Same-day 90Y radioembolization: implementing a new treatment paradigm
Same-day 90Y radioembolization: implementing a new treatment paradigm
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当天 90Y 放射性栓塞术：实施新的治疗模式
DOI：
10.1007/s00259-016-3438-x
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发表时间：
2016-12-01
影响因子：
9.1
通讯作者：
Salem, Riad
中科院分区：
文献类型：
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作者：
Gabr, Ahmed;Kallini, Joseph Ralph;Salem, Riad
旨在评估在单次、当天、联合门诊中进行治疗前肠系膜血管造影、弹簧圈栓塞、Tc-99m 大聚集白蛋白 (Tc-99m-MAA) 闪烁扫描和 Y-90 放射性栓塞治疗的可行性。这是一项回顾性研究，对象为 2008 年至 2015 年期间接受治疗的 78 名患者，这些患者在介入治疗中心的指导下在单次门诊中接受治疗。放射科和核医学科。通过审查基线成像和估计的带有肿瘤的肝脏灌注体积来制定治疗前计划。使用 3D 软件估计感兴趣区域；该值用于剂量测定计划。假设肝细胞癌的最大肺分流分数为 10%，肝转移的最大肺分流分数为 5%。随后，在一次门诊就诊时进行了肝血管造影和 Tc-99m-MAA 闪烁扫描，随后进行了 Y-90 治疗。记录总室内手术时间。所有患者均在当天接受血管造影、Tc-99m-MAA 闪烁扫描和 Y-90 放射性栓塞。在 78 名患者中，16 名患者接受了双肺叶的多段治疗，44 名患者接受了右肺叶的治疗，18 名患者接受了左肺叶的治疗。中位剂量为 106 Gy。所需 Y-90 瓶的中位数为两瓶（范围为一到六瓶）。房间内停留时间中位数为 160 分钟（75 - 250 分钟）。患者居住状况如下：18%（14/78）为本地居民，55%（43/78）为外地居民，18%（14/78）为州外居民，9%（7/78）为国外居民。在 78 名患者中，61 名（77%）患有肝细胞癌，17 名（22%）患有肝转移。中位肺剂量为 3.5 Gy。本研究证明了当天 Y-90 评估和治疗的可行性，同时保持安全有效的 Y-90 输注原则，包括肿瘤剂量测定（肺叶、肺段切除术）、非目标流量最小化和肺剂量最小化。这种模式转化为快速的癌症护理和显着的成本节省。
To assess the feasibility of conducting pretreatment mesenteric angiography, coil embolization, Tc-99m macroaggregated albumin (Tc-99m-MAA) scintigraphy, and Y-90 radioembolization treatment in a single, same-day, combined outpatient encounter.This was a retrospective study of 78 patients treated during the period 2008 - 2015 who were managed in a single outpatient encounter under the guidance of the Interventional Radiology Department and The Nuclear Medicine Department. Pretreatment planning was performed by reviewing baseline imaging and estimated perfused liver volume bearing the tumor. The region of interest was estimated using 3-D software; this value was used for dosimetry planning. Maximum lung shunting fractions of 10 % for hepatocellular carcinoma and 5 % for liver metastases were assumed. Subsequently, hepatic angiography and Tc-99m-MAA scintigraphy were performed followed by Y-90 treatment in one outpatient encounter. Total in-room procedure time was recorded.All patients underwent same-day angiography, Tc-99m-MAA scintigraphy and Y-90 radioembolization. Of the 78 patients, 16 received multiple segmental treatments to both lobes, 44 received treatment to the right lobe, and 18 received treatment to the left lobe. The median dose was 106 Gy. The median number of Y-90 vials needed was two (range one to six). The median in-room time was 160 min (75 - 250 min). The residential status of the patients was as follows, 18 % (14/78) were local residents, 55 % (43/78) traveled from outside the city limits, 18 % (14/78) were from out-of-state, and 9 % (7/78) were resident abroad. Of the 78 patients, 61 (77 %) had hepatocellular carcinoma, and 17 (22 %) had liver metastases. The median lung dose was 3.5 Gy.This study demonstrated the feasibility of same-day Y-90 evaluation and treatment while maintaining the principles of safe and effective Y-90 infusion including tumoricidal dosimetry (lobar, segmentectomy), minimization of nontarget flow, and minimization of lung dose. This paradigm translates into expeditious cancer care and significant cost savings.