0 avis
Nuclear Medicine Therapy in primary liver cancers
Archive ouverte
International audience. Primary liver cancer, hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), are tumors of poor prognosis where treatment is frequently challenging, especially for inoperable tumors (the majority of the cases). Selective internal radiation therapy (SIRT), mainly using radioactive microspheres, can treat both kinds of tumors. The treatment is provided by injection directly in the hepatic artery, after a treatment simulation to carefully select a suitable candidate. SIRT can be used with good clinical outcomes in several clinical situations, for patients who are not candidates to receive surgery due to general conditions or prior to surgery to facilitate surgery, retracting the tumor from the main vessels or inducing untreated liver hypertrophy to reduce the risk of postoperative liver failure. In a palliative setting, when compared to transarterial chemoembolization (TACE), SIRT provided better results, especially regarding response rates of around 90% with SIRT in comparison to less than 60% with TACE. In well-selected nonoperable patients, SIRT can downstage them to surgery, and then offer a potential curative approach in up to 30% of the patients with unilobar involvement, including patients with portal vein thrombosis, one of the poorest prognosis indicators recognized. SIRT requires a multidisciplinary approach both for the selection of good candidates as well as for the treatment simulation and the treatment itself, where a close collaboration is required between the interventional radiology team and the nuclear medicine team. Recent developments in dosimetry have brought huge improvements in outcomes, especially for HCC where overall survival is more than doubled when using a personalized dosimetry approach in comparison to a standard (i.e., nontailored) dosimetry approach. Based on this evolution, new trials are warranted to better define the role of SIRT using personalized dosimetry in the therapeutic strategy of primary liver disease. © 2022 Elsevier Inc. All rights reserved.
Consulter en ligne
Suggestions
Du même auteur
