AIM: To further define variables associated with increased incidences of severe toxicities following administration of yttrium-90 (<sup>90</sup>Y) microspheres.METHODS: Fifty-eight patients undergoing 79 t...AIM: To further define variables associated with increased incidences of severe toxicities following administration of yttrium-90 (<sup>90</sup>Y) microspheres.METHODS: Fifty-eight patients undergoing 79 treatments were retrospectively assessed for development of clinical and laboratory toxicity incidence following <sup>90</sup>Y administration. Severe toxicity events were defined using Common Terminology Criteria for Adverse Events version 4.03 and defined as grade ≥ 3. Univariate logistic regression analyses were used to evaluate the effect of different factors on the incidence of severe toxicity events. Multicollinearity was assessed for all factors with P < 0.1 using Pearson correlation matrices. All factors not excluded due to multicollinearity were included in a multivariate logistic regression model for each measurement of severe toxicity.RESULTS: Severe (grade ≥ 3) toxicities occurred following 21.5% of the 79 treatments included in our analysis. The most common severe laboratory toxicities were severe alkaline phosphatase (17.7%), albumin (12.7%), and total bilirubin (10.1%) toxicities. Decreased pre-treatment albumin (OR = 26.2, P = 0.010) and increased pre-treatment international normalized ratio (INR) (OR = 17.7, P = 0.048) were associated with development of severe hepatic toxicity. Increased pre-treatment aspartate aminotransferase (AST; OR = 7.4, P = 0.025) and decreased pre-treatment hemoglobin (OR = 12.5, P = 0.025) were associated with severe albumin toxicity. Increasing pre-treatment model for end-stage liver disease (MELD) score (OR = 1.8, P = 0.033) was associated with severe total bilirubin toxicity. Colorectal adenocarcinoma histology was associated with severe alkaline phosphatase toxicity (OR = 5.4, P = 0.043).CONCLUSION: Clinicians should carefully consider pre-treatment albumin, INR, AST, hemoglobin, MELD, and colorectal histology when choosing appropriate candidates for <sup>90</sup>Y microsphere therapy.展开更多
目的:通过文献计量学分析探讨钇90微球放射栓塞治疗肝脏恶性肿瘤研究的全球现状与发展趋势。方法:以Web of Science数据库中1991-2021年收录的钇90微球放射栓塞治疗肝脏恶性肿瘤相关文献为对象,应用VOS viewer软件对国家、机构、作者、...目的:通过文献计量学分析探讨钇90微球放射栓塞治疗肝脏恶性肿瘤研究的全球现状与发展趋势。方法:以Web of Science数据库中1991-2021年收录的钇90微球放射栓塞治疗肝脏恶性肿瘤相关文献为对象,应用VOS viewer软件对国家、机构、作者、期刊、关键词进行文献计量学分析,并绘制可视化的合作关系网络图谱。结果:根据检索策略和筛选标准,共989篇钇90微球放射栓塞治疗肝脏恶性肿瘤的相关文献纳入本研究,来自47个国家1055个机构4406名研究人员参与其中。该领域发表文献数量整体呈明显上升趋势,2021年达到峰值。美国在国家合作和发表文献数量上占据主导地位。在机构中,美国的西北大学发表文献数量最多,西班牙的纳瓦拉大学和美国的华盛顿大学次之。发表文献数量和总被引频次前3位的作者分别是Salem R、Lewandowski RJ和Mulcahy MF。Journal of Vascular and Interventional Radiology等期刊在推动该领域发展中发挥了重要作用。出现频次最高的10个关键词是放射栓塞、肝细胞癌、钇90、钇90微球、生存、癌症、肝转移、微球、选择性内放射治疗和内放射治疗。结论:目前钇90微球放射栓塞治疗肝脏恶性肿瘤是重要研究热点之一,中国的研究人员不仅需要关注该领域的前沿研究,还应积极开展多中心临床研究项目。展开更多
BACKGROUND Primary appendiceal cancers are rare,and they generally present with liver and/or peritoneal metastases.Currently there are no guidelines to treat metastatic appendiceal cancer,and hence they are treated as...BACKGROUND Primary appendiceal cancers are rare,and they generally present with liver and/or peritoneal metastases.Currently there are no guidelines to treat metastatic appendiceal cancer,and hence they are treated as metastatic colorectal cancer.Combining Yttrium 90(Y-90)radioembolization(RE)with systemic chemotherapy early in the treatment of right sided colon cancers has been shown to improve survival.Based on this data,a combination of systemic chemotherapy and Y-90 RE was used to treat a case of metastatic appendiceal cancer.CASE SUMMARY A 76-year-old male presented to the emergency room with progressive right lower quadrant pain.A Computed Tomography of the abdomen and pelvis was performed which showed acute appendicitis and contained perforation.Urgent laparoscopic appendectomy was then followed by