钇-90微球在治疗手术不可切除且化疗耐药的结直肠癌肝转移中的应用——钇-90微球放射栓塞系列回顾(七)

The role of yttrium-90 radioembolization in the treatment of unresectable, chemorefractory colorectal cancer liver metastases. A series review of radioembolization with yttrium-90 microspheres(part Ⅶ)

目的评估钇-90(^(90)Y)微球放射栓塞治疗手术不可切除且化疗耐药的结直肠癌肝转移(CRCLM)的有效性和安全性。方法系统性分析1991年1月至2017年12月收录在PubMed上所有关于^(90)Y微球放射栓塞治疗手术不可切除且化疗耐药的CRCLM的临床研究。观察指标包括:肿瘤缓解率、肝内疾病进展时间、无进展生存时间、总生存时间及并发症和不良反应。结果共纳入符合标准的临床研究21项,其中前瞻性研究7项,回顾性研究14项。21项研究的患者总数为1 923例,均为手术不可切除且化疗耐药,平均接受了2.7种(2～4种)化疗方案。中位随访时间为13.4个月,^(90)Y微球放射栓塞术后3个月,中位肿瘤完全缓解率、部分缓解率、疾病稳定率及疾病进展率分别为0.9%(0～5%),23.0%(0～46.9%),35.4%(10%～71%)及26.5%(4%～71%)。中位肝内疾病进展时间、无疾病生存时间和总生存时间分别为6.0、4.8和9.8个月。共19篇文献报道了^(90)Y微球治疗相关的并发症和不良反应,放射性肝病和胆道系统损伤的中位发生率分别为13.8%和1.3%;放射性胃肠溃疡和肠炎的中位发生率分别为4%和0.8%;乏力、腹痛、恶心/呕吐以及发热的中位发生率分别为29%、25.4%、18%和4.3%。结论^(90)Y微球放射栓塞治疗可以提高不可切除且化疗耐药的CRCLM患者的缓解率和生存时间,其严重的并发症发生率低,不良反应轻,有希望成为一种新的姑息性治疗手段。

Objectives To evaluate the efficacy and safety of yttrium-90 （90Y） radioembolization in patients with unreseetable and ehemorefractory colorectal cancer liver metastases （CRCLM）. Methods A systematic PubMed search was performed on all clinical trials of 90Y microsphere radioembolization for unresectable and chemorefractory CRCLM, dating from January 1991 to December 2017. The following objective data were retrieved and analyzed： tumor response rate （TRR）, time to progression （TIP）, progression-free survival （PFS）, overall survival （OS）, and complications and side effects. Results A total of 21 clinical studies were eligible for inclusion criteria, including 7 prosepective studies and 14 retrospective studies. Of the 21 studies, there was a total of 1 923 patients, all had unresectable and chemorefraetory CRCLM with an average of 2.7 （2 to 4） lines of chemotherapy. The median follow-up time was 13.4 months.At the three months following radioembolization with 90Y microspheres, the median value of patients with complete response rate, partial response rate, stable disease rate and disease progression rate were 0.9% （0- 5% ）, 23.0% （0-46.9%）, 35.4% （10%-71%） and 26.5% （4%-71%）, respectively. The median times to intrahepatic TYP, PFS, and OS were 6.0 months, 4.8 months, and 9.8 months, respectively. Complications and adverse reactions associated with 90Y microspheres treatment were reported in 19 studies. The median incidences of radioactive liver disease and biliary system injury were 13.8% and 1.3%, respectively; the median incidences of radioactive gastrointestinal ulcers and enteritis were 4% and 0.8% ; median incidences of fatigue, abdominal pain, nausea/vomiting and fever, were 29%, 25.4%, 18%, and 4.3%, respectively. Conclusion Radioembolization with 90Y mierospheres can improve the response rate and survival time of patients with unresectable and chemorefraetory CRCLM. The rate of severe complications is low and aeute toxicity is overall mild, which demonstrates that 90Y Radioembolization ean be a promising new palliative treatment.