同日进行的钇-90放射性栓塞联合单光子发射计算机断层扫描/计算机断层扫描：在COVID-19大流行期间及之后改善治疗的契机。
Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond.
作者信息
Elsayed Mohammad, Loya Mohammad, Galt James, Schuster David M, Bercu Zachary L, Newsome Janice, Brandon David, Benenati Sonia, Behbahani Keywan, Duszak Richard, Sethi Ila, Kokabi Nima
机构信息
Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States.
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States.
出版信息
World J Gastrointest Oncol. 2021 May 15;13(5):440-452. doi: 10.4251/wjgo.v13.i5.440.
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic has made it more challenging for patients to undergo yttrium-90 (Y-90) radioembolization (RE). Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19, thus improving patient access.
AIM
To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography (SPECT/CT) in order to optimize therapy.
METHODS
All patients were selected for Y-90 RE through a multidisciplinary tumor board, and were screened and tested for COVID-19 infection per institutional protocol. A same day procedure was developed, consisting of angiography, imaging, and Y-90 resin particle delivery. Routine SPECT/CT after technetium-99m macroaggregated albumin (Tc-99m MAA) administration was performed for assessment of arterial supply, personalized dosimetry, and extrahepatic activity. Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery, by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles.
RESULTS
A total of 14 patients underwent same day Y-90 RE between March and June 2020. Mean lung shunt fraction was 6.13% (range 3.5%-13.1%). Y-90 RE was performed for a single lesion in 7 patients, while the remaining 7 patients had treatment of multifocal lesions. The largest lesion measured 8.3 cm. All patients tolerated the procedure well and were discharged the same day.
CONCLUSION
Same day Y-90 RE with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond. We recommend consideration of SPECT/CT, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.
背景
2019年冠状病毒病（COVID-19）大流行使患者接受钇-90（Y-90）放射性栓塞（RE）变得更具挑战性。当日Y-90 RE提供了一个机会，可将与COVID-19相关的后勤挑战和感染风险降至最低，从而改善患者的治疗机会。
目的
描述当日Y-90 RE联合常规单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）的应用，以优化治疗。
方法
所有患者均通过多学科肿瘤委员会入选Y-90 RE，并按照机构方案进行COVID-19感染筛查和检测。制定了当日手术流程，包括血管造影、成像和Y-90树脂颗粒递送。在注射99m锝标记的大聚合白蛋白（Tc-99m MAA）后进行常规SPECT/CT，以评估动脉供血、个性化剂量测定和肝外活性。治疗后进行Y-90致辐射SPECT/CT，通过利用能量窗来限制先前注射的Tc-99m MAA颗粒的信号，以确认颗粒递送情况。
结果
2020年3月至6月期间，共有14例患者接受了当日Y-90 RE。平均肺分流分数为6.13%（范围3.5%-13.1%）。7例患者对单个病灶进行了Y-90 RE治疗，其余7例患者治疗了多灶性病变。最大病灶直径为8.3 cm。所有患者对手术耐受性良好，均于当日出院。
结论
当日使用基于树脂的微球进行Y-90 RE是可行的，并提供了一个机会来降低与COVID-19大流行及其他情况相关的感染风险和后勤挑战。我们建议考虑使用SPECT/CT，尤其是在患有复杂恶性肿瘤的患者中，因为其有可能改善患者接受当日Y-90 RE的治疗效果和适应症。
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