Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases
Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases
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DOI：
10.1007/s00259-015-3264-6
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发表时间：
2016-07-01
影响因子：
9.1
通讯作者：
Granberg, Dan
中科院分区：
文献类型：
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作者：
Barbier, Charlotte Ebeling;Garske-Roman, Ulrike;Granberg, Dan
目的评价选择性内放射治疗(SIRT)治疗不能切除的神经内分泌肿瘤肝转移(NETLMs)的安全性和有效性。方法对40例进展期NETLMS患者(女性22例，男性18例，平均年龄61.6岁)采用Y-90标记树脂微球进行SIRT治疗。根据修订的实体瘤反应评价标准(MRECIST)在CT或MR图像上对肿瘤反应进行评价。结果40例患者共接受SIRT治疗54例，其中右肝33例(平均活度1.31 GBq)，左叶13例(平均活度0.85GBq)，双叶8例(平均活度1.61 GBq)。在44次治疗后进行晚期随访(平均20个月)。目的早期随访(平均3个月)肿瘤缓解率和疾病控制率分别为54%(29/54)和94%(51/54)，晚期随访分别为34%(15/15)和57%(25/25)。首次SIRT的平均总生存期为34、8个月，1、2、3、5年生存率分别为76%、59%、52%和35%。除了一名死于放射性肝功能衰竭的患者外，不良反应通常轻微且容易控制。45例患者中，18例(45%)在SIRT前接受了多肽受体核素治疗(PRRT)。结论Y-90标记树脂微球SIRT治疗进展期NETLM是一种安全有效的治疗方法，对既往接受过PRRT的患者也是如此。
Purpose To evaluate the safety and efficacy of selective internal radiation therapy (SIRT) in patients with unresectable liver metastases from neuroendocrine tumours (NETLMs).Methods This retrospective study included 40 patients with progressive NETLMs (22 women, 18 men, mean age 61.6 years) who underwent SIRT with Y-90-labelled resin microspheres. Tumour response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) on CT or MR images. Medical records were reviewed.Results In the 40 patients, 54 evaluable SIRT procedures were performed, 33 to the right liver lobe (mean activity 1.31 GBq), 13 to the left lobe (mean activity 0.85 GBq), and 8 to both lobes (mean activity 1.61 GBq). Late follow-up imaging (mean 20 months) was performed after 44 of the treatments. Objective tumour response and disease control rates were 54 % (29 of 54 treatments) and 94 % (51 treatments), respectively, at the early follow-up examination (mean 3 months) and 34 % (15 treatments) and 57 % (25 treatments), respectively at the late follow-up examination. Mean overall survival from the first SIRT was 34,8 months and survival rates at 1, 2, 3 and 5 years were 76 %, 59 %, 52 % and 35 % respectively. Adverse effects were generally mild and easily manageable, except in one patient who died from radiation-induced liver failure. Of the 45 patients, 18 (45 %) had received peptide receptor radionuclide therapy (PRRT) prior to SIRT.Conclusion SIRT with Y-90-labelled resin microspheres is a safe and effective treatment for patients with progressive NETLM, and also for those who have received prior PRRT.