Srinivas Shyam M, Nasr Elie C, Kunam Vamsi K, Bullen Jennifer A, Purysko Andrei S
Department of Nuclear Medicine, Cleveland Clinic, Cleveland, OH, USA ;
Department of Radiology, SUNY Downstate University Hospital, Brooklyn, NY, USA ;
J Gastrointest Oncol. 2016 Aug;7(4):530-9. doi: 10.21037/jgo.2016.03.09.
Given the differences in size, specific activity, and dosing methods for glass yttrium-90 microspheres ((90)Y-glass) and resin (90)Y microspheres ((90)Y-resin), these therapies may expose the liver to different amounts of radiation, thereby affecting their efficacy and tolerability. We aimed to compare the prescribed activity of (90)Y-glass and (90)Y-resin for real-world patients undergoing selective internal radiation therapy (SIRT) for liver-dominant metastatic colorectal cancer (mCRC) and to assess efficacy and safety outcomes in these patients.
We examined the records of 28 consecutive patients with unresectable colorectal liver metastases treated with SIRT between June 2008 and May 2011 at our institution. Using baseline CT and MR images, we calculated a projected activity as if we had used the other product and compared it to the actual prescribed activity of (90)Y-glass and (90)Y-resin for each SIRT treatment per manufacturer guidelines. Progression and adverse events were evaluated at follow up visits. Survival was analyzed by the Kaplan-Meier method.
For (90)Y-glass treatments with a mean prescribed (90)Y activity of 1.77 GBq, the mean projected (90)Y-resin activity was 0.84 GBq. For (90)Y-resin treatments with a mean prescribed (90)Y activity of 1.05 GBq, the mean projected (90)Y-glass activity was 2.48 GBq. The median survival was 9.3 months versus 18.2 months for (90)Y-glass and (90)Y-resin, respectively (P=0.292). During the second year after SIRT, the hazard ratio of death for patients treated with (90)Y-glass versus (90)Y-resin was 4.0 (95% CI: 1.3, 12.3; P=0.017). No significant difference in progression, adverse events or liver toxicity was observed.
Using manufacturer recommended guidelines, (90)Y-resin delivers significantly less activity than (90)Y-glass to patients with liver-dominant mCRC undergoing SIRT with no significant difference in adverse events and a trend toward improved survival.
鉴于玻璃钇-90微球（90Y-玻璃）和树脂钇-90微球（90Y-树脂）在尺寸、比活度和给药方法上存在差异，这些疗法可能会使肝脏受到不同剂量的辐射，从而影响其疗效和耐受性。我们旨在比较接受以肝脏为主的转移性结直肠癌（mCRC）选择性内放射治疗（SIRT）的真实世界患者中90Y-玻璃和90Y-树脂的规定活度，并评估这些患者的疗效和安全性结果。
我们检查了2008年6月至2011年5月在我们机构接受SIRT治疗的28例不可切除的结直肠癌肝转移患者的记录。使用基线CT和MR图像，我们计算了如果使用另一种产品时的预计活度，并根据每个制造商的指南将其与每次SIRT治疗中90Y-玻璃和90Y-树脂的实际规定活度进行比较。在随访时评估疾病进展和不良事件。采用Kaplan-Meier方法分析生存率。
对于平均规定90Y活度为1.77GBq的90Y-玻璃治疗，平均预计90Y-树脂活度为0.84GBq。对于平均规定90Y活度为1.05GBq的90Y-树脂治疗，平均预计90Y-玻璃活度为2.48GBq。90Y-玻璃和90Y-树脂的中位生存期分别为9.3个月和18.2个月（P = 0.292）。在SIRT后的第二年，接受90Y-玻璃治疗的患者与接受90Y-树脂治疗的患者相比，死亡风险比为4.0（95%CI：1.3，12.3；P = 0.017）。在疾病进展、不良事件或肝毒性方面未观察到显著差异。
按照制造商推荐的指南，对于接受SIRT的以肝脏为主的mCRC患者，90Y-树脂给予的活度明显低于90Y-玻璃，不良事件无显著差异，且有生存改善的趋势。
