毒性关系。
对45例接受单疗程全肝树脂微球放射性栓塞治疗的结直肠癌转移患者进行回顾性研究。采用BSA法计算规定的治疗活度。计算肝脏体积和全肝吸收剂量（D(WL)）。D(WL)与毒性、影像学和生化反应相关。
基于标准BSA的给药活度（范围为0.85 - 2.58 GBq）与D(WL)不相关（均值为50.4 Gy；范围为29.8 - 74.7 Gy；r = -0.037；P = 0.809），因为肝脏重量变化很大（均值为1.89 kg；范围为0.94 - 3.42 kg），且与D(WL)密切相关（r = -0.724；P < 0.001），但在BSA法中未予以考虑。肝脏较大的患者相对剂量不足，而肝脏较小的患者相对剂量过量。接受D(WL) > 50 Gy的患者出现更多毒性和不良事件（> 2级肝毒性，46% 对17%；P < 0.05），但与接受D(WL) < 50 Gy的患者相比，对治疗的反应也更好（疾病控制率，88% 对24%；P < 0.01）。
使用标准BSA公式时，给药活度与D(WL)不相关。基于晚期转移性结直肠癌患者挽救治疗后的短期随访，剂量反应和剂量 - 毒性关系支持采用基于肝脏体积而非BSA的方案来开具给药活度处方。
