从放射生物学和剂量学角度看肝脏病变的放射性栓塞治疗。
Radioembolization of hepatic lesions from a radiobiology and dosimetric perspective.
机构信息
Istituto Europeo di Oncologia , Milan , Italy.
Istituto Nazionale dei Tumori , Milan , Italy.
出版信息
Front Oncol. 2014 Aug 19;4:210. doi: 10.3389/fonc.2014.00210. eCollection 2014.
Radioembolization (RE) of liver cancer with (90)Y-microspheres has been applied in the last two decades with notable responses and acceptable toxicity. Two types of microspheres are available, glass and resin, the main difference being the activity/sphere. Generally, administered activities are established by empirical methods and differ for the two types. Treatment planning based on dosimetry is a prerogative of few centers, but has notably gained interest, with evidence of predictive power of dosimetry on toxicity, lesion response, and overall survival (OS). Radiobiological correlations between absorbed doses and toxicity to organs at risk, and tumor response, have been obtained in many clinical studies. Dosimetry methods have evolved from the macroscopic approach at the organ level to voxel analysis, providing absorbed dose spatial distributions and dose-volume histograms (DVH). The well-known effects of the external beam radiation therapy (EBRT), such as the volume effect, underlying disease influence, cumulative damage in parallel organs, and different tolerability of re-treatment, have been observed also in RE, identifying in EBRT a foremost reference to compare with. The radiobiological models - normal tissue complication probability and tumor control probability - and/or the style (DVH concepts) used in EBRT are introduced in RE. Moreover, attention has been paid to the intrinsic different activity distribution of resin and glass spheres at the microscopic scale, with dosimetric and radiobiological consequences. Dedicated studies and mathematical models have developed this issue and explain some clinical evidences, e.g., the shift of dose to higher toxicity thresholds using glass as compared to resin spheres. This paper offers a comprehensive review of the literature incident to dosimetry and radiobiological issues in RE, with the aim to summarize the results and to identify the most useful methods and information that should accompany future studies.
肝癌的放射性栓塞 (RE) 治疗应用于过去二十年,取得了显著的疗效和可接受的毒性。目前有两种类型的微球可供使用,玻璃微球和树脂微球,主要区别在于活性/球体。通常,通过经验方法确定给药的活性,并且两种类型的活性不同。基于剂量学的治疗计划是少数中心的特权,但已经引起了广泛关注,并且有证据表明剂量学对毒性、病变反应和总体生存率 (OS) 具有预测能力。在许多临床研究中,已经获得了放射性生物相关性,即器官风险和肿瘤反应的吸收剂量与毒性之间的关系。剂量学方法已经从器官水平的宏观方法发展到体素分析,提供了吸收剂量空间分布和剂量-体积直方图 (DVH)。在 RE 中也观察到了外照射放疗 (EBRT) 的已知影响,例如体积效应、基础疾病影响、平行器官的累积损伤以及再治疗的不同耐受性,这确定了 EBRT 作为首要的参考。在 RE 中引入了放射性生物模型 - 正常组织并发症概率和肿瘤控制概率 - 以及/或 EBRT 中使用的风格 (DVH 概念)。此外,还关注了树脂和玻璃微球在微观尺度上的固有不同活性分布及其剂量学和放射生物学后果。专门的研究和数学模型已经解决了这个问题,并解释了一些临床证据,例如与树脂球相比,使用玻璃球将剂量转移到更高的毒性阈值。本文对放射性栓塞中的剂量学和放射生物学问题的文献进行了全面综述,旨在总结结果并确定应伴随未来研究的最有用的方法和信息。