对于具有挑战性的肿瘤血管系统，在进行节段性钇-90放射性栓塞之前进行肝内血流改道。

Intrahepatic flow diversion prior to segmental Yttrium-90 radioembolization for challenging tumor vasculature.

作者信息

Young Lindsay B, Kolber Marcin, King Michael J, Ranade Mona, Bishay Vivian L, Patel Rahul S, Nowakowski Francis S, Fischman Aaron M, Lookstein Robert A, Kim Edward

机构信息

Icahn School of Medicine at Mount Sinai Department of Diagnostic, Molecular and Interventional Radiology, One Gustave L. Levy Place Box 1234, NY, 10029-6574, New York, USA.

University of Texas Southwestern Medical Center, Division of Vascular and Interventional Radiology, 5323 Harry Hines Blvd, TX, 75390-9316, Dallas, USA.

出版信息

J Interv Med. 2022 May 21;5(2):79-83. doi: 10.1016/j.jimed.2022.02.001. eCollection 2022 May.

DOI:10.1016/j.jimed.2022.02.001

PMID:35936664

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9349007/

Abstract

BACKGROUND

Hepatic tumors with complex vascular supply or poor relative perfusion are prone to decreased rates of objective response. This is compounded in the setting of Yttrium-90 (Y90) transarterial radioembolization (TARE), which is minimally embolic and flow-dependent, relying on high threshold dose for complete response.

OBJECTIVE

We describe our experience with intrahepatic flow diversion (FD) prior to TARE of hepatocellular carcinoma (HCC) with challenging vascular supply.

MATERIALS AND METHODS

Between April 2014 and January 2020, 886 cases of coinciding MAA or TARE and bland embolization or temporary occlusion were identified. Intraprocedural embolizations performed for more routine purposes were excluded. FD was performed by bland embolization or temporary occlusion of vessels supplying non-malignant parenchyma in cases where flow was not preferential to target tumor. Lesion characteristics, vascular supply, treatment approach, angiography, and adverse events (AEs) were reviewed. Radiographic response was assessed using mRECIST criteria.

RESULTS

22 cases of FD of focal HCC were identified. Embolics included calibrated microspheres (n = 11), microcoils (n = 4), gelfoam (n = 3), temporary balloon occlusion (n = 2) and temporary deployment of a microvascular plug (n = 1). Post-treatment SPECT-CT dosimetry coverage was concordant with target lesions in all cases. Mean follow-up was 16.7 months (1.4-45 mos). Tumor-specific response per mRECIST was 41% complete response, 50% objective response, and 59% disease control rate. No major adverse events or grade 3/4 hepatotoxicity were reported.

CONCLUSION

Our findings suggest that FD prior to TARE is safe and potentially effective in treating HCC with complex vascular supply or poor tumor perfusion.

摘要

背景

具有复杂血管供应或相对灌注不良的肝肿瘤客观缓解率易于降低。在钇-90（Y90）经动脉放射性栓塞（TARE）的情况下，这种情况更加复杂，TARE栓塞作用极小且依赖血流，依靠高阈值剂量来实现完全缓解。

目的

我们描述了在对具有挑战性血管供应的肝细胞癌（HCC）进行TARE之前进行肝内血流改道（FD）的经验。

材料与方法

在2014年4月至2020年1月期间，共识别出886例同时进行MAA或TARE以及单纯栓塞或临时闭塞的病例。排除了为更常规目的而进行的术中栓塞。在血流并非优先流向靶肿瘤的情况下，通过对供应非恶性实质的血管进行单纯栓塞或临时闭塞来进行FD。回顾了病变特征、血管供应、治疗方法、血管造影和不良事件（AE）。使用mRECIST标准评估影像学缓解情况。

结果

共识别出22例局灶性HCC的FD病例。栓塞材料包括校准微球（n = 11）、微线圈（n = 4）、明胶海绵（n = 3）、临时球囊闭塞（n = 2）和微血管栓塞装置临时置入（n = 1）。所有病例治疗后SPECT-CT剂量测定覆盖情况与靶病变一致。平均随访时间为16.7个月（1.4 - 45个月）。根据mRECIST标准，肿瘤特异性缓解率为完全缓解41%、客观缓解50%、疾病控制率59%。未报告重大不良事件或3/4级肝毒性。