Kis Bela, Gyano Marcell
Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida.
Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida; Department of Radiology, Semmelweis University, Budapest, Hungary.
J Vasc Interv Radiol. 2025 Feb;36(2):207-218. doi: 10.1016/j.jvir.2024.08.031. Epub 2024 Oct 19.
To evaluate the available evidence of lung dosimetry and radiation pneumonitis (RP).
The guideline regarding the maximum tolerated lung dose for yttrium-90 (Y) radioembolization is an expert opinion (Level 5 evidence) based on a case series of 5 patients and recommends keeping the absorbed radiation dose to the lungs below 30 Gy per treatment and 50 Gy in a lifetime to prevent RP. The current understanding of the risks of RP is minimal despite its debilitating nature and high mortality rate. A systematic literature review was conducted in PubMed, Embase, Cochrane database, and Google Scholar for reported cases of RP. A database of 48 RP cases was compiled and analyzed.
Thirty patients were treated with resin and 16 patients with glass Y microspheres. The treatment device was not reported in 2 cases. RP developed a median of 3 months after radioembolization. The mortality rate was 40%. The hepatopulmonary shunt was not significantly different between the glass and the resin groups (21.2% [SD ± 14%] vs 15.6% [SD ± 7.5%]; P = .24). The radiation dose to the lungs was significantly higher in patients treated with glass compared with those with resin Y microspheres (41.4 Gy [SD ± 18.4] vs 21.5 Gy [SD ± 9.9]; P = .003).
The dose toxicity threshold for resin microspheres is lower than that of glass microspheres. The established 30-Gy dose limit may not be uniformly applicable in all cases and for both devices. The maximum tolerable lung doses should be reevaluated, and the shortcomings of the hepatopulmonary shunt calculation need to be corrected.
评估肺剂量测定和放射性肺炎（RP）的现有证据。
关于钇-90（Y）放射性栓塞术的最大耐受肺剂量的指南是基于5例患者的病例系列得出的专家意见（5级证据），建议每次治疗时肺吸收辐射剂量低于30 Gy，终生低于50 Gy以预防RP。尽管RP具有使人衰弱的性质和高死亡率，但目前对其风险的了解仍很少。在PubMed、Embase、Cochrane数据库和谷歌学术中对已报道的RP病例进行了系统的文献综述。编制并分析了一个包含48例RP病例的数据库。
30例患者接受了树脂治疗，16例患者接受了玻璃Y微球治疗。2例未报告治疗设备。RP在放射性栓塞术后中位3个月发生。死亡率为40%。玻璃组和树脂组的肝肺分流无显著差异（21.2%[标准差±14%]对15.6%[标准差±7.5%]；P = 0.24）。与接受树脂Y微球治疗的患者相比，接受玻璃治疗的患者肺部的辐射剂量显著更高（41.4 Gy[标准差±18.4]对21.5 Gy[标准差±9.9]；P = 0.003）。
树脂微球的剂量毒性阈值低于玻璃微球。既定的30 Gy剂量限制可能并非在所有情况下及对两种设备都普遍适用。应重新评估最大耐受肺剂量，且肝肺分流计算的缺点需要纠正。
