Download PDF
Nuklearmedizin 1994; 33(05): 206-214
DOI: 10.1055/s-0038-1629756
Original Article
Schattauer GmbH

Superselective Radioembolization of Hepatocellular Carcinoma: 5-Year Results of a Prospective Study

Superselektive Radioembolisation des hepatozellulären Karzinoms: 5-Jahres-Ergebnisse einer prospektiven Studie
H. Rosier
1   From the Dept. of Nuclear Medicine, the Villigen/PSI, Switzerland
,
J. Triller
2   From the Dept. of Diagnostic Radiology, and the Villigen/PSI, Switzerland
,
H. U. Baer
3   From the Clinic of Visceral Surgery, and the Villigen/PSI, Switzerland
,
Livia Geiger
1   From the Dept. of Nuclear Medicine, the Villigen/PSI, Switzerland
,
H. F. Beer
4   From the Paul Scherrer-Institute, Villigen/PSI, Switzerland
,
C. Becker
1   From the Dept. of Nuclear Medicine, the Villigen/PSI, Switzerland
,
L. H. Blumgart
3   From the Clinic of Visceral Surgery, and the Villigen/PSI, Switzerland
› Author Affiliations
Further Information

Publication History

Received: 06 May 1994



Publication Date:
02 February 2018 (online)

    Permissions and Reprints

Summary

Twenty patients with unresectable hepatocellular carcinoma (HCC) were followed up to 5 years after transarterial radiotherapy with 90Y-resin particles. Diagnostic radioembolizations of 99mTc-macroaggregates facilitated scintigraphic assessment of activity distribution, dose evaluation and final procedural verification. The overall survival rates were 56, 38 and 14% (after 1, 2 and 3 years, resp.). Patients with unifocal HCC and a single feeding artery (n = 7) even presented 83, 67 and 40% (2 alive after 2.75 and 4 years). With multiple arteries (n = 7), the longest survival was 26 months. Patients with multifocal HCC survived up to 33 months after selective radioembolization. Quality of life was improved in all. Survival was positively correlated with absorbed dose but residual/recurrent tumour occurred even after ≥300 Gy. Post-treatment symptoms were minimal (35 applications), pulmonary shunt rates were correctly predicted and pulmonary complications avoided.

Zusammenfassung

27 Patienten mit inoperablem hepatozellulärem Karzinom (HCC) wurden bis zu 5 Jahre nach Radiotherapie mit 90Y-Resin-Partikeln beobachtet. Diagnostische Embolisierungen von 99mTc-Macroaggregaten erleichterten die szintigraphische Kontrolle der Dosisverteilung und die Dosisabschätzung sowie die Verifikation nach Therapie. Die 1, 2- und 3-Jahre-Überlebensraten betrugen 56, 38 und 14%. 7 Patienten mit unifokalem Tumor und nur einer versorgenden Arterie überlebten sogar zu 83, 67 und 40% (davon 2 noch am Leben). Unter 7 anderen mit mehrfacher arterieller Tumorversorgung war die längste Überlebenszeit 26 Monate. Patienten mit multifokalem HCC wurden selektiv embolisiert, sie überlebten maximal 33 Monate. Die Lebensqualität verbesserte sich bei allen. Das Überleben war positiv korreliert zur absorbierten Dosis, doch traten Resttumoren/Rückfälle selbst nach ≥300 Gy auf. Symptome nach Therapie waren unbedeutend (insgesamt 35 Applikationen). Lungen-Shunts konnten vorausgesagt und pulmonale Komplikationen vermieden werden.

Key words

Hepatocellular carcinoma - superselective radioembolization - 90Y-resin particles - intrahepatic dose evaluation

Schlüsselwörter

Hepatozelluläres Karzinom - superselektive Embolisierung - 90Y-Resin-Partikel - intrahepatische Dosisabschätzung
 

