Radioactive microspheres have demonstrated excellent therapeutic effects and good tolerance in the treatment of unresectable primary and secondary liver malignancies.This is attributed to precise embolization and pote...Radioactive microspheres have demonstrated excellent therapeutic effects and good tolerance in the treatment of unresectable primary and secondary liver malignancies.This is attributed to precise embolization and potent anti-tumor effect.However,certain limitations such as unstable loading,perfusion stasis,heterogeneous distribution,ectopic distribution,and insufficient dosage,restrict their clinical application.Herein,a novel personalized Y-90 carbon microsphere with high uniformity,high specific activity and high availability(^(90)Y-HUACM)is presented.It is synthesized through planar molecular complex adsorption and chemical deposition solidification.^(90)Y-HUACM exhibited controllable size,excellent biocompatibility,outstanding in vitro and in vivo stability.The radiolabeling efficiency of Y-90 exceeded 99%and the leaching rate of Y-90 is far below 0.1%.Furthermore,the excellent anti-tumor effect,nuclide loading stability,anti-reflux characteristics,precise embolization,and biosafety of^(90)Y-HUACM were validated in a rabbit VX2liver tumor model.In summary,this new,high-performance,and customizable radioactive microsphere provides a superior choice for selective internal radiation treatment of advanced liver cancer is expected to be rapidly applied in clinical practice.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)has become a growing health concern globally.Microvascular invasion and high tumor burden are key factors limiting the curative effect of selective internal radiation therapy(SI...BACKGROUND Hepatocellular carcinoma(HCC)has become a growing health concern globally.Microvascular invasion and high tumor burden are key factors limiting the curative effect of selective internal radiation therapy(SIRT).CASE SUMMARY This case study reports a 49-year-old woman who was diagnosed with China Liver Cancer Staging(CNLC)IIIa HCC and>15 cm tumor diameter.Initially,due to insufficient future liver remnant and vascular invasion,the tumor was unresectable;however,radical hepatectomy was performed after successful conversion therapy with SIRT using yttrium-90(90Y)resin microspheres followed by hepatic arterial infusion chemotherapy(HAIC)with tyrosine kinase inhibitor(TKI)and anti-programmed death-1(PD-1)antibody.SIRT using 90Y resin microspheres was given by the right hepatic artery and chemoembolization was simultaneously performed in the tumor’s feeding vessels from the right diaphragmatic artery.HAIC was followed every three weeks with lenvatinib and tislelizumab.At 4 months post-SIRT,the tumor was downstaged to CNLC Ib and the patient successfully underwent hepatectomy.The histopathological examination of the resected specimen showed extensive necrosis.CONCLUSION This case study provides evidence for an integrated treatment strategy combining SIRT and HAIC with TKI and anti-PD-1 antibodies for patients with large HCC and microvascular invasion.Further confirmatory trials are required in the future.展开更多
The liver is a common site of metastasis, with essentially all metastatic malignancies having been known to spread to the liver. Nearly half of all patients with extrahepatic primary cancer have hepatic metastases. Th...The liver is a common site of metastasis, with essentially all metastatic malignancies having been known to spread to the liver. Nearly half of all patients with extrahepatic primary cancer have hepatic metastases. The severe prognostic implications of hepatic metastases have made surgical resection an important first line treatment in management. However, limitations such as the presence of extrahepatic spread or poor functional hepatic reserve exclude the majority of patients as surgical candidates, leaving chemotherapy and locoregional therapies as next best options. Selective internal radiation therapy(SIRT) is a form of catheter-based locoregional cancer treatment modality for unresectable tumors, involving trans-arterial injection of microspheres embedded with a radioisotope Yttrium-90. The therapeutic radiation dose is selectively delivered as the microspheres permanently embed themselves within the tumor vascular bed. Use of SIRT has been conventionally aimed at treating primary hepatic tumors(hepatocellular carcinoma) or colorectal and neuroendocrine metastases. Numerous reviews are available for these tumor types. However, little is known or reviewed on non-colorectal or nonneuroendocrine primaries. Therefore, the aim of this paper is to systematically review the current literature to evaluate the effects of Yttrium-90 radioembolization on non-conventional liver tumors including those secondary to breast cancer, cholangiocarcinoma, ocular and percutaneous melanoma, pancreatic cancer, renal cell carcinoma, and lung cancer.展开更多
Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial deliv...Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the tumor.Historically employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation segmentectomy.The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not feasible.Radiation segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy tissue.Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.展开更多
