Su Yu-Kai, Mackey Rosewell V, Riaz Ahsun, Gates Vanessa L, Benson Al B, Miller Frank H, Yaghmai Vahid, Gabr Ahmed, Salem Riad, Lewandowski Robert J
Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Chicago, IL 60611-2927.
Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Chicago, IL 60611-2927.
J Vasc Interv Radiol. 2017 Nov;28(11):1520-1526. doi: 10.1016/j.jvir.2017.05.011. Epub 2017 Jun 30.
To determine long-term hepatotoxicity of yttrium-90 (Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms.
Retrospective review from 2003 to 2016 was performed for patients with mNET treated with Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). Preradioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function.
Among patients who underwent unilobar radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0-15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver Y radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver radioembolization exhibited significantly decreased platelet counts (P = .023) and lower albumin levels (P = .0002). Eight patients (20.5%) treated with whole-liver radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity.
Whole-liver Y radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to Y develops in a small percentage of patients.
确定钇-90（Y）放射性栓塞术对转移性神经内分泌肿瘤（mNET）患者的长期肝毒性，并评估肝硬化样形态的影像学和实验室检查结果是否与临床症状相关。
对2003年至2016年接受Y玻璃微球治疗的mNET患者进行回顾性研究。54例随访超过2年的患者被分为单叶治疗组（n = 15）和全肝治疗组（n = 39）。最常见的原发性mNET部位是小肠（54例中的19例）、胰腺（54例中的19例）和不明（54例中的8例）。将放射性栓塞术前的影像学和实验室检查结果与最近的随访结果进行比较，以评估门静脉高压恶化和肝功能下降的迹象。
在接受单叶放射性栓塞术的患者中，平均4.1年（范围2.0 - 15.2年）的影像学随访显示，26.7%（15例中的4例）出现肝硬化样形态，13.3%（15例中的2例）出现腹水，6.7%（15例中的1例）出现静脉曲张，脾体积增加21.9%。全肝Y放射性栓塞术治疗患者的相应发生率分别为56.4%（39例中的22例）、41.0%（39例中的16例）和15.4%（39例中的6例），脾体积增加64.7%。接受全肝放射性栓塞术的患者血小板计数显著降低（P = .023），白蛋白水平较低（P = .0002）。8例（20.5%）接受全肝放射性栓塞术且表现出肝硬化样形态的患者出现肝失代偿的临床体征；39例患者中只有2例（5.1%）没有其他肝毒性原因。
mNET患者接受全肝Y放射性栓塞术会导致超过50%的治疗患者出现肝硬化样形态和门静脉高压的长期影像学表现，但大多数患者仍无临床症状。仅由Y引起的长期肝毒性在一小部分患者中出现。
