Radioembolization based on personalized treatment planning requires established dose–response and dose–toxicity relationships. The aim of this study was to investigate dose–response and dose–toxicity relationships in patients with colorectal liver metastases (CRLMs) treated with glass ⁹⁰Y-microspheres. Methods: All CRLM patients treated with glass ⁹⁰Y-microspheres in our institution were retrospectively analyzed. The tumor-absorbed dose was calculated for each measurable metastasis (i.e.,¹⁸F-FDG–positive and more than a 5-cm³ tumor volume) on posttreatment ⁹⁰Y PET. Metabolic tumor response was determined on ¹⁸F-FDG PET/CT by measuring the total lesion glycolysis at baseline and at 3 mo after treatment. The relationship between tumor-absorbed dose and metabolic response was determined on a per-lesion and per-patient basis using a linear mixed-effects regression model. Clinical toxicity and laboratory toxicity were correlated with healthy liver–absorbed dose. Results: Thirty-one patients were included. The median tumor-absorbed dose of 85 measurable metastases was 133 Gy (range, 20–1001 Gy). Per response category, this was 196 Gy for complete response (CR), 177 Gy for partial response (PR), 72 Gy for stable disease, and 95 Gy for progressive disease (PD). A significant dose–response relationship was found on a tumor level, with a significantly higher tumor-absorbed dose in metastases with CR (+94%) and PR (+74%) than in metastases with PD (P < 0.001). A similar relationship was found on a patient level, with PR having a higher tumor-absorbed dose than did PD (+58%, P = 0.044). A tumor-absorbed dose of more than 139 Gy predicted a 3-mo metabolic response with the greatest accuracy (89% specificity and 77% sensitivity), whereas a tumor-absorbed dose of more than 189 Gy predicted response with 97% specificity and 45% sensitivity. The median healthy liver–absorbed dose was 63 Gy (range, 24–113 Gy). Toxicity was limited mostly to grades 1 and 2, with 1 case of radioembolization-induced liver disease in a patient who received the highest healthy liver–absorbed dose. A positive trend was seen for most laboratory parameters in our dose–toxicity analysis. Conclusion: A significant relationship was observed between dose and response in CRLM patients treated with glass ⁹⁰Y radioembolization.

基于个性化治疗计划的放射栓塞需要建立剂量反应和剂量毒性关系。本研究的目的是调查玻璃⁹⁰ Y 微球治疗结直肠肝转移 (CRLM) 患者的剂量反应和剂量毒性关系。方法：对我院所有接受玻璃^90Y微球治疗的CRLM患者进行回顾性分析。计算治疗后⁹⁰ Y PET 上每个可测量转移（即¹⁸ F-FDG 阳性且肿瘤体积超过 5 cm ³ ）的肿瘤吸收剂量。通过测量基线和治疗后 3 个月时的总病灶糖酵解，在¹⁸ F-FDG PET/CT 上确定代谢肿瘤反应。使用线性混合效应回归模型根据每个病变和每个患者确定肿瘤吸收剂量和代谢反应之间的关系。临床毒性和实验室毒性与健康肝脏吸收剂量相关。结果：纳入 31 名患者。 85 个可测量转移瘤的中位肿瘤吸收剂量为 133 Gy（范围：20-1001 Gy）。根据缓解类别，完全缓解 (CR) 为 196 Gy，部分缓解 (PR) 为 177 Gy，疾病稳定为 72 Gy，疾病进展 (PD) 为 95 Gy。在肿瘤水平上发现了显着的剂量反应关系，CR (+94%) 和 PR (+74%) 转移瘤的肿瘤吸收剂量显着高于 PD 转移瘤 ( P < 0.001)。在患者水平上也发现了类似的关系，PR 的肿瘤吸收剂量高于 PD（+58%， P = 0.044）。 肿瘤吸收剂量超过 139 Gy 可以最准确地预测 3 个月的代谢反应（特异性为 89%，敏感性为 77%），而肿瘤吸收剂量超过 189 Gy 则可以预测反应，特异性为 97%，敏感性为 45%。 ％灵敏度。健康肝脏吸收剂量中位数为 63 Gy（范围：24-113 Gy）。毒性主要限于 1 级和 2 级，其中 1 例接受最高健康肝脏吸收剂量的患者出现放射性栓塞诱发的肝病。在我们的剂量毒性分析中，大多数实验室参数都呈现出积极的趋势。结论：在接受玻璃⁹⁰ Y 放射栓塞治疗的 CRLM 患者中观察到剂量和反应之间存在显着关系。