Zusammenfassung
Die selektive interne Radiotherapie (SIRT, Radioembolisation) wird zur Behandlung
von primären und sekundären Lebertumoren eingesetzt. Derzeit wird diese innovative
Therapieform (außerhalb von Studien) empfohlen, wenn die Lebererkrankung unter etablierten
Therapiekonzepten weiter fortschreitet oder diese Therapien aufgrund intolerabler
Toxizitäten vorzeitig abgebrochen werden müssen. Bei der Radioembolisation werden
Mikrosphären, die Betastrahlen emittierendes Yttrium-90 enthalten, über einen transarteriellen
Zugangsweg superselektiv in die Leberarterien injiziert. Die Mikrosphären sammeln
sich in präkapillären Gefäßen in und um das Tumorgewebe an. Hier entfalten die Betastrahlen
aufgrund ihrer geringen Penetrationstiefe von durchschnittlich 2,5 mm ihre lokale,
strahlentherapeutische Wirkung unter Schonung des umgebenden, gesunden Leberparenchyms.
Abstract
Selective Internal Radiation Therapy (SIRT, Radioembolization) is used for the treatment
of primary and secondary liver tumors. Currently, the treatment is performed when
under classical and well established treatment concepts a tumor progression is detected
or when the treatment has to be abandoned due to toxic effects. Microspheres are labelled
with the beta-emitting isotope 90Yttrium and are infused into the hepatic arteries
resulting in very high doses of radiation being selectively targeted to tumours via
their arterial blood supply. The beta radiation of 90Yttrium has an average penetration in soft tissue of approximately 2,5 mm und therefore
provides high doses of radiation delivered to the tumor without harming the surrounding,
healthy liver parenchyma.
Keywords
Radioembolization, 90Yttrium, liver metastases, colorectal cancer, hepatocellular carcinoma
Kernaussagen
-
Die Radioembolisation ist eine Methode zur gezielten Behandlung von primären und sekundären
Lebertumoren.
-
Bei der Radioembolisation/SIRT (selektive interne Radiotherapie) werden mit einem
Betastrahler beladene Mikrosphären über einen transarteriellen Zugangsweg selektiv
in die Äste der A. hepatica eingebracht.
-
Gegenwärtig wird diese palliative Therapieform eingesetzt, wenn chirurgische oder
andere lokal ablative Maßnahmen nicht möglich sind bzw. unter Standardchemotherapiekonzepten
eine Progression der Lebermetastasen aufgetreten ist.
-
Bislang wird die SIRT bei Patienten eingesetzt, bei denen keine andere Therapieoption
mehr besteht. Daher sind nun Studien nötig, um zu definieren, ob die Radioembolisation
zu einem früheren Zeitpunkt der Erkrankung eingesetzt werden kann und welche Patienten
besonders von der Radioembolisation als Therapieoption profitieren.
Literatur
- 1
Leung T W, Lau W Y, Ho S K.
Radiation pneumonitis after selective internal radiation treatment with intraarterial
90yttrium-microspheres for inoperable hepatic tumors.
Int J Radiat Oncol Biol Phys.
1995;
33
919-924
- 2
Liu D M, Salem R, Bui J T et al.
Angiographic considerations in patients undergoing liver-directed therapy.
J Vasc Interv Radiol.
2005;
16
911-935
- 3
Dancey J E, Shepherd F A, Paul K et al.
Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres.
J Nucl Med.
2000;
41
1673-1681
- 4
Salem R, Thurston K G, Carr B I et al.
Yttrium-90 microspheres: radiation therapy for unresectable liver cancer.
J Vasc Interv Radiol.
2002;
13
223-229
- 5
Goin J E, Salem R, Carr B I et al.
Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres:
factors associated with liver toxicities.
J Vasc Interv Radiol.
2005;
16
205-213
- 6
Ho S, Lau W Y, Leung T W et al.
Clinical evaluation of the partition model for estimating radiation doses from yttrium-90
microspheres in the treatment of hepatic cancer.
Eur J Nucl Med.