histological analysis,which was significant for appendiceal adenocarcinoma.After complete workup he underwent right hemicolectomy and lymph node dissection.He received adjuvant chemotherapy as the local lymph nodes were positive.Follow-up imaging was significant for liver metastasis.Due to rapid growth of the liver lesions and new peritoneal nodules,the patient was treated with a combination of Y-90 RE and folinic acid,fluorouracil,and irinotecan with bevacizumab and not microwave ablation as previously planned.Follow up imaging demonstrated complete response of the liver lesions.At 12-mo follow-up,the patient continued to enjoy good quality of life with no recurrent disease.CONCLUSION Utilization of Y-90 RE concomitantly with systemic chemotherapy early in the treatment of appendiceal cancer may provide improved control of this otherwise aggressive cancer.展开更多
BACKGROUND Surgical resection and liver transplantation(LT)are the most effective curative options for hepatocellular carcinoma(HCC).However,few patients with huge HCC(>10 cm in diameter),especially those with port...BACKGROUND Surgical resection and liver transplantation(LT)are the most effective curative options for hepatocellular carcinoma(HCC).However,few patients with huge HCC(>10 cm in diameter),especially those with portal vein tumor thrombus(PVTT),can receive these treatments.Selective internal radiation therapy(SIRT)can be used as a conversion therapy for them because it has the dual benefit of shrinking tumors and increasing residual hepatic volume.However,in patients with huge HCC,high lung absorbed dose often prevents them from receiving SIRT.CASE SUMMARY A 35-year-old man was admitted because of emaciation and pain in the hepatic region for about 1 month.The computed tomography scan showed a 20.2 cm×19.8 cm tumor located in the right lobe–left medial lobes with right portal vein and right hepatic vein invasion.After the pathological type of HCC was confirmed by biopsy,two conversions were presented.The first one was drug-eluting bead transarterial chemoembolization plus hepatic arterial infusion chemotherapy and lenvatinib and sintilimab,converted to SIRT,and the second one was sequential SIRT with continued systemic treatment.The tumor size significantly decreased from 20.2 cm×19.8 cm to 16.2 cm×13.8 cm,then sequentially to 7.8 cm×6.8 cm.In the meantime,the ratio of spared volume to total liver volume increased gradually from 34.4%to 55.7%,then to 62.9%.Furthermore,there was visualization of the portal vein,indicating regression of the tumor thrombus.Finally,owing to the new tumor in the left lateral lobe,the patient underwent LT instead of resection without major complications.CONCLUSION Patients with inoperable huge HCC with PVTT could be converted to SIRT first and accept surgery sequentially.展开更多
Objective To study the clinical results of hepatic radioembolization wi th Yttrium 90 ( 90 Y) glass microspheres in the treatment of primary li ver cancer. Methods Seventeen patients with liver cancer were ...Objective To study the clinical results of hepatic radioembolization wi th Yttrium 90 ( 90 Y) glass microspheres in the treatment of primary li ver cancer. Methods Seventeen patients with liver cancer were treated with glass mi crospheres from August 1996 to May 1998. Hepatic radioembolization with 90 Y and lipiodol ultrafluid was used. Percutaneous port catheter system (PCS) implantations via femoral artery were performed in 12 patients.Results In the 17 patients,their mean ratio of absorbed doses b etween tumor and normal liver was 2.4∶1. CT showed a significant reduction in t umor size in 11 of the 17 patients. Average survival was 19.5 months. The indwel ling catheters of all the 12 patients were patent and no catheter tip dlocatio ns were found.Conclusions 90 Y glass microsphere is one of the best radioi sotop es. Not only good responses to the therapy of 90 Y glass microspheres can be achieved in patients with metastatic liver cancer, but also in those with pri mary liver cancer, specially the localized or hypervascular mass. The patients w ith massive arterioportal shunt should not be limited to this form of radiation therapy. The percutaneous PCS implantation via the femoral artery is a new passa geway for the treatment of primary liver cancer with 90 Y glass microspher es and other interventional therapy.展开更多
