钇-90微球肝动脉放射栓塞在肝癌肝移植前降期治疗中的研究进展

摘要/Abstract

摘要： 对符合肝移植标准的肝癌患者,肝移植是一种有效的根治方案。然而大多数肝癌患者就诊时已超过肝移植的米兰标准,使得这部分患者难以从肝移植中受益。通过局部或全身治疗对肝癌进行降期,使患者的肿瘤负荷减轻,从而使超过肝移植标准的患者在治疗后能够达到移植标准,让更多的患者能够接受肝移植治疗。在众多降期治疗手段中,钇-⁹⁰微球肝动脉放射栓塞（或称选择性内放射治疗）具有用药剂量小、治疗次数少、较好的杀瘤效应以及相对较低的不良反应等优点。在此,本文将对钇-⁹⁰微球肝动脉放射栓塞基本技术、肝移植前降期治疗的必要性、钇-⁹⁰微球肝动脉放射栓塞在肝癌肝移植前降期治疗的疗效和安全性以及国内开展的情况进行综述。

关键词: 肝细胞肝癌, 肝移植, 钇-90微球肝动脉放射栓塞, 降期

Abstract: Patients with hepatocellular carcinoma who meet the requirements for liver transplantation can benefit from this treatment. The Milan standard for liver transplantation has been surpassed by the majority of hepatocellular carcinoma patients, making it challenging for them to benefit from this therapy. Hepatocellular carcinoma can be treated locally or systemically to lower its stage and patients' tumor loads, allowing more patients to qualify for liver transplantation therapy even if they now fall outside of the standard for transplant candidates. Radioembolization with ⁹⁰Y microspheres, one of the many downstaging phase treatment options, has the benefits of a small dosage and shorter treatment times, small volume targeted administration, a good tumor killing effect, and relatively low toxicity. This article will review the fundamentals of radioembolization using ⁹⁰Y microspheres, the need for downstaging prior to liver transplantation, the effectiveness and safety of radioembolization using ⁹⁰Y microspheres in downstaging prior to liver transplantation, and it's advancement in China.

Key words: Hepatocellular carcinoma, Liver transplantation, Radioembolization with 90Ymicrospheres, Downstaging

李开富, 凡军, 罗德, 苏松, 李波, 杨小李. 钇-⁹⁰微球肝动脉放射栓塞在肝癌肝移植前降期治疗中的研究进展[J]. 肝癌电子杂志, 2025, 12(3): 41-44.

Li Kaifu, Fan Jun, Luo De, Su Song, Li Bo, Yang Xiaoli. Research progress of radioembolization with ⁹⁰Y microspheres for hepatocellular carcinoma in downstaging before liver transplantation[J]. Electronic Journal of Liver Tumor, 2025, 12(3): 41-44.

参考文献 24

[1]	SUNG H, FERLAY J, SIEGEL R L, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J] . CA: Cancer J Clin, 2021, 71(3): 209-249.
[2]	中华人民共和国国家卫生健康委员会.原发性肝癌诊疗指南(2022年版)[J/CD] .肿瘤综合治疗电子杂志,2022,8(2):16-53.
[3]	GARIN E, ROLLAND Y, EDELINE J, et al.Personalized dosimetry with intensification using 90Y-loaded glass microsphere radioembolization induces prolonged overall survival in hepatocellular carcinoma patients with portal vein thrombosis[J] . J Nucl Med, 2015, 56(3): 339-346.
[4]	中国医师协会器官移植医师分会,中华医学会器官移植学分会肝移植学组.中国肝癌肝移植临床实践指南(2021版)[J] .中华消化外科杂志,2022,21(4):433-443.
[5]	SALEM R, THURSTON K G.Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: part 1: technical and methodologic considerations[J] . J Vasc Interv Radiol, 2006, 17(8): 1251-1278.
[6]	李家平,滕皋军.经肝动脉化疗栓塞术指南:规范化与个体化并举[J] .中华放射学杂志,2019(4):241-242.
[7]	MAZZAFERRO V, REGALIA E, DOCI R, et al.Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis[J] . N Engl J Med, 1996, 334(11): 693-700.
[8]	王建军,柴楚星,孙释然,等.肝癌肝移植前降期治疗的研究进展[J] .中华肝胆外科杂志,2021,27(4):305-309.
[9]	CHAPMAN W C, GARCIA-AROZ S, VACHHARAJANI N, et al.Liver transplantation for advanced hepatocellular carcinoma after downstaging without up-front stage restrictions[J] . J Am Coll Surg, 2017, 224(4): 610-621.
[10]	GABR A, KULIK L, MOULI S, et al.Liver transplantation following Yttrium‐90 radioembolization: 15‐year experience in 207‐patient cohort[J] . Hepatology, 2021, 73(3): 998-1010.
[11]	SANGRO B, IÑARRAIRAEGUI M, BILBAO J I. Radioembolization for hepatocellular carcinoma[J] . J hepatol, 2012, 56(2): 464-473.
[12]	LEWANDOWSKI R J, KULIK L M, RIAZ A, et al.A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization[J] . Am J Transplant, 2009, 9(8): 1920-1928.
[13]	ETTORRE G M, LEVI SANDRI G B, LAURENZI A, et al. Yttrium-90 radioembolization for hepatocellular carcinoma prior to liver transplantation[J] . World J Surg, 2017, 41(1): 241-249.
[14]	MEHTA N, FRENETTE C, TABRIZIAN P, et al.Downstaging outcomes for hepatocellular carcinoma: results from the multicenter evaluation of reduction in tumor size before liver transplantation (MERITS-LT) consortium[J] . Gastroenterology, 2021, 161(5): 1502-1512.
[15]	SALEM R, GORDON A C, MOULI S, et al.Y90 radioembolization significantly prolongs time to progression compared with chemoembolization in patients with hepatocellular carcinoma[J] . Gastroenterology, 2016, 151(6): 1155-1163.
[16]	GB L S, BERARDI G, GIANNELLI V, et al.Primary role of Radioembolization as a downstaging strategy in patients with macrovascular invasion prior to liver transplantation[J] . Transpl Int, 2020, 33(12): 1833-1834.
[17]	ASSALINO M, TERRAZ S, GRAT M, et al.Liver transplantation for hepatocellular carcinoma after successful treatment of macrovascular invasion-a multi‐center retrospective cohort study[J] . Transpl Int, 2020, 33(5): 567-575.
[18]	HSIEH T C, WU Y C, SUN S S, et al.Treating hepatocellular carcinoma with 90Y-bearing microspheres: a review[J] . Biomedicine, 2016, 6(4): 1-7.
[19]	KOLLIGS F T, BILBAO J I, JAKOBS T, et al.Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma[J] . Liver Int, 2015, 35(6): 1715-1721.
[20]	SALEM R, LEWANDOWSKI R J, KULIK L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma[J] . Gastroenterology, 2011, 140(2): 497-507. e2.
[21]	LABGAA I, TABRIZIAN P, TITANO J, et al.Feasibility and safety of liver transplantation or resection after transarterial radioembolization with Yttrium-90 for unresectable hepatocellular carcinoma[J] . HPB, 2019, 21(11): 1497-1504.
[22]	北京清华长庚医院牵头:中国首例特许准入钇(~(90)Y)树脂微球临床治疗肝癌项目成功实施[J] .中华医学信息导报,2021,36(20):19-19.
[23]	高洁,郑小北,王红亮,等.放射性治疗药物的发展现状与展望[J] .同位素,2022,35(3):151-163.
[24]	牛惠敏,王志恒,高石鑫,等.钇90放射性微球在肝脏恶性肿瘤中的应用及进展[J/CD] .肝癌电子杂志,2021,8(4):36-40.

