钇-90精准介入内放疗治疗右肝恶性肿瘤的临床疗效观察  

Yttrium-90 precision intervention in radiotherapy for malignant tumor of the right liver clinical curative effect observation

作　　者：廖勇 张琳[1,2,3] 黄鑫[1,3] 梁子威 梁斌[3,5] 杨世忠[1] 张田田 张雅绯 贾波 冯晓彬[1,3] LIAO Yong;ZHANG Lin;UANG Xin;LIANG Ziwei;LIANG Bin;YANG Shizhong;ZHANG Tiantian;ZHANG Yafei;JIA Bo;FENG Xiaobin(Department of Hepatobiliary and Pancreatic Surgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102200,P.R.China;Department of Hepatobiliary Intervention,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102200,P.R.China;Yttrium-90 Precision Interventional Radiotherapy Center,Tsinghua Changgung Hospital,Tsinghua University,Beijing 102200,P.R.China;Department of Nuclear Medicine,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102200,P.R.China;Department of Radiology,Tsinghua Changgung Hospital,Tsinghua University,Beijing 102200,P.R.China)

机构地区：[1]清华大学附属北京清华长庚医院肝胆胰腺外科,北京102200 [2]清华大学附属北京清华长庚医院肝胆介入科,北京102200 [3]清华大学附属北京清华长庚医院钇-90精准介入放疗中心,北京102200 [4]清华大学附属北京清华长庚医院核医学科,北京102200 [5]清华大学附属北京清华长庚医院放射科,北京102200

出　　处：《中国普外基础与临床杂志》2024年第12期1434-1439,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨钇-90选择性内放射治疗(Yttrium-90 selective internal radiotherapy,^(90)Y-SIRT)对右肝恶性肿瘤的肿瘤控制及诱导肝左叶代偿性增生效果。方法收集2022年9月至2023年11月期间于清华大学附属北京清华长庚医院肝胆胰外科接受^(90)Y-SIRT治疗的134例肝脏恶性肿瘤(原发性或继发性)患者的临床资料,回顾性分析符合纳入及排除标准的29例患者,通过CT或MRI检查测量治疗前和治疗后1个月及3个月的肝脏体积、肿瘤体积、术后剩余肝脏体积(future liver remnant,FLR)和相对于治疗前的FLR增生百分比,分析^(90)Y-SIRT治疗后外科手术切除率及肿瘤病灶病理坏死率。结果29例患者中肝细胞癌22例、胆管细胞癌2例和结直肠癌肝转移5例患者接受了右半肝的^(90)Y-SIRT治疗。29例患者治疗后1个月及3个月的肿瘤体积较治疗前分别平均缩小了149.2mL(P=0.124)及228.2mL(P=0.012);右肝体积较治疗前分别平均缩小了197.4mL(P=0.026)及318.6mL(P=0.001);左肝体积较治疗前分别平均增大了64.9mL(P=0.261)和144.7mL(P=0.023);FLR百分比较治疗前分别增加了6.6%(P=0.018)和13.4%(P<0.001)。术后3个月采用mRECIST标准进行肿瘤影像学疗效评价,结果显示:肿瘤的客观缓解率为79.3%,疾病控制率为93.1%。结论肝右叶恶性肿瘤行^(90)Y-SIRT治疗能有效控制肿瘤生长,诱导左肝代偿性增生;同时可获得较高的客观缓解率及肿瘤病灶的病理坏死率。Objective To investigate the effect of Yttrium-90 selective internal radiotherapy(^(90)Y-SIRT)on tumor control and compensatory hyperplasia of left hepatic lobe in the treatment of right hepatic malignant tumor.Methods The clinical data of 134 patients with liver malignant tumor(primary or secondary)who were treated with oy.SIRT in the Department of Hepatobiliary and Pancreatic Surgery,Beijing Tsinghua Changgung Hospital from September 2022 to November 2023 were collected,and 29 patients who met the inclusion and exclusion criteria were analyzed retrospectively.The liver volume,tumor volume,postoperative future liver remnant(FLR)and the percentage of FLR proliferation before and after treatment were measured by CT or MRI,and the surgical resection rate and pathological necrosis rate of tumor focus after 9o^(90)Y-SIRT treatment were analyzed.The liver volume,tumor volume,postoperative future liver remnant(FLR)and the percentage of FLR hyperplasia were measured by CT or MRI before and 1 and 3 months after ^(90)Y-SIRT,and the surgical resection rate and pathological necrosis rate of tumor lesions after ^(90)Y-SIRT treatment were analyzed.ResultsOf the 29 patients,22 patients with hepatocellular carcinoma,2 patients with cholangiocarcinoma and 5 patients with liver metastases from colorectal cancer received oy-SIRT of the right liver.At 1 and 3 months after treatment,the tumor volume average decreased by 149.2 mL(P=0.124)and 228.2 mL(P=0.012),the right liver volume was average reduced by 197.4 mL(P=0.026)and 318.6 mL(P=0.023),the left liver volume average increased by 64.9 mL(P=0.261)and 144.7 mL(P=0.124),and the percentage of FLR increased by 6.6%(P=0.018)and 13.4%(P<0.001)of 29 patients,respectively.Three months after operation,mRECIST standard was used to evaluate the curative effect of tumor imaging.The results showed that the objective response rate of tumor was 79.3%and the disease control rate was 93.1%.Conclusionss ^(90)Y-SIRT can effectively control the growth of malignant tumors in the right lobe of the liv

关 键 词：钇-90选择性内放射治疗 右肝恶性肿瘤 残余肝体积 客观缓解率 疾病控制率 

分 类 号：R735.7[医药卫生—肿瘤]