Jia Zhongzhi, Paz-Fumagalli Ricardo, Frey Gregory, Sella David M, McKinney J Mark, Wang Weiping
Department of Interventional Radiology, The Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, China.
Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
J Gastroenterol Hepatol. 2017 Sep;32(9):1617-1623. doi: 10.1111/jgh.13752.
The aim of this study was to assess the effectiveness of yttrium-90 ( Y) microspheres for the treatment of unresectable metastatic liver neuroendocrine tumors (NET).
From February 2006 to September 2015, 36 patients (19 male and 17 female, age 63.6 ± 9.4 years) who underwent Y therapy for unresectable liver metastases of NET were included and analyzed retrospectively. All patients received a variety of treatments before Y therapy. The radiological response, symptoms improvement of carcinoid syndrome, tumor marker changes, complications, side effects/toxicity, survival, and factors related to survival were evaluated and analyzed.
Of the 36 patients, the mean delivered dose of Y was 1.8 ± 0.7 GBq with a total of 40 treatments. Overall disease control rate was 88.9% (32/36) at 3 months following therapy. In 16 patients with carcinoid syndrome, 15 (93.8%) patients had symptomatic improvement. Tumor marker response (5-hydroxyindoleacetic acid [n = 7] and chromogranin A [n = 13]) at 3 months after treatment were as follows: none (n = 0, 4), partial (n = 6, 7), and complete (n = 1, 2). Radiation-induced gastrointestinal ulcers (n = 2, 5.6%) were identified. Side effects included fatigue (n = 31, 86.1%), anorexia (n = 26, 72.2%), nausea (n = 15, 41.7%), vomiting (n = 14, 38.9%), abdominal pain (n = 10, 27.8%), and fever (n = 8, 22.2%). The mean follow-up was 27.0 ± 16.4 months, with a median survival of 41.0 months. Child-Pugh classification (P = 0.008) and lymph node metastases (P = 0.045) had statistically significant influence on overall survival.
Yttrium-90 radioembolization can be effective in the treatment of unresectable liver metastases of NET who failed to respond to other treatments.
本研究旨在评估钇-90（Y）微球治疗不可切除的转移性肝神经内分泌肿瘤（NET）的有效性。
回顾性分析2006年2月至2015年9月期间36例接受Y治疗的不可切除肝转移NET患者（男19例，女17例，年龄63.6±9.4岁）。所有患者在Y治疗前均接受过多种治疗。评估并分析放射学反应、类癌综合征症状改善情况、肿瘤标志物变化、并发症、副作用/毒性、生存率以及与生存相关的因素。
36例患者中，Y的平均给药剂量为1.8±0.7GBq，共进行了40次治疗。治疗后3个月时总体疾病控制率为88.9%（32/36）。16例类癌综合征患者中，15例（93.8%）症状改善。治疗后3个月时肿瘤标志物反应（5-羟吲哚乙酸[n = 7]和嗜铬粒蛋白A[n = 13]）如下：无反应（n = 0, 4）、部分反应（n = 6, 7）和完全反应（n = 1, 2）。发现放射性胃肠道溃疡（n = 2, 5.6%）。副作用包括疲劳（n = 31, 86.1%）、厌食（n = 26, 72.2%）、恶心（n = 15, 41.7%）、呕吐（n = 14, 38.9%）、腹痛（n = 10, 27.8%）和发热（n = 8, 22.2%）。平均随访时间为27.0±16.4个月，中位生存期为41.0个月。Child-Pugh分级（P = 0.008）和淋巴结转移（P = 0.045）对总生存期具有统计学显著影响。
钇-90放射性栓塞术可有效治疗对其他治疗无反应的不可切除肝转移NET。