  • Literatur

  • 1 Baer HU, Schweizer W, Mathew JB. et al. Resectability of large focal liver lesions. Br J Surg 1989; 76: 1042-5.
    CrossrefPubMedGoogle Scholar
  • 2 Beer HF, Bläuenstein P, Schubiger PA. et al. Y-90 Partikel für die Embolisierungsthera-pie. Schweiz Med Wschr 1989; 119(Suppl. 30): 14.
    Google Scholar
  • 3 Bretagne JF. Hepatic artery injection of I-131-labeled Lipiodol: Part II: Preliminary results of therapeutic use in patients with hepatocellular carcinoma and liver metastases. Radiology 1988; 168: 547-550.
    CrossrefPubMedGoogle Scholar
  • 4 Caldarola L, Badellino F, Cavalli A. Intrahepatic localization of P32-labelled particles administered by endoportal and intrasplenic injections. Panminerva med 1965; 7: 176.
    PubMedGoogle Scholar
  • 5 Caldarola L, Sosi S, Badellino F. Preliminary experimental observations on endoarterial introduction of radiating resin microspheres. IJARI 1968; 19: 135.
    Google Scholar
  • 6 Ehrhardt GJ, Day DE. Therapeutic use of 90Y microspheres. Nucl Med Biol 1987; 14: 233-42.
    Google Scholar
  • 7 Friedman MA. Primary hepatocellular cancer: present results and future prospects. Int J Radiat Oncol Biol Phys 1983; 9: 1841-50.
    CrossrefPubMedGoogle Scholar
  • 8 Geiger L, Zimmermann A, Beer HF. et al. Yttrium-90 Partikel für Tumorembolisation. Wirksamkeit und Nebeneffekte in einem Tiermodell. In: Höfer R, Bergmann H, Sinzinger H. (eds). Radioactive Isotopes in Clinical Medicine and Research. Stuttgart -New York: Schattauer; 1991: 30-4.
    Google Scholar
  • 9 Herba MJ, lllescas FF, Thirlwell MP. et al. Hepatic malignancies: improved treatment with intraarterial Y-90. Radiology 1988; 172: 857-60.
    Google Scholar
  • 10 Houle S, Yip TCK, Shepard FA. et al. Hepatocellular carcinoma: pilot trial of treatment with Y-90 microspheres. Radiology 1989; 172: 857-60.
    CrossrefPubMedGoogle Scholar
  • 11 Kaplan WD. Radionuclide delivery by hepatic artery catheter: diagnostic and therapeutic uses. In: Interventional Nuclear Medicine. Spencer R. ed. Orlando, FL: Grune & Stratton; 1984: 3-13.
    Google Scholar
  • 12 Kinser JA, Rosier H, Furrer T, Grüter D, Zimmermann H. Nonimmunogenic hyperthyroidism, cumulative hypothyroidism incidence after radioiodine and surgical treatment. J Nucl Med 1989; 30: 1960-5.
    PubMedGoogle Scholar
  • 13 Leung WT, Lau WL, Ho SKW. et al. Measuring lung shunting in hepatocellular carcinoma with intrahepatic-arterial technetium-99m macroaggregated albumin. J Nucl Med 1994; 35: 70-73.
    PubMedGoogle Scholar
  • 14 London WT. Primary hepatocellular carcinoma: etiology, pathogenesis, and prevention. Hum Pathol 1981; 12: 1085-97.
    CrossrefPubMedGoogle Scholar
  • 15 Nakajo M, Kobayashi H, Shimabukuro K. et al. Biodistribution and in vivo kinetics of iodine-131 Lipiodol infused via the hepatic artery of patients with hepatic cancer. J Nucl Med 1988; 29: 1066-77.
    PubMedGoogle Scholar
  • 16 Park CH, Yoo HS, Lee JT. et al. A new therapeutic modality for vascular hepatic tumors using intra-arterially injected I-131-Li-piodol. In: Buraggi GL, Schmidt HAE. (eds). Trends and Possibilities in Nuclear Medicine. Stuttgart – New York: Schattauer; 1989: 638-42.
    Google Scholar
  • 17 Raoul JL, Bourguet P, Bretagne JF. et al. Hepatic artery injection of I-131-labeled Lipiodol. Radiology 1988; 168: 541-5.
    CrossrefPubMedGoogle Scholar
  • 18 Raoul JI, Bretagne JF, Caucanas JP. et al. Internal radiation therapy for hepatocellular carcinoma. Cancer 1992; 69: 346-52.
    CrossrefPubMedGoogle Scholar
  • 19 Rentsch M, Triller J, Rosier H. et al. Ein Tu-mor-Retentionsregister für Microsphären als Grundlage für die selektive Radionuklid-Embolisierungstherapie von Tumoren mit 90-Yttrium Microsphären. In: Höfer R, Bergmann H, Sinzinger H. et al. Radioactive Isotopes in Clinical Medicine and Research. Stuttgart – New York: Schattauer; 1991: 12-3.
    Google Scholar
  • 20 Rosier H, Noelpp U, Bläuenstein P, Triller KJ, Steffen R. Endoarterial radionuclide embolizing tumor therapy. In: Schubiger PA, Hasler PH. (eds). Radionuclides for Therapy. Würenlingen, Böttsteiner Kolloquium, Hoffmann-La Roche/Basel: 1986: 227-44.
    Google Scholar
  • 21 Rosier H, Triller J, Baer HU, Geiger J. Super-selective 90Y-resin embolization therapy of solid tumors. J Cancer Res Clin Oncol 1990; 116: 1042.
    Google Scholar
  • 22 Rosier H, Birrer A, Lüscher D, Kinser J. Langzeitverläufe beim differenzierten Schilddrüsenkarzinom. Schweiz Med Wschr 1992; 122: 1843-57.
    PubMedGoogle Scholar
  • 23 Schubiger PA, Beer HF, Geiger L. et al. 90Y-resin particles in animal experiments on pigs with regard to the introduction of super-selective embolization therapy. Nucl Med Biol 1991; 18: 302-11.
    Google Scholar
  • 24 Takahashi H, Wands JR. Prognosis of hepatocellular carcinoma: known to be poor yet difficult to predict. J Nucl Med 1991; 32: 235-6.
    PubMedGoogle Scholar
  • 25 Triller J, Rosier H, Geiger L, Baer HU. Methodik der superselektiven Radio-Embolisa-tion von Lebertumoren mit 90Yttrium-Re-sinpartikeln. Fortschr Röntgenstr 1994 in press
    PubMedGoogle Scholar
  • 26 Triller J, Baer HU, Geiger L. et al. Radioembolization of hepatocellular carcinoma with 90Yttrium resin particles. Europ Radiol; Submitted (II. 1994)
    Google Scholar
  • 27 Zimmermann A, Schubiger PA, Mettler D. et al. Mikroembolisation mit Y-90-Partikeln: Radiopathologische Veränderungen an der Niere des Schweines. Schweiz Med Wschr 1991; 41: 1512.
    Google Scholar