放射性钇-90玻璃微球制剂治疗肝癌时局部吸收剂量的估算

放射性钇－９０玻璃微球制剂治疗肝癌时局部吸收剂量的估算周淑珍，郑文忠，祝霄霞，刘国廉，于莲英，于海滨目前，对肝癌除早期外科手术外，尚无特别有效的治疗措施。为探索肝癌治疗新的技术途径，作者报告了由体外局部病灶注入放射性化一９０玻璃微球在裸鼠移植性肝癌组...     

放射性钇-90玻璃微球制剂局部注入对裸鼠移植性肝癌的疗效观察

放射性钇－９０玻璃微球制剂局部注入对裸鼠移植性肝癌的疗效观察周淑珍，刘国廉，祝霄霞，郑文忠，于莲英，于海滨，谢国良，马柳舫近几年来，已制成不同材料和性能的微球制剂［‘一’］，为肿病治疗提供一个新的技术途径。我们研究观察了放射性化一９０（”Ｙ）玻璃微球...     

^90钇玻璃微球内放射治疗原发性肝癌的初步临床应用

￣（９０）钇玻璃微球内放射治疗原发性肝癌的初步临床应用颜志平，林贵，赵惠扬￣（９０）钇（￣（９０）Ｙ）玻璃微球是一种新型的内放射治疗用微球￣［１～３］，我们在动物实验基础上对１８例原发性肝癌患者讲行了￣（９０）Ｙ玻璃微球内放射治疗的研究，现报告作者单...     

超扬引导瘤内注射^90Y—GTMS治疗肝恶性肿瘤的研究

为寻找一种列有效的肝癌治疗方法，对７０只带瘤小鼠和３３例肝瘤病人进行超声引导下＾９０Ｙ－玻璃微球瘤内注射治疗。动物实验结果证实，当肿瘤边缘吸收剂量〉１７６Ｇｙ／ｇ时，可使肿瘤细胞完全坏死；随访１２－３２个月，２８例病人存活，９０．６％肿瘤缩小；９例治疗后再次活检，８例示肿瘤细胞完全坏死。     

^90Y在肿瘤治疗中的应用

成功的肿瘤治疗应在减慢肿瘤生长和扩散的同时，较少或不损伤正常组织，＾９０Ｙ作为一种治疗肿的放射性核素，通过标记单克隆抗体，玻璃微球等多种途径，在肿瘤的放射免疫治疗，肝癌的动脉栓塞治疗及瘤内直接注入注射性核素等治疗方法中得到了广泛的应用。     

一种简便安全的^90Y玻璃微球注入方法

一种简便安全的￣（９０）Ｙ玻璃微球注入方法颜志平，赵惠扬９０Ｙ玻璃微球是一种具有放射栓塞作用的新型栓塞剂［１］，自１９９０年６月，我们采用国产９０Ｙ玻璃微球在动物实验的基础上，对１９例肝癌患者进行了初步临床应用［１］．由于９０Ｙ玻璃微球具有放射性，临...     

90钇玻璃微球内放射治疗原发性肝癌的临床研究

目的 :探讨90 钇玻璃微球内放射治疗原发性肝癌的疗效及其与肿瘤血供的关系。方法 :搜集 2 0 0 1年 3～ 12月采用含90 钇玻璃微球的“夹心面包”法治疗的原发性肝癌 18例 ,根据肝动脉造影情况将其肿瘤血供分为 3类 ,探讨肿瘤血供与疗效的关系。结果 :术后 13例肿瘤缩小 ,6例缩小明显 ,其中Ⅰ类 4例 ;12例患者术后AFP不同程度下降 ,平均生存期为 8.8个月。 3类患者疗效间的比较采用Ridit检验 ,结果Ⅰ类疗效最好 ,与Ⅱ类 (P <0 .0 5 )及Ⅲ类 (P <0 .0 1)间的差异有显著意义。结论 :应用90 钇玻璃微球治疗原发性肝癌尤其是对富血供的局限性或单发性肝癌是一种安全、有效、有潜力的治疗方法。     