1997;
24
293-298
- 7
Golfinopoulos V, Salanti G, Pavlidis N, Ioannidis J P.
Survival and disease-progression benefits with treatment regimens for advanced colorectal
cancer: a meta-analysis.
Lancet Oncol.
2007;
8
898-911
- 8
Nordlinger B, Sorbye H, Glimelius B et al.
Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable
liver metastases from colorectal cancer (EORTC Intergroup trial 40 983): a randomised
controlled trial.
Lancet.
2008;
371
1007-1016
- 9
Grothey A, Sugrue M M, Purdie D M et al.
Bevacizumab beyond first progression is associated with prolonged overall survival
in metastatic colorectal cancer: results from a large observational cohort study (BRiTE).
J Clin Oncol.
2008;
26
5326-5334
- 10
Tol J, Koopman M, Cats A et al.
Chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer.
N Engl J Med.
2009;
360
563-572
- 11
Cianni R, Urigo C, Notarianni E et al.
Selective internal radiation therapy with SIR-spheres for the treatment of unresectable
colorectal hepatic metastases.
Cardiovasc Intervent Radiol.
2009;
32
1179-1186
- 12
Kennedy A S, Coldwell D, Nutting C et al.
Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases:
modern USA experience.
Int J Radiat Oncol Biol Phys.
2006;
65
412-425
- 13
Jakobs T F, Hoffmann R T, Dehm K et al.
Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer
liver metastases.
J Vasc Interv Radiol.
2008;
19
1187-1195
- 14
Jakobs T F, Hoffmann R T, Tatsch K et al.
Therapy response of liver tumors after selective internal radiation therapy.
Radiologe.
2008;
48(9)
839-849
- 15
Hendlisz A, Van den Eynde M, Peeters M et al.
Phase III trial comparing protracted intravenous fluorouracil infusion alone or with
yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal
cancer refractory to standard chemotherapy.
J Clin Oncol.
2010;
28
3687-3694
- 16
Cosimelli M, Golfieri R, Cagol P P et al.
Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable,
chemotherapy refractory colorectal liver metastases.
Br J Cancer.
2010;
103
324-331
- 17
Van den Eynde M, Flamen P, El N et al.
Inducing resectability of chemotherapy refractory colorectal liver metastasis by radioembolization
with yttrium-90 microspheres.
Clin Nucl Med.
2008;
33
697-699
- 18
Gray B, Van Hazel G, Hope M et al.
Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating
patients with liver metastases from primary large bowel cancer.
Ann Oncol.
2001;
12
1711-1720
- 19
Van Hazel G, Blackwell A, Anderson J et al.
Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy
versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer.
J Surg Oncol.
2004;
88
78-85
- 20
Sharma R A, Van Hazel G A, Morgan B et al.
Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres
with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy.
J Clin Oncol.
2007;
25
1099-1106
- 21
Van Hazel G A, Pavlakis N, Goldstein D et al.
Treatment of fluorouracil-refractory patients with liver metastases from colorectal
cancer by using yttrium-90 resin microspheres plus concomitant systemic irinotecan
chemotherapy.
J Clin Oncol.
2009;
27
4089-4095
- 22
Lim L, Gibbs P, Yip D et al.
Prospective study of treatment with selective internal radiation therapy spheres in
patients with unresectable primary or secondary hepatic malignancies.
Intern Med J.
2005;
35
222-227
- 23
Jakobs T F, Hoffman R T, Dehm K et al.
Regional 90Yttrium Micropshere Treatment of Chemorefractory Colorectal Cancer Liver
Metastases.
submitted.
2008;
19(8)
1187-1195
- 24
Ricke J, Rühl R, Seidensticker M et al.
Safety and efficacy of 90Y microsphere therapy in patients with extensive liver-dominant
colorectal (CRC) metastases failing multiple lines of systemic chemotherapy: a matched-pair
analysis.
Ann Oncol.
2009;
20(suppl 6)
Abs PD-002
- 25
Hendlisz A, Van den Eynde M, Peeters M et al.
