Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
J Vasc Interv Radiol. 2024 Jul;35(7):1012-1021.e1. doi: 10.1016/j.jvir.2024.04.010. Epub 2024 Apr 24.
To evaluate the histopathologic changes and potential correlations of tumor absorbed dose (TAD) after yttrium-90 transarterial radioembolization (TARE) for colorectal liver metastases (CLMs).
This prospective pilot study assessed 12 patients with 13 CLMs through positron emission tomography (PET)/computed tomography (CT)-guided biopsies before, immediately after TARE (T0), and 3 weeks after TARE (T3). Subsequent sampling from the same location was enabled by fiducial placement. Biopsy samples were evaluated with hematoxylin and eosin, TUNEL, Ki67, OxPhos, caspase-3 (CC3), and pH2AX antibodies. Proliferation changes (Ki67) and double-strand DNA breaks (DSBs) were evaluated quantitatively. TAD was calculated on post-TARE PET/CT scan of the biopsy needle location at T0 and T3.
Median TAD at 3 weeks after TARE was 162 Gy (interquartile range (IQR), 92-211 Gy). DSBs decreased significantly from T0 (median, 77%; IQR, 75%-100%) to T3 (median, 14%; IQR, 0%-54%; P = .028). A decrease in Ki67 was also documented (median, 73%; IQR, 70%-80% at T0 vs median, 41%; IQR, 0%-66% at T3; P = .046). There was a strong positive correlation between TAD and DSBs at T0 (r[9] = 0.68) and a strong negative correlation at T3 (r[10] = -0.855; P = .042 and P = .002, respectively). There was a strong negative correlation between TAD and Ki67 at both T0 (r[9] = -0.733; P = .025) and T3 (r[10] = -0.681; P = .030). Tumors that exhibited caspase-3 activation (8/13, 62%) at either T0 or T3 time point were more likely to develop progression (7/8 [88%] vs 1/5 [20%]; P = .015).
Post-TARE biopsy can be used to assess TAD and histopathologic changes. Significant decreases in DSBs and proliferation index were noted after TARE. Post-TARE CC3 activation deserves further exploration.
评估钇-90 经动脉放射性栓塞术（TARE）治疗结直肠癌肝转移瘤（CLM）后肿瘤吸收剂量（TAD）的组织病理学变化及其潜在相关性。
本前瞻性初步研究采用正电子发射断层扫描（PET）/计算机断层扫描（CT）引导的活检，在 TARE 前（T0）、TARE 即刻（T0）和 TARE 后 3 周（T3）评估了 12 例 13 个 CLM。通过放置基准点，可在同一位置进行后续采样。苏木精和伊红、TUNEL、Ki67、OxPhos、半胱天冬氨酸蛋白酶-3（CC3）和 pH2AX 抗体用于评估活检样本。定量评估增殖变化（Ki67）和双链 DNA 断裂（DSBs）。TARE 后，在 T0 和 T3 时通过活检针位置的 PET/CT 扫描计算 TAD。
TARE 后 3 周的中位 TAD 为 162 Gy（四分位距（IQR），92-211 Gy）。DSBs 从 T0 时的中位数 77%（IQR，75%-100%）显著下降至 T3 时的中位数 14%（IQR，0%-54%；P=.028）。Ki67 也有下降（T0 时中位数 73%（IQR，70%-80%），T3 时中位数 41%（IQR，0%-66%；P=.046）。T0 时 TAD 与 DSBs 呈强正相关（r[9]=0.68），T3 时呈强负相关（r[10]=-0.855；P=.042 和 P=.002）。T0 和 T3 时 TAD 与 Ki67 均呈强负相关（r[9]=-0.733；P=.025 和 r[10]=-0.681；P=.030）。在 T0 或 T3 时间点表现出半胱天冬氨酸蛋白酶-3 激活（8/13，62%）的肿瘤更有可能发生进展（8/8 [88%] vs 5/5 [20%]；P=.015）。
TARE 后活检可用于评估 TAD 和组织病理学变化。TARE 后 DSBs 和增殖指数显著下降。CC3 激活后的 TARE 值得进一步研究。