经导管注入内放疗源治疗原发性肝癌的术中护理

经导管注入内放疗源治疗原发性肝癌是目前临床研究的热点之一。局部内放疗源的聚集能直接作用于癌肿病灶 ,在短期内对癌肿组织连续辐照射 ,达到直接杀死癌肿细胞的作用。此外 ,同时经导管内注入化疗药物和注入栓塞剂填塞肿瘤瘤床和阻断肿瘤的供血动脉可达到控制癌肿发展的协同作用。现有的临床资料表明 ,经导管注入内放疗源治疗原发性肝癌可以提高患者生活质量 ,延长生存时间。而其介入手术期间的护理则是介入治疗整体工作中不可分割的部分。为此 ,我们将经导管注入内放疗源90 钇玻璃微球 ( 90 Ｙ ＧＴＭＳ)治疗原发性肝癌患者的介入手术护…     

131I-MIBG治疗58例恶性嗜铬细胞瘤的临床疗效与副反应

目的 探讨用＾１３１Ｉ间－碘苄胍（ＭＩＢＧ）治疗５８例恶性嗜铬细胞瘤软组织转移灶的临床价值。方法 第一疗程每月静脉滴注＾１３１Ｉ－ＭＩＢＧ２５９０～３７００ＭＢｑ，共６个月，此后每隔２～３个月继续治疗１－３次，用ＭＩＲＤ法测试肿瘤吸收剂量，结果 （１）５８例患者按肿瘤大小分成３组，第１组肿瘤体积〈８ｃｍ＾３（１１例）第２组８－２０ｃｍ＾３（２１例）第３组〉２０ｃｍ＾３（２６例）第１组１１例肿瘤平均     

Graves甲亢^131I治疗后早发甲低

８２７例Ｇｒａｖｅｓ甲亢＾１３１Ｉ治疗病人门诊随访一年以上已愈，每次随访作体检及甲状机能生长指标ＴＴ３、ＴＴ４和ＴＳＨ测定，９０％早发甲低发生在＾１３１Ｉ治疗后２－３个月内，此时应认真随访。ＴＴ４是诊断＾１３１Ｉ治疗后甲低的灵敏指标，而ＴＴ３诊断甲低价值不大，ＴＳＨ在诊断＾１３１Ｉ治疗后甲低不如ＴＴ４灵敏，早发甲低的发生与＾１３１Ｉ剂量密切相关，如何计算剂量使其既治愈甲亢又不发生永久性甲低是我们工     

经皮不同径路肝动脉内植入药盒导管系统的对照研究

探讨肝动脉内植入药盒导管系统的最佳径路。材料与方法２１６例中晚期肝癌,１１８例采取经皮左锁骨下动脉径路肝动脉内植入ＰＣＳ,另外９８例采取经皮股动脉径路植入ＰＣＳ。结果ＬＳＡ组与ＦＡ组植入成功率分别为９１．５％和８８．７％。结论常规采取ＦＡ径路肝动脉内植入ＰＣＳ安全可行。     

钇-90微球的特性、放射栓塞的操作技术及安全防护——钇-90微球放射栓塞系列回顾(一)

钇-90(90Y)微球放射栓塞是一种局部治疗方法,它将载有发射β射线的90Y树脂或玻璃微球选择性地注射到肝动脉.90Y微球随血流被阻塞在肿瘤血管床,其发出的射线对靶肿瘤具有细胞毒性作用.该方法的安全性和有效性已经在不可切除的肝脏恶性肿瘤患者中得到证实.本文作为90Y微球放射栓塞系列综述的第一部分,将讨论90Y和90Y微球的基本特性,90Y微球放射栓塞的基本操作方法,以及放射性安全与防护.     

