Intrahepatic Flow Redistribution in Patients Treated with Radioembolization
Intrahepatic Flow Redistribution in Patients Treated with Radioembolization
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DOI：
10.1007/s00270-014-0921-2
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发表时间：
2015-04-01
影响因子：
2.9
通讯作者：
Mazzaferro, Vincenzo
中科院分区：
文献类型：
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作者：
Spreafico, Carlo;Morosi, Carlo;Mazzaferro, Vincenzo
在计划钇-90（Y-90）放射栓塞，战略问题出现在肿瘤与多个动脉供应。我们的目的是证明，肿瘤可以通过一个主要的供血动脉实现血流再分配栓塞辅助vessel.100 Y-90-放射栓塞90例患者使用玻璃微球进行治疗。在17例患者的19处病变中，发现副支为较小的肿瘤部分供血并栓塞。在所有17例患者中，通过血管造影和单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）获得完整灌注的评估。将血流再分配后治疗患者的剂量测定、毒性和肿瘤反应率与83例标准治疗患者进行比较。选择15例患者的17个血流再分布病灶作为靶病灶，根据mRECIST标准进行评价，所有患者在放射性栓塞前即刻进行血管造影评估，15例患者在Y-90灌注后进行SPECT-CT评估。在15例可评估患者中，17处病灶的缓解率为3例CR，8例PR和6例SD。剂量和毒性数据，以及肿瘤反应率，与83例正常脉管系统患者相当。所有栓塞手术均成功进行，无并发症，所有病例均获得血流再分布。在毒性、中位给药剂量和放射学反应方面的结果与标准放射栓塞相当。我们的研究结果证实了栓塞副动脉后肿瘤内血流的重新分布，这使得通过单一的主要供血动脉治疗肿瘤成为可能。
In planning Yttrium-90 (Y-90)-radioembolizations, strategy problems arise in tumours with multiple arterial supplies. We aim to demonstrate that tumours can be treated via one main feeding artery achieving flow redistribution by embolizing accessory vessels.One hundred Y-90-radioembolizations were performed on 90 patients using glass microspheres. In 19 lesions/17 patients, accessory branches were found feeding a minor tumour portion and embolized. In all 17 patients, the assessment of the complete perfusion was obtained by angiography and single photon emission computerized tomography-computerized tomography (SPECT-CT). Dosimetry, toxicity, and tumor response rate of the patients treated after flow redistribution were compared with the 83 standard-treated patients. Seventeen lesions in 15 patients with flow redistribution were chosen as target lesions and evaluated according to mRECIST criteria.In all patients, the complete tumor perfusion was assessed immediately before radioembolization by angiography in all patients and after the Y-90-infusion by SPECT-CT in 15 of 17 patients. In the 15 assessable patients, the response rate in their 17 lesions was 3 CR, 8 PR, and 6 SD. Dosimetric and toxicity data, as well tumour response rate, were comparable with the 83 patients with regular vasculature.All embolization procedures were performed successfully with no complications, and the flow redistribution was obtained in all cases. Results in term of toxicity, median dose administered, and radiological response were comparable with standard radioembolizations. Our findings confirmed the intratumoral flow redistribution after embolizing the accessory arteries, which makes it possible to treat the tumour through its single main feeding artery.