ABSTRACT
Studies correlated with yttrium-90 (90Y) radioembolization for unresectable liver metastases of melanoma (LMM) were analyzed during January 1st, 1991 to September 1st, 2018. A total of 9 reports involving 207 patients were included for the analysis. The most common primary site of melanoma was choroid, followed by cutaneous and rectal. A total of 199 cases were followed-up, and in 181 patient the complete response rate was 1.1%(2/181), partial response rate was 18.2%(33/181), stable disease rate was 46.4%(84/181), and cancer control rate was 65.7%(119/181). The median survival was 10 months. Complications were found in 42 cases (21.5%, 42/195), including radioembolization induced liver disease (n=39), gastric ulceration (n=2), cholecystitis (n=1), and liver failure (n=3). Adverse reaction included fatigue (14.3%~44.0%), nausea (6.3%~23.0%), and abdominal pain (7.0%~38.0%). 90Y radioembolization is a promising alternative therapy for the treatment of unresectable LMM, with encouraging effects on disease control and survival. Some complications can occur, and adverse reaction are frequent but mild.
ABSTRACT
Studies correlated with yttrium-90 ( 90 Y) radioembolization for unresectable liver metasta-ses of melanoma ( LMM) were analyzed during January 1st, 1991 to September 1st, 2018. A total of 9 reports involving 207 patients were included for the analysis. The most common primary site of melanoma was choroid, followed by cutaneous and rectal. A total of 199 cases were followed-up, and in 181 patient the complete response rate was 1. 1％(2/181), partial response rate was 18. 2％(33/181), stable disease rate was 46. 4％ ( 84/181 ) , and cancer control rate was 65. 7％ ( 119/181 ) . The median survival was 10 months. Complications were found in 42 cases (21. 5％, 42/195), including radioembolization induced liver disease ( n =39 ) , gastric ulceration ( n =2 ) , cholecystitis ( n =1 ) , and liver failure ( n =3 ) . Adverse reaction included fatigue ( 14. 3％ ～44. 0％) , nausea ( 6. 3％ ～23. 0％) , and abdominal pain (7. 0％ ～38. 0％). 90Y radioembolization is a promising alternative therapy for the treatment of unresectable LMM, with encouraging effects on disease control and survival. Some complications can occur, and adverse reaction are frequent but mild.
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OBJECTIVE: To identify an imaging predictor for the assessment of early treatment response to yttrium-90 transarterial radioembolization (TARE) in patients with hepatocellular carcinoma (HCC), using a quantitative assessment of dynamic computed tomography (CT) images. MATERIALS AND METHODS: Dynamic contrast-enhanced CT was obtained pre- and 4 weeks post-TARE in 44 patients (34 men, 10 women; mean age, 60 years) with HCC. Computer software was developed for measuring the percentage increase in the combined delayed-enhancing area and necrotic area (pD + N) and the percentage increase in the necrotic area (pNI) in the tumor-containing segments pre- and post-TARE. Local progression-free survival (PFS) was compared between patient groups using Cox regression and Kaplan-Meier analyses. RESULTS: Post-TARE HCC with pD + N ≥ 35.5% showed significantly longer PFS than those with pD + N < 35.5% (p = 0.001). The local tumor progression hazard ratio was 17.3 (p = 0.009) for pD + N < 35.5% versus pD + N ≥ 35.5% groups. HCCs with a high pNI tended to have longer PFS, although this difference did not reach statistical significance. CONCLUSION: HCCs with a larger pD + N are less likely to develop local progression after TARE.
Subject(s)
Female , Humans , Male , Carcinoma, Hepatocellular , Disease-Free Survival , Tomography, X-Ray Computed , Treatment Outcome , Yttrium RadioisotopesABSTRACT
ABSTRACT Transarterial selective internal radiation therapy with yttrium-90, also known as radioembolization, is a therapy based on the administration of resin or glass microspheres loaded with the radioisotope yttrium-90, via selective arterial catheterization of tumor-feeding vessels. It is classified as a type of locoregional therapy and its main goal is to treat patients with primary or secondary hepatic lesions that are unresectable and not responsive to other therapies. Since it is a new technology still restricted to very few hospitals in Brazil, but used in patients throughout the country, it is necessary to demonstrate the main aspects of hepatic lesions treated with selective internal radiation therapy found in magnetic resonance imaging, and to make specific considerations on interpretation of these images. The objective of this report is to demonstrate the main aspects of magnetic resonance imaging of unresectable primary or secondary hepatic lesions, in patients submitted to transarterial selective internal radiation therapy.
RESUMO A radioterapia interna seletiva transarterial com ítrio-90, também conhecida como radioembolização, é uma terapia baseada na administração de microesferas de resina ou vidro carregadas com o radioisótopo ítrio-90, via cateterismo arterial seletivo dos vasos nutridores do tumor. É classificada como um tipo de terapia locorregional e seu principal objetivo é tratar pacientes portadores de lesões hepáticas primárias ou secundárias irressecáveis e não responsivas a outras terapias. Por se tratar de uma nova tecnologia, portanto ainda restrita a pouquíssimos hospitais no Brasil (ainda que utilizada em todo país), é necessário demonstrar os principais aspectos de imagem das lesões hepáticas tratadas com radioterapia interna seletiva transarterial encontrados em exame de ressonância magnética, além de delinear considerações específicas de interpretação destas imagens. O objetivo deste relato é demonstrar os principais aspectos encontrados em ressonância magnética de lesões hepáticas irressecáveis, primárias ou secundárias, de pacientes submetidos à radioterapia interna seletiva transarterial.