钇-⁹⁰微球肝动脉放射栓塞在肝癌肝移植前降期治疗中的研究进展

Research progress of radioembolization with ⁹⁰Y microspheres for hepatocellular carcinoma in downstaging before liver transplantation

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 24

相关文章 15

编辑推荐

Metrics

本文评价

[1]	郑煜琳, 张莉莉, 郭会敏, 刘薪, 席双梅, 王超群, 谷艳梅, 井学敏. 运动干预对肝移植患者生活质量影响的Meta分析[J]. 肝癌电子杂志, 2025, 12(3): 30-35.
[2]	席双梅, 张莉莉, 谷艳梅, 郭会敏, 刘薪, 郑煜琳, 金伯旬, 栗光明. 肝移植患者术后早期疲劳发展轨迹研究[J]. 肝癌电子杂志, 2024, 11(2): 94-99.
[3]	栗光明. 免疫治疗用于肝癌肝移植术前治疗的研究进展[J]. 肝癌电子杂志, 2024, 11(1): 47-49.
[4]	魏炜, 崔臣, 刘秀连, 韩桂杰, 潘晶, 高艳平, 张晶晶, 王苑. 肝癌肝移植患者术后疲乏的现状调查及影响因素分析[J]. 肝癌电子杂志, 2022, 9(3): 22-26.
[5]	贺强, 周林. 构建以雷帕霉素为主预防肝癌肝移植术后肿瘤复发的综合防治体系[J]. 肝癌电子杂志, 2021, 8(3): 1-7.
[6]	姜涛, 潘飞, 陈晴, 黄金灿, 贺强, 郎韧. CYP3A5基因多态性指导肝细胞癌肝移植术后他克莫司个体化用药的临床研究[J]. 肝癌电子杂志, 2021, 8(3): 8-11.
[7]	谢炎, 张炜琪, 孙纪三, 蒋文涛. 超米兰标准肝癌肝移植术后肿瘤复发的综合治疗与局部治疗的疗效比较[J]. 肝癌电子杂志, 2021, 8(3): 12-16.
[8]	吕少诚, 郎韧. 肝移植技术在治疗转移性肝肿瘤中的研究现状[J]. 肝癌电子杂志, 2021, 8(3): 26-29.
[9]	熊俊, 万赤丹. 免疫调定点抑制剂在肝癌肝移植患者中的应用[J]. 肝癌电子杂志, 2021, 8(3): 30-34.
[10]	曹胤, 王忠夏, 江春平. 简单炎症相关指数在肝癌肝移植预后预测中的价值[J]. 肝癌电子杂志, 2021, 8(3): 35-40.
[11]	林鑫, 肖慜, 李启勇. 肝移植供肝体积评估的研究进展[J]. 肝癌电子杂志, 2021, 8(3): 41-45.
[12]	郑元文, 刘军. 肝癌肝移植术后预防复发的全程管理探讨[J]. 肝癌电子杂志, 2021, 8(3): 46-50.
[13]	李卓, 姜涛, 郎韧, 王苑. 1例胰腺神经内分泌肿瘤肝转移患者肝移植术后护理策略[J]. 肝癌电子杂志, 2021, 8(3): 59-61.
[14]	郑宣, 姜涛, 郞韧, 王维虎. 巨块型肝细胞癌合并门脉癌栓TACE联合放疗降期后肝移植长期生存1例[J]. 肝癌电子杂志, 2021, 8(3): 62-64.
[15]	商福超, 王孟龙. 小肝癌根治性治疗的现状及进展[J]. 肝癌电子杂志, 2020, 7(4): 9-12.