Yttrium-90 microsphere radioembolotherapy of hepatic metastatic neuroendocrine carcinomas after hepatic arterial embolization

Hepatic artery radioembolization was performed in a cohort of patients with unresectable neuroendocrine hepatic metastases who exhibited hepatic progression or toxicity despite technically adequate embolization procedures without other reasonable therapeutic options. Eight patients (five men) with a median age of 55.5 years met the study criteria. Infusions of yttrium-90 resin microspheres were performed in a lobar fashion. Standard clinical, laboratory, and imaging follow-up was performed. Median hepatic parenchyma replacement by tumor was 55% (range, 25%-60%). Twelve (90)Y resin microsphere infusions were performed, and the median delivered activity was 33.25 mCi (range, 23-55 mCi). One partial response, four cases of disease stabilization, and three cases of progressive disease were noted. No cases of radiation-induced liver disease occurred. Median survival times were 14 months (range, 3-15 months) from the time of (90)Y microsphere treatment and 36.5 months (range, 16-105 months) from the time of diagnosis of hepatic metastases. In this cohort, (90)Y microsphere radioembolization of neuroendocrine hepatic metastases was not precluded by previous nonradioactive embolization procedures, but the effectiveness in this population requires further investigation.     

经皮左锁骨下动脉穿刺植入药盒治疗晚期恶性肿瘤

目的 评价经皮左锁骨下动脉植入药盒在晚期恶性肿瘤治疗中的应用价值。方法 对200例中晚期恶性肿瘤病人采用经皮左锁骨下动脉植入药盒治疗。其中原发性肝癌178例,转移性肝癌10例,盆腔肿瘤5例,胆囊癌4例,肺部3例。依据肿瘤供血情况,在DSA路标及透视监控下,施行药盒植入术,药盒体埋置在穿刺点下方的左前胸壁皮下,药盒导管端植入靶动脉内。术后经药盒行规则性化疗或磺油化疗乳剂栓塞。结果 随访3个月－3年,200例病人共植入202个药盒,其中2例肝癌病人因左、右肝动脉各自供血肿瘤,故在右股动脉加埋一个药盒（双药盒）。植入成功率为99％。并发症有9例（4．5％）：导管移位2例（1％）、导管－药盒松脱1例（0．5％）、气胸2例（1％）、皮肤溃烂1例（0．5％）、皮下大量渗血1例（0．5％）,靶血管闭塞2例（1％）。无严重并发症。结论 经皮左锁骨下动脉行药盒植入术安全可行、操作简便易行、创伤小,为动脉内化疗灌注和碘油化疗乳剂栓塞提供了一条安全可靠的途径。     

Outpatient Single-Session Yttrium-90 Glass Microsphere Radioembolization

PurposeTo investigate the feasibility of yttrium-90 (⁹⁰Y) glass microsphere radioembolization (including angiography, lung shunt assessment, and treatment) as a single-session, outpatient procedure.Materials and MethodsBetween January 2008 and June 2013, 14 patients underwent outpatient, single-session radioembolization with ⁹⁰Y glass microspheres. As part of the routine diagnostic work-up, all patients underwent either computed tomography (CT) or magnetic resonance imaging of the liver with three-dimensional analysis and had laboratory results forwarded to our center for confirmation of candidacy before treatment. On treatment day, all patients underwent planning mesenteric angiography with flat panel cone-beam CT imaging. Patients were administered 33–85 MBq of technetium-99m macroaggregated albumin (^99mTc-MAA) via a microcatheter positioned in a hepatic artery supplying the tumor of interest. Planar scintigraphy was initiated within 2 hours after the administration of ^99mTc-MAA and lung shunt fraction was determined. Final dosimetry calculations were performed while the patient was being transferred back from nuclear medicine to interventional radiology.ResultsAll patients successfully underwent planning angiography with administration of ^99mTc-MAA and ⁹⁰Y radioembolization as a single-session treatment. There were no reportable or recordable medical events; treatment was carried out to the desired dose in all cases. The mean total procedure time was 2.70 hours ± 0.72 (range, 1.63–3.97 h).ConclusionsThis study reports a novel proof of concept for performing radioembolization in a single-session setting. By using the described method, time between initial clinical assessments and radioembolization treatment is decreased, and costs are minimized.     

经股动脉右下腹导管药盒系统植入术

目的：研究动脉内导管药盒系统植入新方法。方法：４５例恶性肿瘤患者施行经股动脉导管药盒系统植入术,药盒植入右下腹壁下。结果：４５例均植入成功。结论：该术是一种安全、有效的植入方法。     

Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review

Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.     