A systematic investigation of oxidation on a superconductive Fe Te_（0.5）Se_（0.5）thin film,which was grown on Nb-doped SrTiO_3（001） by pulsed laser deposition,has been carried out.The sample was exposed to ambien...A systematic investigation of oxidation on a superconductive Fe Te_（0.5）Se_（0.5）thin film,which was grown on Nb-doped SrTiO_3（001） by pulsed laser deposition,has been carried out.The sample was exposed to ambient air for one month for oxidation.Macroscopically,the exposed specimen lost its superconductivity due to oxidation.The specimen was subjected to in situ synchrotron radiation photoelectron spectroscopy（PES） and x-ray absorption spectroscopy（XAS） measurements following cycles of annealing and argon ion etching treatments to unravel what happened in the electronic structure and composition after exposure to air.By the spectroscopic measurements,we found that the as-grown FeTe_（0.5）Se_（0.5）superconductive thin film experienced an element selective substitution reaction.The oxidation preferentially proceeds through pumping out the Te and forming Fe–O bonds by O substitution of Te.In addition,our results certify that in situ vacuum annealing and low-energy argon ion etching methods combined with spectroscopy are suitable for depth element and valence analysis of layered structure superconductor materials.展开更多
Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality,with a majority of patients presenting at intermediate or advanced stages,precluding curative interventions.Radioembolization,also known as s...Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality,with a majority of patients presenting at intermediate or advanced stages,precluding curative interventions.Radioembolization,also known as selective internal radiation therapy,has emerged as a promising locoregional therapy that delivers high-dose yttrium-90 microspheres directly to hepatic tumors while sparing healthy parenchyma.This technique is especially beneficial for patients with portal vein tumor thrombosis or impaired liver function.This editorial provides a comprehensive overview of the mechanism,technical considerations,and clinical efficacy of radioembolization in advanced HCC.Landmark trials such as SARAH,SIRveNIB,and DOSISPHERE-01 demonstrate comparable or superior outcomes to systemic therapies like sorafenib,particularly when personalized dosimetry is applied.Radioembolization contributes to tumor downstaging,transplant bridging,and improved disease control rates.The integration of radioembolization with systemic therapies,including immune checkpoint inhibitors and tyrosine kinase inhibitors,represents a key area of ongoing research.Despite current challenges such as microsphere heterogeneity,dosimetry standardization,and limited accessibility,emerging innovations in imaging,isotopes,and personalized treatment strategies are expected to refine its application.Overall,radioembolization is poised to play an increasingly central role in the multidisciplinary management of advanced HCC.展开更多
Background:Selective internal radiation therapy(SIRT)has emerged as a promising and recent treatment for downstaging hepatocellular carcinoma(HCC)before surgical intervention.However,the potential occurrence of postop...Background:Selective internal radiation therapy(SIRT)has emerged as a promising and recent treatment for downstaging hepatocellular carcinoma(HCC)before surgical intervention.However,the potential occurrence of postoperative biliary and respiratory complications following major hepatectomy subsequent to SIRT remains unclear.We hypothesized that SIRT can increase the rate of biliary leakage and cause diaphragmatic dysfunction,especially for huge HCC in contact with the diaphragm.Methods:We conducted a retrospective study including consecutive HCC patients from January 2015 to December 2022 undergoing right hepatectomy after SIRT in the Montpellier University Hospital.Patients were compared in a 1:1 ratio with non-SIRT-treated patients based on the following criteria:same diagnosis,same surgery,same American Society of Anesthesiologists(ASA)score,Child-Turcotte-Pugh(CTP)class,and similar tumor burden.Analysis was done using either a linear or logistic regression.Outcomes were the rate of biliary leakage and of 3 diaphragm-related complications:oxygen flow on day 1,need for intensive oxygen therapy,and pleural effusion.Results:Twenty patients with comparable preoperative characteristics were included in each group.Eight patients(40%)in the SIRT group experienced a postoperative bile leak versus only 2(10%)in the other,with a significantly increased risk[odds ratio(OR)=6;95%confidence interval(CI):1.1-33.3;P<0.05].Similarly,the risk of large postoperative pleural effusion was increased after SIRT,with 6 patients(30%)against 0,respectively(OR=10.5;95%CI:1.8-61.4;P<0.05).Conclusions:SIRT may increase the risk of postoperative biliary leakage and respiratory complications after right hepatectomy.展开更多
Gastrointestinal ulcers occur frequently and are mainly caused by H pylori infection. In this report, we present a rare case of gastro-duodenal ulcer following selective internal radiation therapy (SIRT). SIRT is a pa...Gastrointestinal ulcers occur frequently and are mainly caused by H pylori infection. In this report, we present a rare case of gastro-duodenal ulcer following selective internal radiation therapy (SIRT). SIRT is a palliative treatment for unresectable liver tumours. During SIRT, 90Y-microspheres are infused into the hepatic artery. Pre- treatment evaluation for the presence of arterial shunts to neighbouring organs should be determined in order to avoid complications of SIRT.展开更多
