EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds
EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds
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DOI：
10.1007/s00259-011-1812-2
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发表时间：
2011-07-01
影响因子：
9.1
通讯作者：
Luster, Markus
中科院分区：
文献类型：
--
作者：
Giammarile, Francesco;Bodei, Lisa;Luster, Markus
手术(即切除或肝移植)，但只有10%-20%的患者适合这样做。在其他患者中，可以给予各种姑息治疗，如化疗栓塞术、射频消融术或最近发现的癌症--原发性肝癌(即肝细胞癌或胆管癌)是世界上最常见的一些癌症，在大多数患者中具有迅速致命的肝功能衰竭。治疗方法包括引入酪氨酸激酶抑制剂，如索拉非尼。在欧洲，结直肠癌是第二大致命性癌症，肝转移无论是在诊断时还是在随访中都很常见。这些患者通常接受一系列的手术、化疗和抗体治疗[Okuda等人]。(癌症56：918-928,1985)；Schafer和Sorrell(柳叶刀353：1253-1257,1999)；Leong等人。(阿诺德，伦敦，1999)]。放射栓塞术是一种创新的治疗方法，其定义是通过经皮动脉内技术注入装载有放射性同位素的微米级栓塞剂。使用这些动脉内放射性化合物的优点是能够向小靶区发射高剂量辐射，毒性相对较低，可以治疗包括显微疾病在内的整个肝脏，以及与其他治疗方式相结合的可行性。缺点主要是由于辐射防护的限制，主要是对(131)碘标记剂的限制、物流以及意外交付或分流的可能性[Novell等人]。(BR J Surg 78：901-906,1991)]。治疗、肿瘤学和剂量学委员会共同努力，修订欧洲核医学会(EANM)关于放射性药物(131)碘碘油(Lipiocis(R)，IBA，布鲁塞尔，比利时)的使用指南，并纳入带有(90)Y-微球的较新医疗设备。(90)Y要么与树脂结合(SIR-Sphes(R)，Sirtex Medical，澳大利亚莱恩湾)，要么嵌入玻璃基质(TheraSphere(R)，MDS Nordion，Kanata，ON，加拿大)。由于(90)Y-微球不被代谢，它们不被登记为非密封源。然而，微球是在水溶液中传递的：放射性污染是一个令人担忧的问题，微球应该像其他放射性药物一样作为开放来源处理。本指南的目的是帮助核医学医生治疗和管理接受这种治疗的患者。(131)碘-碘化油是一种综合治疗方案，先前的欧洲核医学协会(EANM)指南已针对其用途进行了修订。较新的(90)Y-微球疗法正迅速在整个核医学界推广。到目前为止，已发表的关于微球的数据，特别是关于剂量学特征和客观反应的表征的数据，仍然是初步的。因此，该文件这一部分的目的是建立第一个基本程序来指导核医学医生使用放射性标记微球进行治疗。
surgery (i.e. resection or liver transplantation), but only 10-20% of patients are candidates for this. In other patients, a variety of palliative treatments can be given, such as chemoembolization, radiofrequency ablation or recentlyPrimary liver cancers (i.e. hepatocellular carcinoma or cholangiocarcinoma) are worldwide some of the most frequent cancers, with rapidly fatal liver failure in a large majority of patients. Curative therapy consists of introduced tyrosine kinase inhibitors, e. g. sorafenib. Colorectal cancer is the second most lethal cancer in Europe and liver metastases are prevalent either at diagnosis or in follow-up. These patients are usually treated by a sequence of surgery, chemotherapy and antibody therapy [Okuda et al. (Cancer 56: 918-928, 1985); Schafer and Sorrell (Lancet 353: 1253-1257, 1999); Leong et al. (Arnold, London, 1999)]. Radioembolization is an innovative therapeutic approach defined as the injection of micron-sized embolic particles loaded with a radioisotope by use of percutaneous intra-arterial techniques. Advantages of the use of these intra-arterial radioactive compounds are the ability to deliver high doses of radiation to small target volumes, the relatively low toxicity profile, the possibility to treat the whole liver including microscopic disease and the feasibility of combination with other therapy modalities. Disadvantages are mainly due to radioprotection constraints mainly for (131)I-labelled agents, logistics and the possibility of inadvertent delivery or shunting [Novell et al. (Br J Surg 78: 901-906, 1991)]. The Therapy, Oncology and Dosimetry Committees have worked together in order to revise the European Association of Nuclear Medicine (EANM) guidelines on the use of the radiopharmaceutical (131)I-Lipiodol (Lipiocis (R), IBA, Brussels, Belgium) and include the newer medical devices with (90)Y-microspheres. (90)Y is either bound to resin (SIR-Spheres (R), Sirtex Medical, Lane Cove, Australia) or embedded in a glass matrix (TheraSphere (R), MDS Nordion, Kanata, ON, Canada). Since (90)Y-microspheres are not metabolized, they are not registered as unsealed sources. However, the microspheres are delivered in aqueous solution: radioactive contamination is a concern and microspheres should be handled, like other radiopharmaceuticals, as open sources. The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients undergoing such treatment. (131)I-Lipiodol is a consolidated treatment option and the previous European Association of Nuclear Medicine (EANM) guidelines have been revised for its use. The newer (90)Y-microsphere therapy is rapidly expanding throughout the nuclear medicine community. To date, published data on microspheres, particularly on dosimetry features and the characterization of the objective response, are still preliminary. Therefore, the aim of this part of the document is to set up a first basic procedure to guide nuclear medicine physicians in treatment with radiolabelled microspheres.