Increasing Yttrium-90 Dose Conformality Using Proximal Radioembolization Enabled by Distal Angiosomal Truncation for the Treatment of Hepatic Malignancy
Increasing Yttrium-90 Dose Conformality Using Proximal Radioembolization Enabled by Distal Angiosomal Truncation for the Treatment of Hepatic Malignancy
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DOI：
10.1016/j.jvir.2019.12.017
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发表时间：
2020-06-01
影响因子：
2.9
通讯作者：
Toskich, Beau B.
中科院分区：
文献类型：
--
作者：
Core, Jacob M.;Frey, Gregory T.;Toskich, Beau B.
目的：评估通过远端血管体截断实现近端放射栓塞来提高放射剂量适形性的安全性和可行性，其中选择性administrationisnotpractices.Materials和方法：回顾性评价了2017年1月至2019年3月期间通过血管体截断治疗的肝脏恶性肿瘤。33名患者（8名女性，25名男性;平均年龄62.2岁;范围。36-78岁）接受了39次治疗。在治疗中，74.3%（n = 29）用于肝细胞癌，10.2%（n = 4）用于胆管癌，15.4%（n = 6）用于转移性肿瘤（1例结直肠腺癌、1例胰腺癌、3例黑色素瘤和1例子宫内膜样癌）。使用临时栓塞器械（包括微血管塞、可解脱弹簧圈、明胶浆和球囊微导管）实现截断，然后进行近端放射性栓塞。处理活性范围为0.47-5.75 GBq。进行锝-99m大颗粒聚集白蛋白和韧致辐射单光子发射计算机断层扫描（CT）/CT阈值分析，以描绘和比较放射性栓塞前后治疗血管小体内的活性分布。对14名患者的剂量测定分析表明，在5%、20%和40%阈值下，非靶向肝脏辐射暴露显著降低（分别为P =.002、P = .001和P = .008）。未发生3级或以上不良事件。术前和术后3个月，白蛋白-胆红素分级和东部肿瘤协作组体能状态（P = 0.09和P = 0.74）无显著变化。截断的动脉在随后的血管造影中11例和39例中的38例在MR血管造影或CT血管造影中是通畅的。结论：远端血管体截断的近端放射性栓塞是安全的，在不适合选择性给药的情况下，可以减少非靶向实质放射性栓塞剂量。
Purpose: To evaluate safety and feasibility of improving radiation dose conformality via proximal radioembolization enabled by distal angiosomal truncation where selective administration was not practical.Materials and Methods: Hepatic malignancies treated via angiosomal truncation between January 2017 and March 2019 were retrospectively evaluated. Thirty-three patients (8 women, 25 men; mean age, 62.2 y; range. 36-78 y) underwent 39 treatments. Of treatments, 74.3% (n = 29) were for hepatocellular carcinomas, 10.2% (n = 4) were for cholangiocarcinomas, and 15.4% (n = 6) were for metastatic tumors (1 colorectal adenocarcinoma, 1 pancreatic adenocarcinoma, 3 melanomas, and 1 endometroid carcinoma). Truncation was achieved using temporary embolic devices including a microvascular plug, detachable coil, gelatin slurry, and balloon microcatheter, after which proximal radioembolization was performed. Range of treatment activity was 0.47-5.75 GBq. Technetium-99m macroaggregated albumin and bremsstrahlung single photon emission computed tomography (CT)/CT threshold analysis was conducted to delineate and compare distribution of activity within the treatment angiosome before and after radioembolization.Results: Dosimetric analysis of 14 patients demonstrated a significant reduction in nontarget liver radiation exposure at 5, 20, and 40% thresholds (P =.002, P = .001, and P = .008, respectively). There were no grade 3 or higher adverse events. There was no significant change in Albumin-Bilirubin grade and Eastern Cooperative Oncology Group Performance Status (P = .09 and P = .74) before and 3 months after the procedure. Truncated arteries were patent on subsequent angiography in 11 cases and on MR angiography or CT angiography in 38 of 39 cases.Conclusions: Proximal radioembolization enabled by distal angiosomal truncation is safe d decreases nontarget parenchymal radioembolization dose in cases not amenable to selective administration.