Background and Objective:Selective internal radiation therapy(SIRT)represents an endovascular treatment option for patients with hepatocellular carcinoma(HCC).Its use is widely recognized in the intermediate and advan...Background and Objective:Selective internal radiation therapy(SIRT)represents an endovascular treatment option for patients with hepatocellular carcinoma(HCC).Its use is widely recognized in the intermediate and advanced HCC,but it has become more prevalent in recent years in different Barcelona Clinic Liver Cancer(BCLC)stages.The aim of this review is to summarize the role of SIRT and its clinical implications through different stages of HCC.Methods:A literature review of papers on this topic was performed using PubMed MEDLINE,focusing exclusively on the role of yttrium-90 SIRT across all BCLC stages and comparing it with other treatments.Only English-language papers currently available until September 2023 were considered.Key Content and Findings:Many studies have shown that SIRT is a promising tool with multiple uses,such as tumour control in the context of bridge-to-liver transplantation or resection,tumour downstaging,and curative therapy in selected patients.Therefore,according to the recent update of BCLC staging system criteria,SIRT now emerges as a potential curative treatment for early-stage HCC patients,serving as an alternative when ablation or resection is not feasible.It is also a promising treatment compared to transarterial chemoembolization(TACE)as well as in combination with immunotherapies.Conclusions:SIRT is a safe and effective treatment for selected patients at all BCLC stages of HCC.Therefore,due to its numerous advantages,SIRT may prove useful in many complex HCC treatment situations in the near future.展开更多
Background and aim:Whereas Yttrium-90 selective internal radiation therapy(Y-90 SIRT)was shown to improve local tumor control in non-Asian population,the efficacy of this therapy for Asian population in real-world set...Background and aim:Whereas Yttrium-90 selective internal radiation therapy(Y-90 SIRT)was shown to improve local tumor control in non-Asian population,the efficacy of this therapy for Asian population in real-world setting remains poorly detailed.We aimed to determine outcomes and identify predictors of response in hepatocellular carcinoma(HCC)patients treated by Y-90 SIRT.Methods:We retrospectively enrolled 52 HCC patients receiving Y-90 SIRT at our tertiary center between 2014 and 2019.Overall survival(OS),progression free survival(PFS),and predictive factors were determined by KaplaneMeier method and Cox-proportional hazard analysis.Results:Of the 52 patients(81% male,mean age 64.9 years),71%and 29% were classified as Barcelona Clinic Liver Cancer stage C and B HCC,respectively;63% had portal vein thrombosis,and 35% had objective tumor response defined by the modified Response Evaluation Criteria in Solid Tumors(mRE-CIST)criteria.OS and PFS were 11.0 and 2.4 months,respectively.Two patients were successfully down-staged and further underwent surgical resection.Multifocal lesion,alpha-fetoprotein(AFP)≥200 ng/mL,and Eastern Cooperative Oncology Group(ECOG)score≥1 were significantly associated with poor sur-vival,with adjusted hazard ratio(95% confidence interval)of 7.7(2.0e29.8),5.4(2.0e14.7),and 3.1(1.0 e9.6),respectively(all in P<0.05).Conclusions:Y-90 SIRT is an effective treatment for the local tumor control of HCC without serious adverse events.Single lesion,AFP level and ECOG status were predictors of response.展开更多
BACKGROUND Two-stage hepatectomy(TSH)is a well-established surgical technique,used to treat bilateral colorectal liver metastases(CRLM)with a small future liver remnant(FLR).However,in classical TSH,drop-out is report...BACKGROUND Two-stage hepatectomy(TSH)is a well-established surgical technique,used to treat bilateral colorectal liver metastases(CRLM)with a small future liver remnant(FLR).However,in classical TSH,drop-out is reported to be around 25%-40%,due to insufficient FLR increase or progression of disease.Trans-arterial radioembolization(TARE)has been described to control locally tumor growth of liver malignancies such as hepatocellular carcinoma,but it has been also reported to induce a certain degree of contralateral liver hypertrophy,even if at a lower rate compared to portal vein embolization or ligation.CASE SUMMARY Herein we report the case of a 75-year-old female patient,where TSH and TARE were combined to treat bilateral CRLM.According to computed tomography(CT)-scan,the patient had a hepatic lesion in segment VI-VII and two other confluent lesions in segment II-III.Therefore,one-stage posterior right sectionectomy plus left lateral sectionectomy(LLS)was planned.The liver volumetry estimated a FLR of 38%(segments I-IV-V-VIII).However,due to a more than initially planned,extended right resection,simultaneous LLS was not performed and the patient underwent selective TARE to segments II-III after the first surgery.The CT-scan performed after TARE showed a reduction of the treated lesion and a FLR increase of 55%.Carcinoembryonic antigen and CA 19.9 decreased significantly.Nearly three months later after the first surgery,LLS was performed and the patient was discharged without any postoperative complications.CONCLUSION According to this specific experience,TARE was used to induce liver hypertrophy and simultaneously control cancer progression in TSH settings for bilateral CRLM.展开更多
Liver malignancy,including primary liver cancer and metastatic liver cancer has become one of the most common causes of cancer-related death worldwide due to the high malignant degree and limited systematic treatment ...Liver malignancy,including primary liver cancer and metastatic liver cancer has become one of the most common causes of cancer-related death worldwide due to the high malignant degree and limited systematic treatment strategy.Radioembolization with yttrium-90(^(90)Y)-loaded microspheres is a relatively novel technology that has made significant progress in the local treatment of liver malignancy.The different steps in the extensive work-up of radioembolization for patients with an indication for treatment with^(90)Y microspheres,from patient selection to follow up,both technically and clinically,are discussed in this paper.It describes the application and development of^(90)Y microspheres in the treatment of liver cancer.展开更多