The effect of catheter-directed CT angiography on yttrium-90 radioembolization treatment of hepatocellular carcinoma

PURPOSE: Yttrium 90 radioembolization is a transcatheter therapy for unresectable hepatocellular carcinoma (HCC) that delivers internal radiation to tumors. In contrast to the usual method of lobar regional delivery, catheter-directed computed tomographic (CT) angiography was investigated as a potentially useful technique to evaluate the administration of segmental 90Y tumor radiation doses superselectively without significantly altering liver function or Child-Pugh classification. MATERIALS AND METHODS: Fourteen patients underwent 90Y therapy for unresectable HCC. After standard angiographic placement of a 3-F microcatheter in a segmental hepatic artery supplying the tumor, each patient underwent CT angiography with use of segmental hepatic artery injection of iodinated contrast agent to confirm segmental perfusion and delineate segmental liver volume. 90Y was later injected into the same segmental artery. Target dose was calculated according to infused 90Y activity and targeted hepatic volume with standard lobar volume (before CT angiography) versus segmental liver volume (after CT angiography). The Wilcoxon signed-rank test (alpha = 0.05) was used to compare the estimated 90Y dose before CT angiography with the actual 90Y dose after CT angiography, as well as changes in serum bilirubin level and Child-Pugh classification as a result of treatment. RESULTS: The mean estimated tumor dose before CT angiography (SD) was 100 Gy +/- 43 (range, 35-169 Gy). The mean actual tumor dose after CT angiography was 348 Gy +/- 204 (range, 105-857 Gy), which was significantly greater (P < .001). The mean bilirubin level before treatment was 1.0 mg/dL +/- 0.97 (range, 0.2-4.0 mg/dL), whereas the mean bilirubin level after treatment was 1.3 mg/dL +/- 0.85 (range, 0.5-3.8 mg/dL). This difference, although statistically significant (P = .03), was not clinically important. Thirteen of 14 patients had no change in Child-Pugh class. CONCLUSION: CT angiography can be used to delineate the blood supply and volume to a targeted hepatic segment, allowing superselective 90Y radioembolization. This approach significantly increases effective 90Y tumor radiation dose without clinically altering liver function or Child-Pugh class.     

经股浅动脉入路介入法药盒植入术研究

目的：研究经股浅动脉植入介入药盒（PCS）的可行性。方法：（1）患者60例,无栓塞适应证的原发性肝癌36例,转移性肝癌14例,其它晚期肿瘤10例,均经股浅动脉植入PCS,泵导管 端置于相应靶血管50例,10例置于胸或腹主动脉;（2）杂种犬2只,采用Seldinger技术经股动脉置入PCS导管至主动脉,观察指标：（1）临床体征;（2（泵导管远端位置,形态及与体位关系,靶血管及植入侧股动脉形态;（3）PCS植入前,后股动脉血流动力学变化;（4）狗PCS植入侧股动脉病理学改变。结果：导管到位率95％,植入侧下肢及局部无异常。植入侧股动脉无狭窄,无明显血流动力学改变,靶血管闭塞3．3％,PCSN地管移位8．3％,PCS导管远端位于主动脉者无导管下移,移位者其导管远端均不同程度缓慢下移。结论：经股浅动脉化疗泵植入术安全可行,熟练的植入泵技术可避免或减少并发症,主动脉内泵导管远端是滞下坠与体们无关,主要取决于血管,血液生物物理学特性及泵导管远端形态。     

Radiation pneumonitis following yttrium-90 radioembolization: case report and literature review

Radiation-induced pneumonitis (RP) is a rare complication of radioembolization with yttrium-90 ((90)Y) microspheres. The present report describes a case of RP in a patient with liver metastases from a gastrointestinal stromal tumor after radioembolization with (90)Y glass microspheres. This patient developed clinical, functional, and radiographic findings consistent with RP, with near-complete pulmonary parenchymal recovery and no clinical evidence of relapse or progressive decline in pulmonary function over a 9-month period. As clinical use of radioembolization expands, rare adverse events such as RP may become more frequent. It is essential that interventional radiologists, radiation/medical oncologists, and nuclear medicine physicians recognize this potential complication.