Selective intraarterial radionuclide therapy with yttrium-90 (Y-90) microspheres for hepatic neuroendocrine metastases: Initial experience at a single center

Nuri Arslan, Mustafa Emi, Engin Alagöz, Bahri Üstünsöz, Kaan Oysul, Fikret Arpacı, Şahin Uğurel, Murat Beyzadeoğlu, Ali Özgüven
2011 Vojnosanitetski Pregled  
Background/Aim. Selective intraarterial radionuclide therapy (SIRT) with Yttrium-90 (Y-90) microspheres is also known as radioembolization and delivers high doses of radiation to hepatic tumors with minimum healthy liver exposure. The aim of this study was to present our preliminary experience in the role of liver directed radiotherapy with Y-90 microspheres for the treatment of unresectable hepatic metastases from neuroendocrine tumors (NET). Methods. The results of SIRT in 10 patients (5
more » ... 10 patients (5 males, 5 females; mean age 48.7 years; age range 24-73 years) with metastatic liver disease from NETs during the period from April 2008 through August 2010 were reviewed. All patients had meticulous pre-and post-imaging studies as a part of their work-up procedure, as well as serologic tests of liver function to determine the extent of liver function damage. The patients who were eligible for SIRT had pretreatment visceral angiography to define and occlude non-target arteries. Results. The mean ± SD administered SIR-Spheres ® activity was 1.49 ± 0.42 GBq (range 0.72-2.21 GBq) in all the patients. These treatments delivered a dose of 99.73 ± 66.36 Gy (range 49-420.8 Gy) to the target tumors. The estimated dose to the lungs and normal liver was 4.45 ± 1.95 Gy (range 2.4-8.5 Gy) and 26.73 ± 14.19 Gy (range 5-58.9 Gy), respectively. Overall response rate of 90% and patient tolerance was satisfactory for most patients. Conclusion. From our limited experience, we can conclude that SIRT with Y-90 microspheres is a safe and efficacious treatment option for patients with liver metastasis of NET without any serious side effects. Uvod/Cilj. Selektivno intraarterijsko radionuklidno lečenje (selective intraarterial radionuclide therapy -SIRT) primenom mikrosfera sa itrijumom-90 (Y-90) poznato je kao radioembolizacija kojom se hepatički tumori zrače visokom dozom radijacije uz minimalno izlaganje zdravog dela jetre. Cilj ove studije bio je prikazivanje našeg prvog saznanja o ulozi SIRT, primenom mikrosfera Y-90, kod neoperabilnih hepatičkih metastaza sa poreklom od neuroendokrinih tumora (NET). Metode. Prikazani su rezultati SIRT kod 10 bolesnika (pet muškaraca i pet žena, srednje starosti 48,7 godina, u rasponu od 24 do 73 godine) sa metastatskim oboljenjem jetre izazvanim NET u periodu od aprila 2008. do avgusta 2010. Svi bolesnici prošli su kroz detaljno ispitivanje pre i posle snimanja, što je deo procedure, kao i kroz serološka ispitivanja funkcije jetre kako bi se utvrdio stepen njenog funkcijskog oštećenja. Bolesnicima koji su bili određeni za SIRT urađena je visceralna angiografija pre početka lečenja da bi se definisale i okludirale neciljne arterije. Rezultati. Prosečna aktivnost datih mikrosfera (SIR-Spheres ® ) iznosila je 1,49 ± 0,42 GBq (opseg 0,72-2,21 GBq) kod svih bolesnika. Ovim tretmanom ciljni tumori ozračeni su dozom od 99,73 ± 66,8 Gy). Procenjena doza za pluća i zdravu jetru bila je 4,45 ± 1,95 Gy (opseg 2,4-8,5 Gy) i 26,73 ± 14,19 Gy (opseg 5-58,9 Gy), respektivno. Ukupni terapijski odgovor od 90% i podnošljivost tretmana bili su zadovoljavajući kod većine bolesnika. Zaključak. Prema našem ograničenom iskustvu možemo zaključiti da SIRT primenom mikrosfera sa Y-90 predstavlja sigurni i efikasni način lečenja bolesnika sa metastazama u jetri nastalih zbog NET i to bez ozbiljnijih neželjenih dejstava. Ključne reči: neuroendokrini tumori; jetra; neoplazme, metastaze; injekcije, intra-arterijske; itrijum; prognoza. Strana 342 VOJNOSANITETSKI PREGLED Volumen 68, Broj 4 Arslan N, et al. Vojnosanit Pregl 2011; 68(4): 341-348.
doi:10.2298/vsp1104341a pmid:21627019 fatcat:jz7ruffb3fbr5ahxe4ujflkl7q