Selective Internal Radiation Therapy (SIRT) is used as a treatment option for unresectable liver tumors. In SIRT, microspheres, which have a radioactive substance as an integral component, are placed via image guided ...Selective Internal Radiation Therapy (SIRT) is used as a treatment option for unresectable liver tumors. In SIRT, microspheres, which have a radioactive substance as an integral component, are placed via image guided catheters into the hepatic artery. The ionizing radiation is directly delivered to the tumor. Currently used commercially available microspheres are based on Yttrium 90, a β-emitter, which has been shown to be safe and to produce good clinical results. The technical features of Y90, their applications and their limitations are presented. Image guidance and intraoperative depiction of Yttrium 90 microspheres are restricted, which is currently one of the main limitations in SIRT. Therapy planning and control is currently based on pre- and post-operative images to evaluate the placement of the microspheres respectively. Holmium 166, another possible nuclide integrated into the microspheres emits a higher amount of secondary γ-radiation (Bremsstrahlung) than Yttrium 90. This enables an improved depiction of the microspheres inside the patient during and immediately after application, but comes with other shortfalls. Imaging of delivery and verification of the microsphere placement could solve many of the identified problems with SIRT. The different technologies are reviewed and an outlook in future developments is given particularly on image guidance and therapy control.展开更多
Gastrointestinal stromal tumors(GISTs),the most prevalent mesenchymal neoplasms of the gastrointestinal tract,frequently metastasize to the liver.Despite this clinical reality,there is a lack of standardized therapeut...Gastrointestinal stromal tumors(GISTs),the most prevalent mesenchymal neoplasms of the gastrointestinal tract,frequently metastasize to the liver.Despite this clinical reality,there is a lack of standardized therapeutic protocols for GIST liver metastases(GISTLM).Here we present the first case of a GISTLM patient treated with Yttrium‐90(Y90)resin microsphere selective internal radiation therapy(SIRT)in China.We further reviewed the current challenges in GISTLM management and highlighted the emerging role of SIRT.By integrating case‐specific insights with broader therapeutic paradigms,we aim to develop safe and effective individualized treatment strategies for GIST patients.展开更多
Background:Transarterial radioembolization(TARE)has recently been recognized as a bridging/downstaging therapy to surgery for early hepatocellular carcinomas(HCCs)with high rates of complete pathological necrosis(CPN)...Background:Transarterial radioembolization(TARE)has recently been recognized as a bridging/downstaging therapy to surgery for early hepatocellular carcinomas(HCCs)with high rates of complete pathological necrosis(CPN)on liver explants.In patients with portal vein tumoral thrombus(PVTT),multifocal or large tumors,TARE has mainly a palliative role and surgery remains controversial in this poor-prognosis population.Personalized dosimetry recently proved to outperform standard dosimetry used in prior negative Y90 randomized-controlled trials.Methods:In this retrospective study,we evaluated safety,radiological and pathological response and outcomes in HCC patients with PVTT,multifocal or large tumors,who underwent surgery after downstaging using TARE with Y90-loaded glass microspheres with personalized dosimetry.Results:Between December 2015 and October 2021,18 unresectable patients(14/18 with PVTT)had surgery(16 resections,2 liver transplantations)6.2 months(range,2-14.6 months)after a single Y90 treatment.No 90-day mortality was reported.Objective modified response criteria in solid tumors(mRECIST)response were noted in all but one patient.Complete and extensive(50-99%)necrosis was observed in 36%and 45%of tumors,respectively.The post-treatment tumor-absorbed dose significantly differed depending on the extent of pathological necrosis(P=0.045).Median overall survival and progression-free survival(PFS)were respectively of 61.8 months[95%CI:31.4 months-not reached(NR)]and 49.3 months(95%CI:14 months-NR).PFS was longer in patients with complete imaging response[median NR(none recurred or died)vs.21.5 months(95%CI:10.1 months-NR),P<0.001]and in those with complete pathological response[median NR vs.22.5 months(95%CI:10.1 months-NR),P<0.001].Conclusions:Y90 TARE using personalized dosimetry can provide high rates of imaging and pathological response in patients with PVTT,large or multifocal HCC.Subsequent surgery is safe and leads to outcomes far exceeding expectations in an otherwise poor prognosis population with no chance for cure.展开更多
