Transcatheter Arterial Embolization With Spherical Embolic Agent for Pulmonary Metastases From Renal Cell Carcinoma
Transcatheter Arterial Embolization With Spherical Embolic Agent for Pulmonary Metastases From Renal Cell Carcinoma
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DOI：
10.1007/s00270-013-0576-4
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发表时间：
2013-12-01
影响因子：
2.9
通讯作者：
Maeda, Masahiko
中科院分区：
文献类型：
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作者：
Seki, Akihiko;Hori, Shinichi;Maeda, Masahiko
为评价高吸水性聚合物微球（SAP-MS）经导管动脉栓塞（TAE）治疗肾细胞癌（RCC）肺转移瘤的安全性和局部疗效，对16例常规治疗无效的RCC肺转移瘤患者进行TAE治疗。制备的SAP-MS溶胀至比它们的干燥状态尺寸（100-150 μ m [n = 14]，50-100 μ m [n = 2]）大约两倍。选择49个肺结节（肺n = 22，纵隔淋巴结n = 17，肺门淋巴结n = 10）作为靶病变进行评价。根据实体瘤疗效评价标准（RECIST;版本1.1），在TAE后3个月评价局部肿瘤缓解。评价选择性血管造影中CT肿瘤增强率与局部肿瘤反应的关系。每位患者的TAE次数范围为1 - 5次（中位数为2.9次）。初始TAE时栓塞的动脉为14例患者（87.5%）的支气管动脉和11例患者（68.8%）的非支气管体动脉。基于结节的评价显示5个（10.2%）结节完全缓解，17个（34.7%）结节部分缓解，15个（30.6%）结节病情稳定，12个（24.5%）结节病情进展。22个高肿瘤增强率病灶的缓解率显著高于27个轻度或中度增强率病灶（90.9 vs. 7.4%，p = 0.01）。TAE联合SAP-MS可能是RCC肺转移患者耐受性良好且局部有效的姑息性治疗选择。
This retrospective study aimed to evaluate the safety and local efficacy of transcatheter arterial embolization (TAE) with superabsorbent polymer microspheres (SAP-MS) in patients with pulmonary metastases from renal cell carcinoma (RCC).Sixteen patients with unresectable pulmonary metastases from RCC refractory to standard therapy were enrolled to undergo TAE with the purpose of mass reduction and/or palliation. The prepared SAP-MS swell to approximately two times larger than their dry-state size (100-150 mu m [n = 14], 50-100 mu m [n = 2]). Forty-nine pulmonary nodules (lung n = 22, mediastinal lymph node n = 17, and hilar lymph node n = 10) were selected as target lesions for evaluation. Local tumor response was evaluated 3 months after TAE according to Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). The relationship between tumor enhancement ratio by CT during selective angiography and local tumor response was evaluated.The number of TAE sessions per patient ranged from 1 to 5 (median 2.9). Embolized arteries at initial TAE were bronchial arteries in 14 patients (87.5 %) and nonbronchial systemic arteries in 11 patients (68.8 %). Nodule-based evaluation showed that 5 (10.2 %) nodules had complete response, 17 (34.7 %) had partial response, 15 (30.6 %) had stable disease, and 12 (24.5 %) had progressive disease. The response rate was significantly greater in 22 lesions that had a high tumor enhancement ratio than in 27 lesions that had a slight or moderate ratio (90.9 vs. 7.4 %, p = 0.01). Severe TAE-related adverse events did not occur.TAE with SAP-MS might be a well-tolerated and locally efficacious palliative option for patients with pulmonary metastases from RCC.