Radioembolization for primary and metastatic liver cancer.
Radioembolization for primary and metastatic liver cancer.
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DOI：
10.1016/j.semradonc.2011.05.004
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发表时间：
2011-10
影响因子：
3.5
通讯作者：
Salem, Riad
中科院分区：
文献类型：
--
作者：
Memon, Khairuddin;Lewandowski, Robert J.;Kulik, Laura;Riaz, Ahsun;Mulcahy, Mary F.;Salem, Riad
肝细胞癌的发病率呈上升趋势。大多数患者存在潜在的治愈选择，并且通常受到基础肝硬化的影响。在这种情况下，经动脉治疗，如放射性栓塞，作为肝细胞癌和肝转移的潜在治疗方法正在迅速获得认可。放射性栓塞是一种基于导管的肝脏定向治疗，涉及通过使用经皮经动脉技术注射载有放射性同位素的微米级栓塞颗粒。癌细胞优先由动脉血供应，正常肝细胞优先由门静脉血供应;因此，放射性栓塞专门针对具有高剂量致死辐射的肿瘤细胞，而不影响健康肝细胞。抗肿瘤作用主要来自放射而不是栓塞。最常用的放射性同位素是钇-90。市售器械为TheraSphere®（玻璃基）和SIR-Sphere®（树脂基）。该程序是在门诊基础上进行。并发症的发生率通常低于其他局部治疗，可能包括恶心、疲劳、腹痛、肝功能障碍、胆道损伤、纤维化、放射性肺炎、胃肠道溃疡和血管损伤。然而，这些可以通过细致的预处理评估、仔细的患者选择和适当的剂量测定来避免。本文重点介绍了放射性栓塞的技术和临床方面，重点是患者的选择，用途和并发症。
The incidence of hepatocellular carcinoma is increasing. Most patients present beyond potentially curative options and are usually affected by underlying cirrhosis. In this scenario, trans-arterial therapies, such as radioembolization, are rapidly gaining acceptance as a potential therapy for hepatocellular carcinoma and liver metastases. Radioembolization is a catheter-based liver-directed therapy that involves injection of micron-sized embolic particles loaded with a radioisotope by use of percutaneous transarterial techniques. Cancer cells are preferentially supplied by arterial blood and normal hepatocytes by portal venous blood; radioembolization therefore specifically targets tumor cells with a high dose of lethal radiation and spares healthy hepatocytes. The antitumor effect mostly comes from radiation rather than embolization. The most commonly used radioisotope is Yttrium-90. The commercially available devices are TheraSphere® (glass-based) and SIR-Sphere® (resin-based). The procedure is performed on outpatient basis. The incidence of complications is generally less than other locoregional therapies and may include nausea, fatigue, abdominal pain, hepatic dysfunction, biliary injury, fibrosis, radiation pneumonitis, gastrointestinal ulcers and vascular injury. However, these can be avoided by meticulous pretreatment assessment, careful patient selection and adequate dosimetry. This article focuses on both the technical and clinical aspects of radioembolization with emphasis on patient selection, uses and complications.
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