Recent clinical trials and new agents have permitted greater clarity in the choice of effective agents for that majority of patients with hepatocellular carcinoma who have advanced disease at diagnosis and thus cannot...Recent clinical trials and new agents have permitted greater clarity in the choice of effective agents for that majority of patients with hepatocellular carcinoma who have advanced disease at diagnosis and thus cannot be offered potentially curative resection,ablation or liver transplantation.The main treatment for these patients remains chemoembolization,although evidence for selective internal radiation therapy(SIRT)with SIR-Spheres or Theraphere,is beginning to suggest that the results with this may be comparable with less toxicity.Patients who have failed chemoembolization or SIRT or have metastatic disease at presentation are suitable for the multikinase inhibitor sorafenib(nexavar)or newly-approved lenvatinib(lenvima)as first line therapies.The choice between which of them to use first is not currently clear.Patients who have failed sorafenib can be offered a choice of FDA-approved regorafenib(stivarga)or immune checkpoint inhibitor nivolumab(opdivo)as second line agents.For that considerable percent of patients presenting with macroscopic portal vein thrombosis,the choice appears to be between multikinase inhibitor or SIRT,given the potential toxicity of chemoembolization in this setting.However,considering the potency of both nivolumab and regorafenib and the pipeline of new agents such as atezolizumab(tecentriq)in current clinical trials,including new immune checkpoint inhibitors,this landscape may change within a couple of years,especially if new evidence arises for the superior effectiveness of combinations of any of these agents over single agents.展开更多
基金supported by the National Major Scientific and Technological Special Project for“Significant New Drugs Development”(No.2018ZX09201018–028)the nuclear energy development projects of China during the 13thFive Year Plan periodthe key research and development project of the Sichuan Provincial Department of Science and Technology(No.18ZDYF1466)。
文摘Radioactive microspheres have demonstrated excellent therapeutic effects and good tolerance in the treatment of unresectable primary and secondary liver malignancies.This is attributed to precise embolization and potent anti-tumor effect.However,certain limitations such as unstable loading,perfusion stasis,heterogeneous distribution,ectopic distribution,and insufficient dosage,restrict their clinical application.Herein,a novel personalized Y-90 carbon microsphere with high uniformity,high specific activity and high availability(^(90)Y-HUACM)is presented.It is synthesized through planar molecular complex adsorption and chemical deposition solidification.^(90)Y-HUACM exhibited controllable size,excellent biocompatibility,outstanding in vitro and in vivo stability.The radiolabeling efficiency of Y-90 exceeded 99%and the leaching rate of Y-90 is far below 0.1%.Furthermore,the excellent anti-tumor effect,nuclide loading stability,anti-reflux characteristics,precise embolization,and biosafety of^(90)Y-HUACM were validated in a rabbit VX2liver tumor model.In summary,this new,high-performance,and customizable radioactive microsphere provides a superior choice for selective internal radiation treatment of advanced liver cancer is expected to be rapidly applied in clinical practice.
基金The Fujian Key Laboratory of Translational Cancer Medicine and The Yttrium Little Red Flower Health Fund Project of Henan Sunshine Medical and Health Development Foundation,No.HKP2024001.
文摘BACKGROUND Hepatocellular carcinoma(HCC)has become a growing health concern globally.Microvascular invasion and high tumor burden are key factors limiting the curative effect of selective internal radiation therapy(SIRT).CASE SUMMARY This case study reports a 49-year-old woman who was diagnosed with China Liver Cancer Staging(CNLC)IIIa HCC and>15 cm tumor diameter.Initially,due to insufficient future liver remnant and vascular invasion,the tumor was unresectable;however,radical hepatectomy was performed after successful conversion therapy with SIRT using yttrium-90(90Y)resin microspheres followed by hepatic arterial infusion chemotherapy(HAIC)with tyrosine kinase inhibitor(TKI)and anti-programmed death-1(PD-1)antibody.SIRT using 90Y resin microspheres was given by the right hepatic artery and chemoembolization was simultaneously performed in the tumor’s feeding vessels from the right diaphragmatic artery.HAIC was followed every three weeks with lenvatinib and tislelizumab.At 4 months post-SIRT,the tumor was downstaged to CNLC Ib and the patient successfully underwent hepatectomy.The histopathological examination of the resected specimen showed extensive necrosis.CONCLUSION This case study provides evidence for an integrated treatment strategy combining SIRT and HAIC with TKI and anti-PD-1 antibodies for patients with large HCC and microvascular invasion.Further confirmatory trials are required in the future.
文摘The liver is a common site of metastasis, with essentially all metastatic malignancies having been known to spread to the liver. Nearly half of all patients with extrahepatic primary cancer have hepatic metastases. The severe prognostic implications of hepatic metastases have made surgical resection an important first line treatment in management. However, limitations such as the presence of extrahepatic spread or poor functional hepatic reserve exclude the majority of patients as surgical candidates, leaving chemotherapy and locoregional therapies as next best options. Selective internal radiation therapy(SIRT) is a form of catheter-based locoregional cancer treatment modality for unresectable tumors, involving trans-arterial injection of microspheres embedded with a radioisotope Yttrium-90. The therapeutic radiation dose is selectively delivered as the microspheres permanently embed themselves within the tumor vascular bed. Use of SIRT has been conventionally aimed at treating primary hepatic tumors(hepatocellular carcinoma) or colorectal and neuroendocrine metastases. Numerous reviews are available for these tumor types. However, little is known or reviewed on non-colorectal or nonneuroendocrine primaries. Therefore, the aim of this paper is to systematically review the current literature to evaluate the effects of Yttrium-90 radioembolization on non-conventional liver tumors including those secondary to breast cancer, cholangiocarcinoma, ocular and percutaneous melanoma, pancreatic cancer, renal cell carcinoma, and lung cancer.
