Rodríguez Lidia Sancho, Thang Sue Ping, Li HuiHua, Khor Lih Kin, Tay Young Soon, Myint Khin Ohnmar, Tong Aaron Kian Ti
Department of Nuclear Medicine, Clínica Universidad de Navarra, Avenida Pio XII, 36, Pamplona, 31008, Navarra, Spain.
Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Ann Nucl Med. 2016 Apr;30(3):255-61. doi: 10.1007/s12149-015-1052-9. Epub 2015 Dec 21.
Activity planning for (90)Y radioembolization aims to maximize the effect of the treatment while keeping toxicity acceptably low. Our aim was to describe the amount of residual activity in post-treatment v-vials and tubing and analyze the possible factors affecting it (total activity administered, number of split activity injection(s), previous treatments, administration artery and microcatheter size), as these may influence dosimetric planning and treatment.
This was a retrospective review using case records of patients who received (90)Y-radioembolization for hepatic tumors at a single tertiary center. From August 2013 to September 2015, seventy-seven out of one hundred and fifty patients who received radioembolization with (90)Y resin microspheres due to inoperable Hepatocellular Carcinoma (HCC) or liver metastases were included. The rest were mainly excluded due to incomplete data sets. The number of split activities (injections) for the radioembolization could be: one single injection, two or three. The remnant activity in post-treatment v-vials and tubing were measured for every patient. The administration arteries evaluated were: proper hepatic artery (PHA), right hepatic artery (RHA), middle hepatic artery (MHA), left hepatic artery (LHA) and small caliber branch arteries. The sizes of the microcatheters (2.2 or 2.7 Fr) used to administer the dose were also evaluated.
In total, 77 out of 150 patients were included in the final analysis. There were 59 men of median age 64.0 years old. The total median dose loss was 0.10 GBq. The total dose loss increased 0.244 GBq [95 % CI = (0.169, 0.318)] when three split activities were given compared to single activity injection. Activity loss for each injection increased 0.0297 GBq [95 % CI = (0.0151, 0.0443)] for every 1.0 GBq increase of split activity injection. There were no significant statistical differences in the rest of patient characteristics.
There is significant loss of activity observed during radioembolization, which can have a major dosimetric impact. The total administered activity and the number of split injections during radioembolization are the main influencing factors. Further prospective studies as well as measures of clinical outcome are warranted.
钇-90放射性栓塞的活度规划旨在使治疗效果最大化，同时将毒性控制在可接受的低水平。我们的目的是描述治疗后小瓶和导管中的残余活度，并分析影响它的可能因素（给药的总活度、分次活度注射次数、既往治疗、给药动脉和微导管尺寸），因为这些因素可能影响剂量规划和治疗。
这是一项回顾性研究，使用了在单一三级中心接受钇-90放射性栓塞治疗肝肿瘤患者的病例记录。2013年8月至2015年9月，150例因无法手术切除的肝细胞癌（HCC）或肝转移而接受钇-90树脂微球放射性栓塞治疗的患者中，有77例被纳入研究。其余患者主要因数据集不完整而被排除。放射性栓塞的分次活度（注射）次数可以是：单次注射、两次或三次。对每位患者测量治疗后小瓶和导管中的残余活度。评估的给药动脉包括：肝固有动脉（PHA）、肝右动脉（RHA）、肝中动脉（MHA）、肝左动脉（LHA）和小口径分支动脉。还评估了用于给药的微导管尺寸（2.2或2.7 Fr）。
最终分析共纳入150例患者中的77例。有59名男性，中位年龄64.0岁。总中位剂量损失为0.10 GBq。与单次活度注射相比，进行三次分次活度注射时，总剂量损失增加0.244 GBq [95%置信区间=（0.169，0.318）]。每次分次活度注射每增加1.0 GBq，每次注射的活度损失增加0.0297 GBq [95%置信区间=（0.0151，0.0443）]。其余患者特征无显著统计学差异。
在放射性栓塞过程中观察到有显著的活度损失，这可能对剂量学产生重大影响。给药的总活度和放射性栓塞过程中的分次注射次数是主要影响因素。有必要进行进一步的前瞻性研究以及临床结局测量。
