Guney Isa Burak, Balli Huseyin Tugsan, Kucuker Kadir Alper, Unal Ilker, Kibar Mustafa
Department of Nuclear Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey.
Department of Radiology, Faculty of Medicine, Cukurova University, Adana, Turkey.
Diagn Interv Radiol. 2022 Mar;28(2):156-165. doi: 10.5152/dir.2022.20775.
PURPOSE We aimed to evaluate whether the perfusion pattern from pretreatment hepatic artery perfusion scintigraphy (HAPS) in patients with liver malignancies can predict response to selective internal radiation therapy (SIRT). METHODS This retrospective study analyzed 152 consecutive patients treated with yttrium-90 (90Y) resin microspheres between April 2015 and July 2017. HAPS using single-photon emission computed tomography/computed tomography (SPECT/CT) with 99mtechnetium macroaggregated albumin (99mTc-MAA) was performed before SIRT. Investigators visually classified perfusion patterns of tumors as heterogeneous or diffuse in HAPS. Between diffuse and heterogeneous pattern group, positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) were performed in third and sixth month after SIRT, and tumor response assessed and compared by using RECIST 1.1 or mRECIST. Overall survival (OS) and progression-free survival (PFS) were also compared with Kaplan-Meier/log-rank analyses. RESULTS Of 216 SIRT procedures, 172 were classified as heterogeneous and 44 as diffuse. Diffuse 99mTc- MAA uptake was associated with longer median OS than heterogeneous (22.2 vs. 14.4 months, respectively; P = .047). Subsegmental infusion was associated with longer OS than either lobar or segmental infusion (P = .090). Mean estimated OS was longer in patients with hepatocellular carcinoma (HCC) (34.2 months) than with colorectal carcinoma (CRC) (16.4 months) (P = .044). Patients with both diffuse and heterogeneous patterns were able to show complete response after SIRT. No statistically significant differences were observed between perfusion patterns and PFS or response rates to SIRT. CONCLUSION Although tumor perfusion patterns from preplanning HAPS analyses are useful for estimating tumor uptake of 90Y, they may not reliably predict hepatic treatment response, as patients with different perfusion patterns can show clinical response to SIRT.
目的 我们旨在评估肝恶性肿瘤患者治疗前肝动脉灌注闪烁显像（HAPS）的灌注模式是否能够预测选择性内放射治疗（SIRT）的疗效。方法 这项回顾性研究分析了2015年4月至2017年7月期间连续接受钇-90（90Y）树脂微球治疗的152例患者。在SIRT前使用单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）和99m锝标记的大聚合白蛋白（99mTc-MAA）进行HAPS检查。研究人员在HAPS中通过视觉将肿瘤的灌注模式分类为不均匀或弥漫性。在弥漫性和不均匀性模式组之间，在SIRT后的第三个月和第六个月进行正电子发射断层扫描/计算机断层扫描（PET/CT）和磁共振成像（MRI），并使用RECIST 1.1或mRECIST评估和比较肿瘤反应。还通过Kaplan-Meier/对数秩分析比较总生存期（OS）和无进展生存期（PFS）。结果 在216例SIRT手术中，172例被分类为不均匀性，44例为弥漫性。弥漫性99mTc-MAA摄取与比不均匀性更长的中位OS相关（分别为22.2个月和14.4个月；P = 0.047）。亚段注入与比叶注入或段注入更长的OS相关（P = 0.090）。肝细胞癌（HCC）患者的平均估计OS（34.2个月）比结直肠癌（CRC）患者（16.4个月）更长（P = 0.044）。弥漫性和不均匀性模式的患者在SIRT后均能够显示完全缓解。在灌注模式与PFS或SIRT反应率之间未观察到统计学上的显著差异。结论 尽管预规划HAPS分析中的肿瘤灌注模式有助于估计90Y的肿瘤摄取，但它们可能无法可靠地预测肝脏治疗反应，因为具有不同灌注模式的患者对SIRT均可显示临床反应。