Phase III trial comparing protracted intravenous fluorouracil infusion alone or with
yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal
cancer refractory to standard chemotherapy.
J Clin Oncol.
2010;
28
3687-3694
- 26
Bruix J, Llovet J M, Castells A et al.
Transarterial embolization versus symptomatic treatment in patients with advanced
hepatocellular carcinoma: results of a randomized, controlled trial in a single institution.
Hepatology.
1998;
27
1578-1583
- 27
Llovet J M, Real M I, Montana X et al.
Arterial embolisation or chemoembolisation versus symptomatic treatment in patients
with unresectable hepatocellular carcinoma: a randomised controlled trial.
Lancet.
2002;
359
1734-1739
- 28
Llovet J M, Burroughs A, Bruix J.
Hepatocellular carcinoma.
Lancet.
2003;
362
1907-1917
- 29
Ho S, Lau J W, Leung T W.
Intrahepatic (90)Y-microspheres for hepatocellular carcinoma.
J Nucl Med.
2001;
42
1587-1589
- 30
Lau W Y, Ho S, Leung T W et al.
Selective internal radiation therapy for nonresectable hepatocellular carcinoma with
intraarterial infusion of 90yttrium microspheres.
Int J Radiat Oncol Biol Phys.
1998;
40
583-592
- 31
Salem R, Lewandowski R J, Atassi B et al.
Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere):
safety, tumor response, and survival.
J Vasc Interv Radiol.
2005;
16
1627-1639
- 32
Sangro B, Bilbao J I, Boan J et al.
Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular
carcinoma.
Int J Radiat Oncol Biol Phys.
2006;
66
792-800
- 33
Llovet J M et al.
The Barcelona approach: Diagnosis, staging, and treatment of hepatocellular carcinoma.
Liver Transplantation.
2004;
10 (Suppl 1)
S115-S120
- 34
Kulik L M, Atassi B, van Holsbeeck L et al.
Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma:
downstaging to resection, RFA and bridge to transplantation.
J Surg Oncol.
2006;
94
572-586
- 35
Salem R, Lewandowski R, Roberts C et al.
Use of Yttrium-90 glass microspheres (TheraSphere) for the treatment of unresectable
hepatocellular carcinoma in patients with portal vein thrombosis.
J Vasc Interv Radiol.
2004;
15
335-345
- 36
Salem R, Lewandowski R J, Mulcahy M F et al.
Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive
report of long-term outcomes.
Gastroenterology.
2010;
138
52-64
- 37 Sangro B, Carpanese L, Cianni R et al. European multicenter evaluation of survival
for patients with HCC treated by radioembolization [RE] with 90Y-labelled resin microspheres..
ASCO Gastrointestinal Cancer Symposium. 2010. Abstract
- 38
Kulik L M, Carr B I, Mulcahy M F et al.
Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without
portal vein thrombosis.
Hepatology.
2008;
47
71-81
- 39
Carr B I.
Hepatic arterial 90Yttrium glass microspheres (Therasphere) for unresectable hepatocellular
carcinoma: interim safety and survival data on 65 patients.
Liver Transpl.
2004;
10
107-110
- 40
Geschwind J F, Salem R, Carr B I et al.
Yttrium-90 microspheres for the treatment of hepatocellular carcinoma.
Gastroenterology.
2004;
127
194-205
- 41
Lau W Y, Leung W T, Ho S et al.
Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90
microspheres: a phase I and II study.
Br J Cancer.
1994;
70
994-999
- 42
Jakobs T F, Hoffmann R T, Tatsch K et al.
Developments and perspectives in radioablative techniques.
Radiologe.
2007;
47(12)
1083-1088
Priv.-Doz. Dr. med. Tobias F. Jakobs
Geschäftsführender Chefarzt Radiologie
Krankenhaus Barmherzige Brüder München
Romanstraße 93
80639 München
Phone: 089 1797-2828
Fax: 089 1797-2830
Email: tobias.jakobs@barmherzige-muenchen.de
