Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: a novel approach to improving the safety of major hepatic resections.
Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: a novel approach to improving the safety of major hepatic resections.
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DOI：
10.1186/1477-7819-7-6
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发表时间：
2009-01-08
影响因子：
3.2
通讯作者：
Fong Y
中科院分区：
文献类型：
--
作者：
Gulec SA;Pennington K;Hall M;Fong Y
扩大肝切除术比以往任何时候都更加自由。然而，肝转移瘤的切除范围受到未来肝残留（FLR）体积的限制。一种既能实现肿瘤控制又能诱导代偿性肥大的干预措施，具有良好的患者耐受性，可以改善临床结局。一名53岁的女性，有宫颈癌病史，表现为肝脏大肿块。随后的活检表明低分化癌伴坏死，提示鳞状细胞起源。决定进行术前化疗和Y-90微球SIRT，目的是获得对疾病的全身控制，缩小肝脏病变，并改善FLR。第一次SIRT后6个月（第二次后3个月）进行手术探查。无肝外病变。发现肿瘤的大小显著减小，中央和外周瘢痕形成。左叶肥大，令人满意。进行了正式的右肝叶切除术，肉眼可见阴性切缘。钇-90（Y-90）微球选择性内照射治疗（SIRT）已成为一种有效的肝脏定向治疗，具有良好的治疗比。我们提出这一病例报告表明，门静脉辐射剂量可以大大增加，目的是诱导门静脉/门静脉周围纤维化。在叶状Y-90微球治疗中的这种治疗操作可以实现PVE的终点，同时避免关于肿瘤进展的担忧。
Extended liver resections are being performed more liberally than ever. The extent of resection of liver metastases, however, is restricted by the volume of the future liver remnant (FLR). An intervention that would both accomplish tumor control and induce compensatory hypertrophy, with good patient tolerability, could improve clinical outcomes. A 53-year-old woman with a history of cervical cancer presented with a large liver mass. Subsequent biopsy indicated poorly differentiated carcinoma with necrosis suggestive of squamous cell origin. A decision was made to proceed with pre-operative chemotherapy and Y-90 microsphere SIRT with the intent to obtain systemic control over the disease, downsize the hepatic lesion, and improve the FLR. A surgical exploration was performed six months after the first SIRT (three months after the second). There was no extrahepatic disease. The tumor was found to be significantly decreased in size with central and peripheral scarring. The left lobe was satisfactorily hypertrophied. A formal right hepatic lobectomy was performed with macroscopic negative margins. Selective internal radiation treatment (SIRT) with yttrium-90 (Y-90) microspheres has emerged as an effective liver-directed therapy with a favorable therapeutic ratio. We present this case report to suggest that the portal vein radiation dose can be substantially increased with the intent of inducing portal/periportal fibrosis. Such a therapeutic manipulation in lobar Y-90 microsphere treatment could accomplish the end points of PVE with avoidance of the concern regarding tumor progression.
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