Safety of Repeated Yttrium-90 Radioembolization
Safety of Repeated Yttrium-90 Radioembolization
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DOI：
10.1007/s00270-013-0547-9
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发表时间：
2013-10-01
影响因子：
2.9
通讯作者：
Sze, Daniel Y.
中科院分区：
文献类型：
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作者：
Lam, Marnix G. E. H.;Louie, John D.;Sze, Daniel Y.
由于肝脏对先前暴露的累积记忆，重复放射栓塞术(RE)理论上具有更高的放射性肝损伤风险。我们对2004~2011年间247例重复心脏复位术的患者进行了回顾性安全性分析。8名患者(5名男性，3名女性，年龄范围51-71岁)接受了目标区域的重复治疗，全部使用树脂微球(SIR-Sphes；Sirtex，Lane Cove，澳大利亚)。在标准化的随访中，对不良事件进行分级。此外，在接受RE治疗的247名患者中，对REILD的发生与多变量之间的相关性进行了单因素和多因素分析。两名患者在第二次治疗后不久(分别在84天和107天)死亡，出现REILD的症状和体征。两名患者都接受了两次全肝治疗(累积剂量分别为3.08和2.66 GBq)。其余6例患者在接受2.41~3.88GBq的累积剂量后仅表现出轻微的毒性。所有患者都经历了客观的肿瘤反应。在整个人群中，多因素分析确定了与REILD相关的三个危险因素：重复RE(p=0.036)、基线血清总胆红素(p=0.048)和基线血清天冬氨酸转氨酶(p=0.043)。多因素分析显示，反复RE是REILD的唯一独立危险因素(优势比为9.6；p=0.002)。此外，每靶体积的给药活动(GBQ/L)被发现是REILD的独立危险因素，但仅在全肝治疗中(p=0.033)。反复RE的REILD的风险似乎增加。客观上观察到了肿瘤的反应，但安全限度的建立需要改进剂量测量和预测。
Repeated radioembolization (RE) treatments carry theoretically higher risk of radiation-induced hepatic injury because of the liver's cumulative memory of previous exposure. We performed a retrospective safety analysis on patients who underwent repeated RE.From 2004 to 2011, a total of 247 patients were treated by RE. Eight patients (5 men, 3 women, age range 51-71 years) underwent repeated treatment of a targeted territory, all with resin microspheres (SIR-Spheres; Sirtex, Lane Cove, Australia). Adverse events were graded during a standardized follow-up. In addition, the correlation between the occurrence of RE-induced liver disease (REILD) and multiple variables was investigated in univariate and multivariate analyses in all 247 patients who received RE.Two patients died shortly after the second treatment (at 84 and 107 days) with signs and symptoms of REILD. Both patients underwent whole liver treatment twice (cumulative doses 3.08 and 2.66 GBq). The other 6 patients demonstrated only minor toxicities after receiving cumulative doses ranging from 2.41 to 3.88 GBq. All patients experienced objective tumor responses. In the whole population, multifactorial analysis identified three risk factors associated with REILD: repeated RE (p = 0.036), baseline serum total bilirubin (p = 0.048), and baseline serum aspartate aminotransferase (p = 0.043). Repeated RE proved to be the only independent risk factor for REILD in multivariate analysis (odds ratio 9.6; p = 0.002). Additionally, the administered activity per target volume (in GBq/L) was found to be an independent risk factor for REILD, but only in whole liver treatments (p = 0.033).The risk of REILD appears to be elevated for repeated RE. Objective tumor responses were observed, but establishment of safety limits will require improvement in dosimetric measurement and prediction.