Zimmermann Markus, Schulze-Hagen Maximilian, Liebl Martin, Pedersoli Federico, Goerg Fabian, Ulmer Tom Florian, Heinzel Alexander, Isfort Peter, Kuhl Christiane, Bruners Philipp
Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
Department of General Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
Cardiovasc Intervent Radiol. 2017 Aug;40(8):1206-1212. doi: 10.1007/s00270-017-1629-x. Epub 2017 Mar 29.
To evaluate the safety and efficacy of yttrium-90 radioembolization (RE) following left or right hepatic lobectomy.
Between 2011 and 2016, 15 patients underwent RE with Y90-resin microspheres following right (8/15) or left (7/15) hepatic lobectomy. In eight patients, the whole liver remnant was treated during a single session, whereas the remaining seven patients received up to 3 selective RE at 1- to 2-month intervals. The administered patient activity was calculated based on the body surface area (BSA) method in all cases. In addition, CT-based volumetry of the liver remnant was performed and used to calculate the absorbed liver dose. Patient follow-up data were retrospectively analyzed regarding signs of radioembolization-induced liver disease (REILD), defined as occurrence of bilirubin >3.0 mg/dl and ascites within 1-2 months after treatment without tumor progression or bile duct occlusion.
The mean volume of the liver remnant was 1.471 ± 341 ml, the mean administered amount of activity amounted to 1.31 ± 0.74 GBq, and the calculated mean absorbed dose was 42.8 ± 20.6 Gy. The early response to treatment was generally positive, with only one patient showing signs of progressive disease of the treated area on follow-up examinations within the first 2 months post-RE. None of the 15 patients developed a REILD.
Y-90 radioembolization following extended hepatic lobectomy appears to be safe and effective. Although the standard BSA-based dosing seems to suffice to avoid REILD, it results in quite variable liver doses due to variable hypertrophy of the liver remnant post-hepatectomy.
Level IV, Case series.
评估钇-90放射性栓塞（RE）在左或右肝叶切除术后的安全性和有效性。
2011年至2016年期间，15例患者在右（8/15）或左（7/15）肝叶切除术后接受了Y90树脂微球RE治疗。8例患者在单次治疗中对整个肝残余进行了治疗，而其余7例患者每隔1至2个月接受了多达3次选择性RE治疗。所有病例均根据体表面积（BSA）法计算给药活度。此外，对肝残余进行基于CT的容积测量，并用于计算肝脏吸收剂量。对患者随访数据进行回顾性分析，观察放射性栓塞诱导的肝病（REILD）迹象，定义为治疗后1至2个月内出现胆红素>3.0mg/dl和腹水，且无肿瘤进展或胆管阻塞。
肝残余的平均体积为1.471±341ml，平均给药活度为1.31±0.74GBq，计算出的平均吸收剂量为42.8±20.6Gy。治疗的早期反应总体呈阳性，仅1例患者在RE后前2个月的随访检查中显示治疗区域有疾病进展迹象。15例患者均未发生REILD。
扩大肝叶切除术后的Y-90放射性栓塞似乎是安全有效的。尽管基于标准BSA的给药似乎足以避免REILD，但由于肝切除术后肝残余的肥大程度不同，导致肝脏剂量差异较大。
IV级，病例系列。
