Selektive interne Radiotherapie (SIRT) beim hepatozellulären Karzinom

Zusammenfassung

Die Mikrosphärentechnologie mit transarterieller Applikation von Radionukliden in den Tumor repräsentiert eine neue Generation von Therapeutika in der interventionellen Radiologie. So erlaubt die intrahepatische Applikation von radioaktiven Mikrosphären über die Arteria hepatica eine lokal ablative Behandlung auch diffuser und multifokaler Lebertumoren, die bisher nur einer systemischen Therapie zugänglich waren. Derzeit sind zwei Produkte für die selektive interne Radiotherapie (SIRT) kommerziell erhältlich. Diese bestehen aus dem radioaktiven Nuklid Yttrium-90, das an Glas- oder Kunstharz-Mikrosphären gebunden ist. Die Indikationen, die technische Durchführung und die Ergebnisse der Radioembolisation beim hepatozellulären Karzinom (HCC) werden in dieser Übersichtsarbeit ausführlich diskutiert.

Abstract

Microsphere-based radioembolization represents a new generation of therapeutics in interventional oncology. The intrahepatic application of radioactive microspheres via the hepatic artery allows locoregional therapy of diffuse or multifocal liver tumors, for which to date systemic therapy was the only remaining option. The current standard for this selective internal radiotherapy or radioembolization is yttrium-90 glass or resin microspheres. This review discusses the indications, the technique, and the therapeutic results of microsphere-based radioembolization.

Key words

SIRT - radioembolization - embolization - interventional procedures - liver - HCC

Literatur

• 1 Bruix J, Sherman M, Llovet J M European Association for the Study of the Liver et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference.  J Hepatol. 2001;  35 421
• 2 Llovet J M, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification.  Semin Liver Dis. 1999;  19 329
• 3 Mazzaferro V, Regalia E, Doci R et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis.  N Engl J Med. 1996;  334 693
• 4 Wiesner R, Edwards E, Freeman R et al. Model for end-stage liver disease (MELD) and allocation of donor livers.  Gastroenterology. 2003;  124 91-96
• 5 Llovet J M, Ricci S, Mazzaferro V et al. Sorafenib in advanced hepatocellular carcinoma.  N Engl J Med. 2008;  359 378
• 6 Bruix J, Sherman M. AASLD Practice Guidelines: Management of Hepatocellular Carcinoma.  Hepatology. 2005;  42 1208-1236
• 7 Sato K T, Omary R A, Takehana C et al. The role of tumor vascularity in predicting survival after yttrium-90 radioembolization for liver metastases.  J Vasc Interv Radiol. 2009;  20 1564-1569
• 8 Kennedy A, Nag S, Salem R et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium.  Int J Radiat Oncol Biol Phys. 2007;  68 13
• 9 Ho S, Lau W Y, Leung T W et al. Tumour-to-normal uptake ratio of 90Y microspheres in hepatic cancer assessed with 99Tcm macroaggregated albumin.  Br J Radiol. 1997;  70 823
• 10 Ho S, Lau W Y, Leung T W et al. Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer.  Eur J Nucl Med. 1997;  24 293
• 11 Ho S, Lau W Y, Leung T W et al. Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours.  Eur J Nucl Med. 1996;  23 947
• 12 Salem R, Thurston K G. Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: Technical and methodologic considerations.  J Vasc Interv Radiol. 2006;  17 1251
• 13 Dawson L A, Ten Haken R K. Partial volume tolerance of the liver to radiation.  Semin Radiat Oncol. 2005;  15 279
• 14 Goin J E, Salem R, Carr B I et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: a risk-stratification analysis.  J Vasc Interv Radiol. 2005;  16 195
• 15 Kennedy A, Nag S, Salem R et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium.  Int J Radiat Oncol Biol Phys. 2007;  68 13-23
• 16 Liu D M, Salem R, Bui J T et al. Angiographic considerations in patients undergoing liver-directed therapy.  J Vasc Interv Radiol. 2005;  16 911-935
• 17 Lewandowski R J, Sato K T, Atassi B et al. Radioembolization with 90Y microspheres: angiographic and technical considerations.  Cardiovasc Intervent Radiol. 2007;  30 571
• 18 Liu D M, Salem R, Bui J T et al. Angiographic considerations in patients undergoing liver-directed therapy.  J Vasc Interv Radiol. 2005;  16 911
• 19 Dorfler A, Struffert T, Engelhorn T et al. Rotational flat-panel computed tomography in diagnostic and interventional neuroradiology.  Fortschr Röntgenstr. 2008;  180 891-898
• 20 Hung J C, Redfern M G, Mahoney D W et al. Evaluation of macroaggregated albumin particle sizes for use in pulmonary shunt patient studies.  J Am Pharm Assoc (Wash). 2000;  40 46
• 21 Hamami M E, Poeppel T D, Muller S et al. SPECT/CT with 99mTc-MAA in radioembolization with 90Y microspheres in patients with hepatocellular cancer.  J Nucl Med. 2009;  50 688-692
• 22 Salem R, Lewandowski R, Mulcahy M et al. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes.  Gastroenterology. 2009;  [im Druck]
• 23 Sangro B, Carpanese L, Ezzidin S et al. Nodularity is a strong predictor of survival following treatment with radioembolisation using 90-Y-labelled resin microspheres in unresectable hepatocellular carcinoma: Preliminary results from a European multi-centre evaluation. 3 rd International Liver Cancer Association 2009 Annual Conference. Milan; 2009
• 24 Dancey J E, Shepherd F A, Paul K et al. Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres.  J Nucl Med. 2000;  41 1673
• 25 Geschwind J F, Salem R, Carr B I et al. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma.  Gastroenterology. 2004;  127 S194
• 26 Kulik L M, Carr B I, Mulcahy M F et al. Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis.  Hepatology. 2008;  47 71
• 27 Salem R, Thurston K G, Carr B I et al. Yttrium-90 microspheres: radiation therapy for unresectable liver cancer.  J Vasc Interv Radiol. 2002;  13 S223
• 28 Carr B I. Hepatic arterial 90Yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients.  Liver Transpl. 2004;  10 S107
• 29 Kennedy A S, McNeillie P, Dezarn W A et al. Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors.  Int J Radiat Oncol Biol Phys. 2009;  74 1494-1500
• 30 Goin J E, Salem R, Carr B I. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: factors associated with liver toxicities.  J Vasc Interv Radiol. 2005;  16 205