文摘Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the tumor.Historically employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation segmentectomy.The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not feasible.Radiation segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy tissue.Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.
基金Project supported by the Chinese Academy of Sciences(Grant No.1G2009312311750101)the National Natural Science Foundation of China(Grant Nos.11375228,11204303,and U1332105)
文摘A systematic investigation of oxidation on a superconductive Fe Te_（0.5）Se_（0.5）thin film,which was grown on Nb-doped SrTiO_3（001） by pulsed laser deposition,has been carried out.The sample was exposed to ambient air for one month for oxidation.Macroscopically,the exposed specimen lost its superconductivity due to oxidation.The specimen was subjected to in situ synchrotron radiation photoelectron spectroscopy（PES） and x-ray absorption spectroscopy（XAS） measurements following cycles of annealing and argon ion etching treatments to unravel what happened in the electronic structure and composition after exposure to air.By the spectroscopic measurements,we found that the as-grown FeTe_（0.5）Se_（0.5）superconductive thin film experienced an element selective substitution reaction.The oxidation preferentially proceeds through pumping out the Te and forming Fe–O bonds by O substitution of Te.In addition,our results certify that in situ vacuum annealing and low-energy argon ion etching methods combined with spectroscopy are suitable for depth element and valence analysis of layered structure superconductor materials.
文摘Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality,with a majority of patients presenting at intermediate or advanced stages,precluding curative interventions.Radioembolization,also known as selective internal radiation therapy,has emerged as a promising locoregional therapy that delivers high-dose yttrium-90 microspheres directly to hepatic tumors while sparing healthy parenchyma.This technique is especially beneficial for patients with portal vein tumor thrombosis or impaired liver function.This editorial provides a comprehensive overview of the mechanism,technical considerations,and clinical efficacy of radioembolization in advanced HCC.Landmark trials such as SARAH,SIRveNIB,and DOSISPHERE-01 demonstrate comparable or superior outcomes to systemic therapies like sorafenib,particularly when personalized dosimetry is applied.Radioembolization contributes to tumor downstaging,transplant bridging,and improved disease control rates.The integration of radioembolization with systemic therapies,including immune checkpoint inhibitors and tyrosine kinase inhibitors,represents a key area of ongoing research.Despite current challenges such as microsphere heterogeneity,dosimetry standardization,and limited accessibility,emerging innovations in imaging,isotopes,and personalized treatment strategies are expected to refine its application.Overall,radioembolization is poised to play an increasingly central role in the multidisciplinary management of advanced HCC.
文摘Background:Selective internal radiation therapy(SIRT)has emerged as a promising and recent treatment for downstaging hepatocellular carcinoma(HCC)before surgical intervention.However,the potential occurrence of postoperative biliary and respiratory complications following major hepatectomy subsequent to SIRT remains unclear.We hypothesized that SIRT can increase the rate of biliary leakage and cause diaphragmatic dysfunction,especially for huge HCC in contact with the diaphragm.Methods:We conducted a retrospective study including consecutive HCC patients from January 2015 to December 2022 undergoing right hepatectomy after SIRT in the Montpellier University Hospital.Patients were compared in a 1:1 ratio with non-SIRT-treated patients based on the following criteria:same diagnosis,same surgery,same American Society of Anesthesiologists(ASA)score,Child-Turcotte-Pugh(CTP)class,and similar tumor burden.Analysis was done using either a linear or logistic regression.Outcomes were the rate of biliary leakage and of 3 diaphragm-related complications:oxygen flow on day 1,need for intensive oxygen therapy,and pleural effusion.Results:Twenty patients with comparable preoperative characteristics were included in each group.Eight patients(40%)in the SIRT group experienced a postoperative bile leak versus only 2(10%)in the other,with a significantly increased risk[odds ratio(OR)=6;95%confidence interval(CI):1.1-33.3;P<0.05].Similarly,the risk of large postoperative pleural effusion was increased after SIRT,with 6 patients(30%)against 0,respectively(OR=10.5;95%CI:1.8-61.4;P<0.05).Conclusions:SIRT may increase the risk of postoperative biliary leakage and respiratory complications after right hepatectomy.
文摘Gastrointestinal ulcers occur frequently and are mainly caused by H pylori infection. In this report, we present a rare case of gastro-duodenal ulcer following selective internal radiation therapy (SIRT). SIRT is a palliative treatment for unresectable liver tumours. During SIRT, 90Y-microspheres are infused into the hepatic artery. Pre- treatment evaluation for the presence of arterial shunts to neighbouring organs should be determined in order to avoid complications of SIRT.
