Das Arighno, Riaz Ahsun, Gabr Ahmed, Ali Rehan, Mora Ronald, Al Asadi Ali, Mouli Samdeep, Lewandowski Robert J, Salem Riad
Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, IL, USA.
Eur J Nucl Med Mol Imaging. 2020 Apr;47(4):807-815. doi: 10.1007/s00259-019-04517-y. Epub 2019 Sep 10.
Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%.
With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90.
A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1-28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15-28) and 29.5 Gy (IQR 20.5-44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7-224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient.
Y90 can be performed in patients with LSF > 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF > 15% should not deter from treatment with Y90.
锝-99m 大颗粒白蛋白用于在钇-90（Y90）治疗前评估肺分流分数（LSF）。对于 LSF＞15%的患者，关于 Y90 的安全性和有效性存在争议。我们旨在评估 Y90 在 LSF＞15%的肝细胞癌（HCC）患者中的作用。
经机构审查委员会批准，我们检索了前瞻性收集的 LSF＞15%且接受 Y90 治疗的 HCC 患者数据库。计算 LSF 中位数以及肝脏和肺部剂量。使用实体瘤疗效评价标准（RECIST）评估反应。从首次 Y90 治疗日期开始计算总生存期（OS）。
共有 103 例 HCC 患者接受了 Y90 治疗。基线 LSF 中位数为 24.4%（四分位间距 18.1 - 28.8）。患者表现为多灶性病变（59/103，60%），肿瘤大小中位数为 7.85 cm（四分位间距 5.2，10.57）。巴塞罗那临床肝癌（BCLC）分期为 A、B、C 和 D 期的患者分别有 7 例（7%）、5 例（5%）、85 例（83%）和 6 例（6%）。肝脏剂量中位数为 84.6 Gy（四分位间距 57.4，107.55）。每次治疗和累积的肺部剂量中位数分别为 22.9 Gy（四分位间距 15 - 28）和 29.5 Gy（四分位间距 20.5 - 44.3）。33 例患者（32%）表现为部分缓解，57 例病情稳定，13 例（13%）病情进展。OS 中位数为 7.3 个月（95%置信区间 5.3，11.47）。20 例患者（19%）在 Y90 治疗后 1 年内出现非特异性肺部症状（咳嗽、气短、喘息）。出现非特异性肺部症状的中位时间为 63 天（范围 7 - 224 天）。胸部影像学检查显示，治疗后所有患者均未出现肺纤维化/损伤。
LSF＞15%的患者可以接受 Y90 治疗。32%的患者有 RECIST 反应。单独来看，LSF＞15%不应成为阻止 Y90 治疗的因素。