基金Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR00165 through our institution’s Center for Clinical and Translational Science(in part)
文摘AIM: To further define variables associated with increased incidences of severe toxicities following administration of yttrium-90 (<sup>90</sup>Y) microspheres.METHODS: Fifty-eight patients undergoing 79 treatments were retrospectively assessed for development of clinical and laboratory toxicity incidence following <sup>90</sup>Y administration. Severe toxicity events were defined using Common Terminology Criteria for Adverse Events version 4.03 and defined as grade ≥ 3. Univariate logistic regression analyses were used to evaluate the effect of different factors on the incidence of severe toxicity events. Multicollinearity was assessed for all factors with P < 0.1 using Pearson correlation matrices. All factors not excluded due to multicollinearity were included in a multivariate logistic regression model for each measurement of severe toxicity.RESULTS: Severe (grade ≥ 3) toxicities occurred following 21.5% of the 79 treatments included in our analysis. The most common severe laboratory toxicities were severe alkaline phosphatase (17.7%), albumin (12.7%), and total bilirubin (10.1%) toxicities. Decreased pre-treatment albumin (OR = 26.2, P = 0.010) and increased pre-treatment international normalized ratio (INR) (OR = 17.7, P = 0.048) were associated with development of severe hepatic toxicity. Increased pre-treatment aspartate aminotransferase (AST; OR = 7.4, P = 0.025) and decreased pre-treatment hemoglobin (OR = 12.5, P = 0.025) were associated with severe albumin toxicity. Increasing pre-treatment model for end-stage liver disease (MELD) score (OR = 1.8, P = 0.033) was associated with severe total bilirubin toxicity. Colorectal adenocarcinoma histology was associated with severe alkaline phosphatase toxicity (OR = 5.4, P = 0.043).CONCLUSION: Clinicians should carefully consider pre-treatment albumin, INR, AST, hemoglobin, MELD, and colorectal histology when choosing appropriate candidates for <sup>90</sup>Y microsphere therapy.
文摘目的:通过文献计量学分析探讨钇90微球放射栓塞治疗肝脏恶性肿瘤研究的全球现状与发展趋势。方法:以Web of Science数据库中1991-2021年收录的钇90微球放射栓塞治疗肝脏恶性肿瘤相关文献为对象,应用VOS viewer软件对国家、机构、作者、期刊、关键词进行文献计量学分析,并绘制可视化的合作关系网络图谱。结果:根据检索策略和筛选标准,共989篇钇90微球放射栓塞治疗肝脏恶性肿瘤的相关文献纳入本研究,来自47个国家1055个机构4406名研究人员参与其中。该领域发表文献数量整体呈明显上升趋势,2021年达到峰值。美国在国家合作和发表文献数量上占据主导地位。在机构中,美国的西北大学发表文献数量最多,西班牙的纳瓦拉大学和美国的华盛顿大学次之。发表文献数量和总被引频次前3位的作者分别是Salem R、Lewandowski RJ和Mulcahy MF。Journal of Vascular and Interventional Radiology等期刊在推动该领域发展中发挥了重要作用。出现频次最高的10个关键词是放射栓塞、肝细胞癌、钇90、钇90微球、生存、癌症、肝转移、微球、选择性内放射治疗和内放射治疗。结论:目前钇90微球放射栓塞治疗肝脏恶性肿瘤是重要研究热点之一,中国的研究人员不仅需要关注该领域的前沿研究,还应积极开展多中心临床研究项目。
文摘BACKGROUND Primary appendiceal cancers are rare,and they generally present with liver and/or peritoneal metastases.Currently there are no guidelines to treat metastatic appendiceal cancer,and hence they are treated as metastatic colorectal cancer.Combining Yttrium 90(Y-90)radioembolization(RE)with systemic chemotherapy early in the treatment of right sided colon cancers has been shown to improve survival.Based on this data,a combination of systemic chemotherapy and Y-90 RE was used to treat a case of metastatic appendiceal cancer.CASE SUMMARY A 76-year-old male presented to the emergency room with progressive right lower quadrant pain.A Computed Tomography of the abdomen and pelvis was performed which showed acute appendicitis and contained perforation.Urgent laparoscopic appendectomy was then followed