文摘Background and Objective:Selective internal radiation therapy(SIRT)represents an endovascular treatment option for patients with hepatocellular carcinoma(HCC).Its use is widely recognized in the intermediate and advanced HCC,but it has become more prevalent in recent years in different Barcelona Clinic Liver Cancer(BCLC)stages.The aim of this review is to summarize the role of SIRT and its clinical implications through different stages of HCC.Methods:A literature review of papers on this topic was performed using PubMed MEDLINE,focusing exclusively on the role of yttrium-90 SIRT across all BCLC stages and comparing it with other treatments.Only English-language papers currently available until September 2023 were considered.Key Content and Findings:Many studies have shown that SIRT is a promising tool with multiple uses,such as tumour control in the context of bridge-to-liver transplantation or resection,tumour downstaging,and curative therapy in selected patients.Therefore,according to the recent update of BCLC staging system criteria,SIRT now emerges as a potential curative treatment for early-stage HCC patients,serving as an alternative when ablation or resection is not feasible.It is also a promising treatment compared to transarterial chemoembolization(TACE)as well as in combination with immunotherapies.Conclusions:SIRT is a safe and effective treatment for selected patients at all BCLC stages of HCC.Therefore,due to its numerous advantages,SIRT may prove useful in many complex HCC treatment situations in the near future.
基金This research was supported by Chulalongkorn University CU-GRS-62-02-30-01.
文摘Background and aim:Whereas Yttrium-90 selective internal radiation therapy(Y-90 SIRT)was shown to improve local tumor control in non-Asian population,the efficacy of this therapy for Asian population in real-world setting remains poorly detailed.We aimed to determine outcomes and identify predictors of response in hepatocellular carcinoma(HCC)patients treated by Y-90 SIRT.Methods:We retrospectively enrolled 52 HCC patients receiving Y-90 SIRT at our tertiary center between 2014 and 2019.Overall survival(OS),progression free survival(PFS),and predictive factors were determined by KaplaneMeier method and Cox-proportional hazard analysis.Results:Of the 52 patients(81% male,mean age 64.9 years),71%and 29% were classified as Barcelona Clinic Liver Cancer stage C and B HCC,respectively;63% had portal vein thrombosis,and 35% had objective tumor response defined by the modified Response Evaluation Criteria in Solid Tumors(mRE-CIST)criteria.OS and PFS were 11.0 and 2.4 months,respectively.Two patients were successfully down-staged and further underwent surgical resection.Multifocal lesion,alpha-fetoprotein(AFP)≥200 ng/mL,and Eastern Cooperative Oncology Group(ECOG)score≥1 were significantly associated with poor sur-vival,with adjusted hazard ratio(95% confidence interval)of 7.7(2.0e29.8),5.4(2.0e14.7),and 3.1(1.0 e9.6),respectively(all in P<0.05).Conclusions:Y-90 SIRT is an effective treatment for the local tumor control of HCC without serious adverse events.Single lesion,AFP level and ECOG status were predictors of response.
文摘BACKGROUND Two-stage hepatectomy(TSH)is a well-established surgical technique,used to treat bilateral colorectal liver metastases(CRLM)with a small future liver remnant(FLR).However,in classical TSH,drop-out is reported to be around 25%-40%,due to insufficient FLR increase or progression of disease.Trans-arterial radioembolization(TARE)has been described to control locally tumor growth of liver malignancies such as hepatocellular carcinoma,but it has been also reported to induce a certain degree of contralateral liver hypertrophy,even if at a lower rate compared to portal vein embolization or ligation.CASE SUMMARY Herein we report the case of a 75-year-old female patient,where TSH and TARE were combined to treat bilateral CRLM.According to computed tomography(CT)-scan,the patient had a hepatic lesion in segment VI-VII and two other confluent lesions in segment II-III.Therefore,one-stage posterior right sectionectomy plus left lateral sectionectomy(LLS)was planned.The liver volumetry estimated a FLR of 38%(segments I-IV-V-VIII).However,due to a more than initially planned,extended right resection,simultaneous LLS was not performed and the patient underwent selective TARE to segments II-III after the first surgery.The CT-scan performed after TARE showed a reduction of the treated lesion and a FLR increase of 55%.Carcinoembryonic antigen and CA 19.9 decreased significantly.Nearly three months later after the first surgery,LLS was performed and the patient was discharged without any postoperative complications.CONCLUSION According to this specific experience,TARE was used to induce liver hypertrophy and simultaneously control cancer progression in TSH settings for bilateral CRLM.
文摘Liver malignancy,including primary liver cancer and metastatic liver cancer has become one of the most common causes of cancer-related death worldwide due to the high malignant degree and limited systematic treatment strategy.Radioembolization with yttrium-90(^(90)Y)-loaded microspheres is a relatively novel technology that has made significant progress in the local treatment of liver malignancy.The different steps in the extensive work-up of radioembolization for patients with an indication for treatment with^(90)Y microspheres,from patient selection to follow up,both technically and clinically,are discussed in this paper.It describes the application and development of^(90)Y microspheres in the treatment of liver cancer.
