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Radioembolization with 90Y Resin Microspheres of Neuroendocrine Liver Metastases After Initial Peptide Receptor Radionuclide Therapy.
CardioVascular and Interventional Radiology ( IF 2.9 ) Pub Date : 2019-10-23 , DOI: 10.1007/s00270-019-02350-2
A J A T Braat 1 , H Ahmadzadehfar 2 , S C Kappadath 3 , C L Stothers 4 , A Frilling 5 , C M Deroose 6 , P Flamen 7 , D B Brown 4 , D Y Sze 8 , A Mahvash 9 , M G E H Lam 1
Affiliation  

PURPOSE Peptide receptor radionuclide therapy (PRRT) and radioembolization are increasingly used in neuroendocrine neoplasms patients. However, concerns have been raised on cumulative hepatotoxicity. The aim of this sub-analysis was to investigate hepatotoxicity of yttrium-90 resin microspheres radioembolization in patients who were previously treated with PRRT. METHODS Patients treated with radioembolization after systemic radionuclide treatment were retrospectively analysed. Imaging response according to response evaluation criteria in solid tumours (RECIST) v1.1 and clinical response after 3 months were collected. Clinical, biochemical and haematological toxicities according to common terminology criteria for adverse events (CTCAE) v4.03 were also collected. Specifics on prior PRRT, subsequent radioembolization treatments, treatments after radioembolization and overall survival (OS) were collected. RESULTS Forty-four patients were included, who underwent a total of 58 radioembolization procedures, of which 55% whole liver treatments, at a median of 353 days after prior PRRT. According to RECIST 1.1, an objective response rate of 16% and disease control rate of 91% were found after 3 months. Clinical response was seen in 65% (15/23) of symptomatic patients after 3 months. Within 3 months, clinical toxicities occurred in 26%. Biochemical and haematological toxicities CTCAE grade 3-4 occurred in ≤ 10%, apart from lymphocytopenia (42%). Radioembolization-related complications occurred in 5% and fatal radioembolization-induced liver disease in 2% (one patient). A median OS of 3.5 years [95% confidence interval 1.8-5.1 years] after radioembolization for the entire study population was found. CONCLUSION Radioembolization after systemic radionuclide treatments is safe, and the occurrence of radioembolization-induced liver disease is rare. LEVEL OF EVIDENCE 4, case series.

中文翻译:

初始肽受体放射性核素治疗后,神经内分泌肝转移的90Y树脂微球体的放射性栓塞。

目的肽受体放射性核素治疗(PRRT)和放射栓塞术越来越多地用于神经内分泌肿瘤患者。但是,人们对累积肝毒性提出了关注。本次分析的目的是研究90年代以前接受PRRT治疗的患者中钇90树脂微球体放射栓塞的肝毒性。方法回顾性分析全身放射性核素治疗后接受放射栓塞治疗的患者。收集根据实体瘤反应评估标准(RECIST)v1.1的影像学反应和3个月后的临床反应。还根据不良事件的通用术语标准(CTCAE)v4.03收集了临床,生化和血液学毒性。有关先前的PRRT,后续的放射栓塞治疗,收集放射栓塞和总生存期(OS)后的治疗方法。结果包括44例患者,他们共接受了58例放射性栓塞手术,其中55%的全肝治疗时间为PRRT前353天。根据RECIST 1.1,三个月后发现客观缓解率为16%,疾病控制率为91%。3个月后,有症状的患者中有65%(15/23)出现临床反应。在3个月内,临床毒性发生率为26%。除淋巴细胞减少症(42%)外,CTCAE 3-4级的生化和血液学毒性≤10%。放射性栓塞相关并发症发生率为5%,致命性放射性栓塞引起的肝脏疾病发生率为2%(一名患者)。中位操作系统为3.5年[95%置信区间1.8-5。在整个研究人群中进行了放射栓塞后[1年]。结论全身放射性核素治疗后的放射性栓塞是安全的,很少发生放射性栓塞引起的肝病。证据级别4,案例系列。
更新日期:2020-01-17
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