Subject(s)
Humans , Male , Female , Aged , Yttrium Radioisotopes/therapeutic use , Radiosurgery/methods , Embolization, Therapeutic/methods , Liver Neoplasms/therapy , Magnetic Resonance Imaging , Treatment Outcome , Liver Neoplasms/diagnostic imaging , Middle AgedABSTRACT
Objective To evaluate the efficacy of 90Sr-90Y applicator treatment for hemangioma by superficial ultrasound.Methods A total of 94 infants with hemangioma were retrospectively analyzed,including 37 males and 57 females (age range:1-12 months,mean =4.5 months).Thickness of hemangioma was measured by superficial ultrasound on the day before 90Sr-90Y applicator treatment,10 d and 3 months after treatment.Paired t test and x2 test were used to analyze data.ROC curve was analyzed to determine the tumor thickness which could be cured by one-cycle of treatment.Results Sixty-two cases were cured,29 cases had partial response and 3 cases had treatment failure.Thickness of hemangioma was (0.38 ±0.28)cm before treatment and (0.16±0.35) cm 3 months post-treatment and the difference was statistically significant (t=7.377,P＜0.05).The treatment effect of 90Sr-90Y applicator was not influenced by gender.According to the site of hemangioma,the curative rates were 20/38 in head & neck,22/33 in chest,20/23 in limbs.Only the difference between the curative rates in head & neck and limbs was statistically significant (x2 =7.478,P＜0.05).The treatment effect of 90Sr-90Y applicator was evaluated by the thickness of hemangioma under the skin at 3 months post-treatment and the area under the ROC was 0.93.The threshold of the thickness of hemangioma which could be cured by one-cycle of treatment was 0.32 cm with the sensitivity of 93.8％ and specificity of 85.5％.Conclusions The 90Sr-90Y applicator had a good treatment effect on pure hemangioma in infants,especially for those located in limbs and torso.The lesion with thickness less than 0.32 cm had a higher chance to be cured by one-cycle of treatment.
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Objective To investigate the clinical efficacy and safety of 90Sr-90Y applicator combined with topical timolol maleate for infantile superficial hemangiomas.Methods A total of 59 infants with hemangiomas were randomly divided into a study group (n=33; ≤3 months,15 cases;＞3 months,18 cases) and a control group (n=26; ≤3 months,10 cases; ＞3 months,16 cases).The study group was treated with 90Sr-90Y applicator combined with timolol maleate solution (0.5％) and the control group was treated with the same dose of 90Sr-90Y applicator combined with saline.Treatment effectiveness was compared between the two groups,and x2 test was used for statistical analysis.Adverse reaction was observed and recorded.Results The effective rate was 18/18,and the cure rates were 14/15 (≤ 3 months) and 16/18 (＞3 months) in the study group.The effective rates were 8/10 (≤3 months) and 11/16 (＞3 months),and the cure rates were 6/10 (≤3 months) and 9/16 (＞3 months) in the control group.Both the effective rate and cure rate of the study group were significantly higher than those of control group (x2 =22.22 and 30.29,≤3 months; x2 =36.69 and 27.31,＞3 months; all P＜0.01).Significant adverse reaction was not found in both groups.Conclusion 90Sr-90Y applicator combined with 0.5％ solution of topical timolol maleate has a very high effective and cure rate for infantile superficial hemangiomas,without significant adverse reaction observed.
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Objective To investigate the clinical efficacy of 90Sr-90Y applicator combined with propranolol (inderal) treatment for infants with large areas of cutaneous hemangiomas.Methods Thirty-nine infants with large areas of cutaneous hemangiomas were randomly divided into two groups:study group (n =18) treated with 90Sr-90Y applicator in conjunction with propranolol,and control group (n =21) treated by 90Sr-90Y applicator only.The results of curative effects between the two groups were analyzed using rank sum test and x2 test.Results The cure rate,remission rate and effective rate for the study group were 44.4％(8/18),55.6 ％ (10/18) and 100.0％ (18/18),respectively,and the corresponding rates for the control group were 14.3％ (3/21),52.4％ (11/21) and 66.7％ (14/21),respectively.The effective rate in the study group was significantly higher than that in the control group (Z =-2.861,P ＜ 0.05).The adverse reaction rates in the study and control groups were 66.7％ (12/18) and 19.0％ (4/21 ;x2 =9.084,P ＜0.05),respectively.Conclusion Combined propranolol with 90Sr-90Y treatment for large infantile hemangiomas is clinically effective,but its side effects should be closely monitored.
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Objective To evaluate the effcacy and side effects of [~(90)Y-1,4,7,10-tetraazacyclododecane-N,N',N",N'"-tetraacetic acid (DOTA)~0,Tyr3]octreotate (~(90)Y-DOTATATE) combined with lysine as a renal protective agent.Methods Twenty-five patients with advanced neuroendocrine tumors were confirmed as somatostatin receptor subtype-2 (SSTR2)-positive by somatostatin receptor scintigraphy (SRS).Each patient received 1-5 cycles of treatment and the interval between two cycles of treatment was 6-9 weeks.~(90)Y-DOTATATE was administered intravenously within 30 min.Lysine was injected before and after the administration of ~(90)Y-DOTATATE.After each treatment cycle.the side effects were assessed according to National Cancer Institute Grading Criteria(NCIGC).The etticacy was evaluated by the WHO criteria 8 weeks after the last treatment.Results Pattial remission was found in 1 patient (4%).minor response in 3 patients(12%),stable disease in 16 patients (64%)and tumor progression in 5 patients (20%).Two patients suffered from renal functional injuries and 3 patients developed leukocytopenia.Three patients showed nausea while another 3 patients presented vomiting.Conclusions ~(90)Y-DOTATATE in association with lysine may be a promising treatment method for the patients with metastatic and inoperable neuroendocrine tumors.More research work may be directed to reduce renal injury.