文摘Selective Internal Radiation Therapy (SIRT) is used as a treatment option for unresectable liver tumors. In SIRT, microspheres, which have a radioactive substance as an integral component, are placed via image guided catheters into the hepatic artery. The ionizing radiation is directly delivered to the tumor. Currently used commercially available microspheres are based on Yttrium 90, a β-emitter, which has been shown to be safe and to produce good clinical results. The technical features of Y90, their applications and their limitations are presented. Image guidance and intraoperative depiction of Yttrium 90 microspheres are restricted, which is currently one of the main limitations in SIRT. Therapy planning and control is currently based on pre- and post-operative images to evaluate the placement of the microspheres respectively. Holmium 166, another possible nuclide integrated into the microspheres emits a higher amount of secondary γ-radiation (Bremsstrahlung) than Yttrium 90. This enables an improved depiction of the microspheres inside the patient during and immediately after application, but comes with other shortfalls. Imaging of delivery and verification of the microsphere placement could solve many of the identified problems with SIRT. The different technologies are reviewed and an outlook in future developments is given particularly on image guidance and therapy control.
文摘Gastrointestinal stromal tumors(GISTs),the most prevalent mesenchymal neoplasms of the gastrointestinal tract,frequently metastasize to the liver.Despite this clinical reality,there is a lack of standardized therapeutic protocols for GIST liver metastases(GISTLM).Here we present the first case of a GISTLM patient treated with Yttrium‐90(Y90)resin microsphere selective internal radiation therapy(SIRT)in China.We further reviewed the current challenges in GISTLM management and highlighted the emerging role of SIRT.By integrating case‐specific insights with broader therapeutic paradigms,we aim to develop safe and effective individualized treatment strategies for GIST patients.
文摘Background:Transarterial radioembolization(TARE)has recently been recognized as a bridging/downstaging therapy to surgery for early hepatocellular carcinomas(HCCs)with high rates of complete pathological necrosis(CPN)on liver explants.In patients with portal vein tumoral thrombus(PVTT),multifocal or large tumors,TARE has mainly a palliative role and surgery remains controversial in this poor-prognosis population.Personalized dosimetry recently proved to outperform standard dosimetry used in prior negative Y90 randomized-controlled trials.Methods:In this retrospective study,we evaluated safety,radiological and pathological response and outcomes in HCC patients with PVTT,multifocal or large tumors,who underwent surgery after downstaging using TARE with Y90-loaded glass microspheres with personalized dosimetry.Results:Between December 2015 and October 2021,18 unresectable patients(14/18 with PVTT)had surgery(16 resections,2 liver transplantations)6.2 months(range,2-14.6 months)after a single Y90 treatment.No 90-day mortality was reported.Objective modified response criteria in solid tumors(mRECIST)response were noted in all but one patient.Complete and extensive(50-99%)necrosis was observed in 36%and 45%of tumors,respectively.The post-treatment tumor-absorbed dose significantly differed depending on the extent of pathological necrosis(P=0.045).Median overall survival and progression-free survival(PFS)were respectively of 61.8 months[95%CI:31.4 months-not reached(NR)]and 49.3 months(95%CI:14 months-NR).PFS was longer in patients with complete imaging response[median NR(none recurred or died)vs.21.5 months(95%CI:10.1 months-NR),P<0.001]and in those with complete pathological response[median NR vs.22.5 months(95%CI:10.1 months-NR),P<0.001].Conclusions:Y90 TARE using personalized dosimetry can provide high rates of imaging and pathological response in patients with PVTT,large or multifocal HCC.Subsequent surgery is safe and leads to outcomes far exceeding expectations in an otherwise poor prognosis population with no chance for cure.
基金This work was supported in part by NIH(CA 82723)to Carr BI.
文摘Recent clinical trials and new agents have permitted greater clarity in the choice of effective agents for that majority of patients with hepatocellular carcinoma who have advanced disease at diagnosis and thus cannot be offered potentially curative resection,ablation or liver transplantation.The main treatment for these patients remains chemoembolization,although evidence for selective internal radiation therapy(SIRT)with SIR-Spheres or Theraphere,is beginning to suggest that the results with this may be comparable with less toxicity.Patients who have failed chemoembolization or SIRT or have metastatic disease at presentation are suitable for the multikinase inhibitor sorafenib(nexavar)or newly-approved lenvatinib(lenvima)as first line therapies.The choice between which of them to use first is not currently clear.Patients who have failed sorafenib can be offered a choice of FDA-approved regorafenib(stivarga)or immune checkpoint inhibitor nivolumab(opdivo)as second line agents.For that considerable percent of patients presenting with macroscopic portal vein thrombosis,the choice appears to be between multikinase inhibitor or SIRT,given the potential toxicity of chemoembolization in this setting.However,considering the potency of both nivolumab and regorafenib and the pipeline of new agents such as atezolizumab(tecentriq)in current clinical trials,including new immune checkpoint inhibitors,this landscape may change within a couple of years,especially if new evidence arises for the superior effectiveness of combinations of any of these agents over single agents.
