Zuckerman Darryl A, Kennard Richard F, Roy Amit, Parikh Parag J, Weiner Ashley A
Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
J Gastrointest Oncol. 2019 Feb;10(1):118-127. doi: 10.21037/jgo.2018.10.05.
The prognosis of patients with hepatic metastases from neuroendocrine tumors (NET) is generally good, and radioembolization with Yttrium-90 microspheres is a locoregional therapy that is used in efforts to improve hepatic disease control and survival. This study aims to describe the survival outcomes and toxicities associated with radioembolization for hepatic-predominant metastatic NET in a large single-institution cohort.
A total of 59 patients underwent radioembolization for metastatic NET with hepatic predominant disease at a single academic center. Patient outcomes were analyzed by Kaplan-Meier survival analysis and toxicities were detailed and described. Ten patients within the cohort underwent post-treatment dosimetric analysis using PET-MRI and normal liver dosimetry was correlated with hepatic fibrosis and toxicity.
Median overall survival from time of radioembolization in the patient cohort was 31 months, and the 1- and 2-year overall survival was 80.4% and 65.6% respectively. Median hepatic progression-free survival and overall progression-free survival were 18 and 13 months, respectively. Three patients died of hepatic failure that was possibly therapy-related. Ten patients underwent evaluation of post-treatment dosimetry following radioembolization. In patients who did not develop hepatotoxicity or hepatic fibrosis, mean dose to normal liver was 25.4 Gy, while the mean liver dose in patients who experienced toxicity (hepatic fibrosis in n=2 and death from hepatic failure in n=1) was 59.1 Gy.
Overall survival following radioembolization for hepatic metastases from NET is excellent; however, deaths that are potentially treatment-related have been observed. Preliminary data regarding dose to normal liver is suggestive of a relation between dosimetry and toxicity, however further work is required to further elucidate the mechanism, correlation with dosimetry, as well as additional patient and tumor factors that may predispose these patients to toxicity.
神经内分泌肿瘤（NET）肝转移患者的预后通常较好，钇-90微球放射性栓塞是一种局部治疗方法，旨在改善肝脏疾病控制和生存期。本研究旨在描述在一个大型单机构队列中，针对以肝脏为主的转移性NET进行放射性栓塞的生存结果和毒性。
在一个学术中心，共有59例以肝脏为主的转移性NET患者接受了放射性栓塞治疗。通过Kaplan-Meier生存分析对患者结局进行分析，并详细描述毒性。队列中的10例患者在治疗后使用PET-MRI进行剂量测定分析，并将正常肝脏剂量测定与肝纤维化和毒性相关联。
患者队列中自放射性栓塞时间起的中位总生存期为31个月，1年和2年总生存率分别为80.4%和65.6%。中位肝脏无进展生存期和总无进展生存期分别为18个月和13个月。3例患者死于可能与治疗相关的肝衰竭。10例患者在放射性栓塞后接受了治疗后剂量测定评估。在未发生肝毒性或肝纤维化的患者中，正常肝脏的平均剂量为25.4 Gy，而发生毒性的患者（2例肝纤维化和1例死于肝衰竭）的平均肝脏剂量为59.1 Gy。
NET肝转移患者放射性栓塞后的总体生存期良好；然而，已观察到可能与治疗相关的死亡。关于正常肝脏剂量的初步数据提示剂量测定与毒性之间存在关联，然而需要进一步开展工作以进一步阐明其机制、与剂量测定的相关性以及可能使这些患者易发生毒性的其他患者和肿瘤因素。