by histological analysis,which was significant for appendiceal adenocarcinoma.After complete workup he underwent right hemicolectomy and lymph node dissection.He received adjuvant chemotherapy as the local lymph nodes were positive.Follow-up imaging was significant for liver metastasis.Due to rapid growth of the liver lesions and new peritoneal nodules,the patient was treated with a combination of Y-90 RE and folinic acid,fluorouracil,and irinotecan with bevacizumab and not microwave ablation as previously planned.Follow up imaging demonstrated complete response of the liver lesions.At 12-mo follow-up,the patient continued to enjoy good quality of life with no recurrent disease.CONCLUSION Utilization of Y-90 RE concomitantly with systemic chemotherapy early in the treatment of appendiceal cancer may provide improved control of this otherwise aggressive cancer.
文摘BACKGROUND Surgical resection and liver transplantation(LT)are the most effective curative options for hepatocellular carcinoma(HCC).However,few patients with huge HCC(>10 cm in diameter),especially those with portal vein tumor thrombus(PVTT),can receive these treatments.Selective internal radiation therapy(SIRT)can be used as a conversion therapy for them because it has the dual benefit of shrinking tumors and increasing residual hepatic volume.However,in patients with huge HCC,high lung absorbed dose often prevents them from receiving SIRT.CASE SUMMARY A 35-year-old man was admitted because of emaciation and pain in the hepatic region for about 1 month.The computed tomography scan showed a 20.2 cm×19.8 cm tumor located in the right lobe–left medial lobes with right portal vein and right hepatic vein invasion.After the pathological type of HCC was confirmed by biopsy,two conversions were presented.The first one was drug-eluting bead transarterial chemoembolization plus hepatic arterial infusion chemotherapy and lenvatinib and sintilimab,converted to SIRT,and the second one was sequential SIRT with continued systemic treatment.The tumor size significantly decreased from 20.2 cm×19.8 cm to 16.2 cm×13.8 cm,then sequentially to 7.8 cm×6.8 cm.In the meantime,the ratio of spared volume to total liver volume increased gradually from 34.4%to 55.7%,then to 62.9%.Furthermore,there was visualization of the portal vein,indicating regression of the tumor thrombus.Finally,owing to the new tumor in the left lateral lobe,the patient underwent LT instead of resection without major complications.CONCLUSION Patients with inoperable huge HCC with PVTT could be converted to SIRT first and accept surgery sequentially.
文摘Objective To study the clinical results of hepatic radioembolization wi th Yttrium 90 ( 90 Y) glass microspheres in the treatment of primary li ver cancer. Methods Seventeen patients with liver cancer were treated with glass mi crospheres from August 1996 to May 1998. Hepatic radioembolization with 90 Y and lipiodol ultrafluid was used. Percutaneous port catheter system (PCS) implantations via femoral artery were performed in 12 patients.Results In the 17 patients,their mean ratio of absorbed doses b etween tumor and normal liver was 2.4∶1. CT showed a significant reduction in t umor size in 11 of the 17 patients. Average survival was 19.5 months. The indwel ling catheters of all the 12 patients were patent and no catheter tip dlocatio ns were found.Conclusions 90 Y glass microsphere is one of the best radioi sotop es. Not only good responses to the therapy of 90 Y glass microspheres can be achieved in patients with metastatic liver cancer, but also in those with pri mary liver cancer, specially the localized or hypervascular mass. The patients w ith massive arterioportal shunt should not be limited to this form of radiation therapy. The percutaneous PCS implantation via the femoral artery is a new passa geway for the treatment of primary liver cancer with 90 Y glass microspher es and other interventional therapy.
