Boas F Edward, Bodei Lisa, Sofocleous Constantinos T
Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and.
Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
J Nucl Med. 2017 Sep;58(Suppl 2):104S-111S. doi: 10.2967/jnumed.116.187229.
Liver metastases are a major cause of death from colorectal cancer. Intraarterial therapy options for colorectal liver metastases include chemoinfusion via a hepatic arterial pump or port, irinotecan-loaded drug-eluting beads, and radioembolization using Y microspheres. Intraarterial therapy allows the delivery of a high dose of chemotherapy or radiation into liver tumors while minimizing the impact on liver parenchyma and avoiding systemic effects. Specificity in intraarterial therapy can be achieved both through preferential arterial flow to the tumor and through selective catheter positioning. In this review, we discuss indications, contraindications, preprocedure evaluation, activity prescription, follow-up, outcomes, and complications of radioembolization of colorectal liver metastases. Methods for preventing off-target embolization, increasing the specificity of microsphere delivery, and reducing the lung-shunt fraction are discussed. There are 2 types of Y microspheres: resin and glass. Because glass microspheres have a higher activity per particle, they can deliver a particular radiation dose with fewer particles, likely reducing embolic effects. Glass microspheres thus may be more suitable when early stasis or reflux is a concern, in the setting of hepatocellular carcinoma with portal vein invasion, and for radiation segmentectomy. Because resin microspheres have a lower activity per particle, more particles are needed to deliver a particular radiation dose. Resin microspheres thus may be preferable for larger tumors and those with high arterial flow. In addition, resin microspheres have been approved by the U.S. Food and Drug Administration for colorectal liver metastases, whereas institutional review board approval is required before glass microspheres can be used under a compassionate-use or research protocol. Finally, radiation segmentectomy involves delivering a calculated lobar activity of Y microspheres selectively to treat a tumor involving 1 or 2 liver segments. This technique administers a very high radiation dose and effectively causes the ablation of tumors that are too large or are in a location considered unsafe for thermal ablation. The selective delivery spares surrounding normal liver, reducing the risk of liver failure.
肝转移是结直肠癌致死的主要原因。结直肠癌肝转移的动脉内治疗方法包括通过肝动脉泵或端口进行化学灌注、载有伊立替康的药物洗脱微球以及使用钇微球进行放射性栓塞。动脉内治疗能够将高剂量的化疗药物或辐射输送至肝肿瘤，同时将对肝实质的影响降至最低，并避免全身效应。动脉内治疗的特异性可通过肿瘤的优先动脉血流以及选择性导管定位来实现。在本综述中，我们讨论了结直肠癌肝转移放射性栓塞的适应证、禁忌证、术前评估、活性处方、随访、疗效及并发症。还讨论了预防非靶栓塞、提高微球递送特异性以及降低肺分流分数的方法。钇微球有两种类型：树脂型和玻璃型。由于玻璃微球每颗粒子的活性较高，它们能够用较少的粒子递送特定的辐射剂量，可能会降低栓塞效应。因此，当担心早期血流淤滞或反流时、在伴有门静脉侵犯的肝细胞癌情况下以及对于放射性节段切除术，玻璃微球可能更合适。由于树脂微球每颗粒子的活性较低，需要更多的粒子来递送特定的辐射剂量。因此，树脂微球可能更适用于较大的肿瘤以及动脉血流高的肿瘤。此外，树脂微球已获美国食品药品监督管理局批准用于结直肠癌肝转移，而玻璃微球在根据同情用药或研究方案使用前需要获得机构审查委员会的批准。最后，放射性节段切除术涉及选择性地递送计算好的叶活性钇微球，以治疗累及1个或2个肝段的肿瘤。该技术给予非常高的辐射剂量，并有效地导致太大或位于热消融被认为不安全位置的肿瘤消融。选择性递送可使周围正常肝脏免受影响，降低肝衰竭风险。
