Bozkurt Murat Fani, Salanci Bilge Volkan, Uğur Ömer
Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Semin Nucl Med. 2016 Jul;46(4):324-39. doi: 10.1053/j.semnuclmed.2016.01.008.
Intra-arterial radionuclide therapies serve essentially as internal radiation treatment options for both primary and metastatic liver tumors, which imply delivering implantable radioactive microspheres into branches of hepatic arteries that feed liver tumors to provide a high dose of targeted radiation to tumor tissue, while sparing the healthy liver tissue from hazardous effects of radiation. The principle of this therapeutic option depends on the unique preferential arterial supply of malignant liver tumors in contrast with mostly portal venous supply of normal hepatocytes as well as excess amount of arterial neovascularization in the tumor bed. Therefore, intra-arterial radionuclide therapy can provide very high radiation exposure to tumor tissue, which is impossible to reach with external radiation therapy due to serious side effects and moreover, radiation can be targeted to tumor tissue selectively with less side effects. Yttrium-90 (Y-90), a high-energetic beta emitter is the most preferred radionuclide, which is used to label microspheres. Two types of Y-90 microspheres are commercially available that are made of resin and glass. Many studies in the literature have demonstrated that Y-90 microsphere therapy is an efficient and safe locoregional therapeutic option for unresectable primary and metastatic liver tumors such as hepatocellular carcinoma and liver metastases from colorectal cancer and breast cancer as well as neuroendocrine tumors. Furthermore, limited number of studies has reported its use in some relatively uncommon metastatic liver tumors from melanoma, pancreatic, renal, and lung cancer. Besides Y-90 microspheres, Iodine-131 lipiodol, Rhenium-188 lipiodol, Rhenium-188 microspheres, Holmium-166 chitosan, and Holmium-166 microspheres have been introduced as alternative radiopharmaceuticals for intra-arterial therapy for liver tumors.
动脉内放射性核素疗法本质上是针对原发性和转移性肝肿瘤的内部放射治疗选择，这意味着将可植入的放射性微球输送到为肝肿瘤供血的肝动脉分支中，以向肿瘤组织提供高剂量的靶向辐射，同时使健康肝组织免受辐射的有害影响。这种治疗选择的原理取决于恶性肝肿瘤独特的优先动脉供血，与之形成对比的是正常肝细胞主要由门静脉供血，以及肿瘤床中动脉新血管形成过多。因此，动脉内放射性核素疗法可以为肿瘤组织提供非常高的辐射剂量，这是外部放射治疗由于严重副作用而无法达到的，而且，辐射可以选择性地靶向肿瘤组织，副作用较小。钇-90（Y-90），一种高能β发射体，是最常用的放射性核素，用于标记微球。有两种由树脂和玻璃制成的Y-90微球在市场上有售。文献中的许多研究表明，Y-90微球疗法是一种有效且安全的局部治疗选择，适用于不可切除的原发性和转移性肝肿瘤，如肝细胞癌、结直肠癌和乳腺癌以及神经内分泌肿瘤的肝转移。此外，有限数量的研究报道了其在一些相对不常见的黑色素瘤、胰腺癌、肾癌和肺癌肝转移中的应用。除了Y-90微球外，碘-131碘化油、铼-188碘化油、铼-188微球、钬-166壳聚糖和钬-166微球已被引入作为肝肿瘤动脉内治疗的替代放射性药物。
