Maleux Geert, Deroose Christophe, Laenen Annouschka, Verslype Chris, Heye Sam, Haustermans Karin, De Hertogh Gert, Sagaert Xavier, Topal Baki, Aerts Raymond, Prenen Hans, Vanbeckevoort Dirk, Vandecaveye Vincent, Van Cutsem Eric
a Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology , KU Leuven , Belgium.
b Department of Nuclear Medicine , University Hospitals Leuven , Belgium.
Acta Oncol. 2016;55(4):486-95. doi: 10.3109/0284186X.2015.1101151. Epub 2015 Dec 1.
The purpose of this study was to retrospectively assess the technical and clinical outcomes, overall survival and prognostic factors for prolonged survival after yttrium-90 ((90)Y) radioembolization as a salvage therapy for patients with chemorefractory liver-only or liver-dominant colorectal metastases.
From January 2005 to January 2014, all the patients selected for (90)Y radioembolization to treat chemorefractory colorectal liver metastases were identified. Demographic, laboratory, imaging and dosimetry data were collected. Post-treatment technical and clinical outcomes were analyzed as well as overall survival; finally several factors potentially influencing survival were analyzed.
In total 88 patients were selected for angiographic workup; 71 patients (81%) finally underwent catheter-directed (90)Y microsphere infusion into the hepatic artery 25 days (standard deviation 13 days) after angiographic workup. Median infused activity was 1809 MBq; 30-day toxicity included: fatigue (n = 39; 55%), abdominal discomfort (n = 33; 47%), nausea (n = 5; 7%), fever (n = 14; 20%), diarrhea (n = 6; 9%), liver function abnormalities and elevated bilirubin (transient) (n = 3; 4%). Gastric ulcer was found in five patients (7%). A late complication was radioembolization-induced portal hypertension (REIPH) in three patients (4%). Median time to progression in the liver was 4.4 months. Estimated survival at six and 12 months was 65% and 30%, respectively, with a 50% estimated survival after 8.0 months in this group of chemorefractory patients. Prognostic factors for worse survival were high preprocedural bilirubin, alkaline phosphatase and tumor volume levels.
(90)Y microsphere radioembolization for chemorefractory colorectal liver metastases has an acceptable safety profile with a 50% estimated survival after 8.0 months. Pretreatment high bilirubin, alkaline phosphatase and tumor volume levels were associated with early death.
本研究的目的是回顾性评估钇-90（90Y）放射性栓塞作为化疗难治性单纯肝转移或肝占主导的结直肠癌转移患者挽救治疗的技术和临床结果、总生存期及延长生存期的预后因素。
确定2005年1月至2014年1月期间所有选择90Y放射性栓塞治疗化疗难治性结直肠癌肝转移的患者。收集人口统计学、实验室、影像学和剂量学数据。分析治疗后的技术和临床结果以及总生存期；最后分析几个可能影响生存的因素。
总共88例患者接受血管造影检查；71例患者（81%）最终在血管造影检查后25天（标准差13天）接受经导管将90Y微球注入肝动脉。注入活度的中位数为1809 MBq；30天毒性包括：疲劳（n = 39；55%）、腹部不适（n = 33；47%）、恶心（n = 5；7%）、发热（n = 14；20%）、腹泻（n = 6；9%）、肝功能异常和胆红素升高（短暂性）（n = 3；4%）。5例患者（7%）发现胃溃疡。3例患者（4%）出现晚期并发症放射性栓塞诱导的门静脉高压（REIPH）。肝脏进展的中位时间为4.4个月。该组化疗难治性患者6个月和12个月的估计生存率分别为65%和30%，8.0个月后的估计生存率为50%。生存较差的预后因素是术前胆红素、碱性磷酸酶和肿瘤体积水平较高。
90Y微球放射性栓塞治疗化疗难治性结直肠癌肝转移具有可接受的安全性，8.0个月后的估计生存率为50%。治疗前高胆红素、碱性磷酸酶和肿瘤体积水平与早期死亡相关。
