反流导管可提高树脂微球肝动脉化疗栓塞术的肿瘤靶向性。
Antireflux catheter improves tumor targeting in liver radioembolization with resin microspheres.
机构信息
Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium.
Department of Interventional Radiology, Saint Luc University Hospital and King Albert II cancer Institute, Brussels, Belgium.
出版信息
Diagn Interv Radiol. 2021 Nov;27(6):768-773. doi: 10.5152/dir.2021.20785.
PURPOSE
We aimed to determine whether antireflux (ARC) catheter may result in better tumor targeting in liver radioembolization using 90Y-resin microspheres.
METHODS
Patients treated with resin microspheres for hepatocellular carcinoma (HCC) and secondary liver malignancies were retrospectively analyzed. All patients underwent a 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography (SPECT) following the planning arteriography with a conventional end-hole catheter. For 90Y-microspheres injection, two groups were defined depending on the type of catheter used: an ARC group (n=38) and a control group treated with a conventional end-hole catheter (n=23). 90Y positron emission tomography computed tomography (PET/CT) was performed after the therapeutic arteriography. The choice of the catheter was not randomized, but left to the choice of the interventional radiologist. 99mTc-MAA SPECT and 90Y PET/CT were co-registered with the baseline imaging to determine a tumor to normal liver ratio (T/NL[MAA or 90Y]) and tumor dose (TD[MAA or 90Y]) for the planning and therapy.
RESULTS
Overall, 38 patients (115 lesions) and 23 patients (75 lesions) were analyzed in the ARC and control groups, respectively. In the ARC group, T/NL90Y and TD90Y were significantly higher than T/NLMAA and TDMAA. Median (IQR) T/NL90Y was 2.16 (2.15) versus 1.74 (1.43) for T/NLMAA (p < 0.001). Median (IQR) TD90Y was 90.96 Gy (98.31 Gy) versus 73.72 Gy (63.82 Gy) for TDMAA (p < 0.001). In this group, the differences were highly significant for neuroendocrine metastases (NEM) and HCC and less significant for colorectal metastases (CRM). In the control group, no significant differences were demonstrated.
CONCLUSION
The use of an ARC significantly improves tumor deposition in liver radioembolization with resin microspheres.
目的
本研究旨在探讨使用 90Y 树脂微球进行肝动脉栓塞化疗时，反流抑制（ARC）导管是否能提高肿瘤靶向性。
方法
回顾性分析接受树脂微球治疗的肝细胞癌（HCC）和继发性肝恶性肿瘤患者。所有患者均在常规端孔导管行计划造影后行 99mTc-聚合白蛋白（99mTc-MAA）单光子发射计算机断层扫描（SPECT）。对于 90Y 微球注射，根据导管类型将患者分为两组：ARC 组（n=38）和对照组（n=23），分别使用 ARC 导管和常规端孔导管。治疗性血管造影后行 90Y 正电子发射断层扫描计算机断层扫描（PET/CT）。导管的选择不是随机的，而是由介入放射科医生决定。99mTc-MAA SPECT 和 90Y PET/CT 与基线影像配准，以确定肿瘤与正常肝脏的比值（T/NL[MAA 或 90Y]）和肿瘤剂量（TD[MAA 或 90Y]），用于计划和治疗。
结果
共对 ARC 组的 38 例患者（115 个病灶）和对照组的 23 例患者（75 个病灶）进行了分析。在 ARC 组中，T/NL90Y 和 TD90Y 明显高于 T/NLMAA 和 TDMAA。ARC 组中，T/NL90Y 的中位数（IQR）为 2.16（2.15），高于 T/NLMAA 的 1.74（1.43）（p＜0.001）。TD90Y 的中位数（IQR）为 90.96 Gy（98.31 Gy），高于 TDMAA 的 73.72 Gy（63.82 Gy）（p＜0.001）。在该组中，神经内分泌转移瘤（NEM）和 HCC 的差异具有统计学意义，结直肠转移瘤（CRM）的差异则较小。在对照组中，未显示出统计学差异。
结论
在使用树脂微球进行肝动脉栓塞化疗时，ARC 的应用可显著提高肿瘤的沉积量。
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