Radiation Pneumonitis after Yttrium-90 Radioembolization: A Systematic Review.

IF 2.6 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of Vascular and Interventional Radiology Pub Date : 2024-10-18 DOI:10.1016/j.jvir.2024.08.031

Bela Kis, Marcell Gyano

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引用次数: 0

Abstract

Purpose: The guideline regarding the maximum tolerated lung dose for Yttrium-90 (Y90) radioembolization is an expert opinion (level 5 evidence) based on a case series of 5 patients and recommends keeping the absorbed radiation dose to the lungs below 30 Gy per treatment and 50 Gy in a lifetime to prevent radiation pneumonitis (RP). The current understanding of the risks of RP is minimal despite its debilitating nature and high mortality rate. This review evaluates the available evidence of lung dosimetry and RP.

Materials and methods: A systematic literature review was conducted in PubMed, Embase, Cochrane database, and Google Scholar for reported cases of RP. A database of 48 RP cases was compiled and analyzed.

Results: Thirty patients were treated with resin and 16 patients with glass Y90-microspheres. The treatment device was not reported in 2 cases. RP developed a median of 3 months after radioembolization. The mortality rate was 40%. The hepatopulmonary shunt was not significantly different between the glass and the resin group (21.2±14% vs. 15.6±7.5%, p=0.24). The radiation dose to the lungs was significantly higher in patients treated with glass compared to resin Y90-microspheres (41.4±18.4 Gy vs. 21.5±9.9 Gy, p=0.003).

Conclusions: The dose toxicity threshold for resin microspheres is lower than that of glass microspheres. The established 30 Gy dose limit may not be uniformly applicable in all cases and for both devices. The maximum tolerable lung doses should be re-evaluated and the shortcomings of the hepatopulmonary shunt calculation need to be corrected.

查看原文本刊更多论文

钇-90 放射栓塞术后的放射性肺炎：系统回顾。

目的：关于钇-90（Y90）放射栓塞术肺部最大耐受剂量的指南是专家根据 5 例患者的病例系列提出的意见（5 级证据），建议将肺部吸收的辐射剂量控制在每次治疗 30 Gy 以下，终生 50 Gy 以下，以预防放射性肺炎（RP）。尽管放射性肺炎会使人衰弱且死亡率较高，但目前对其风险的了解却微乎其微。本综述评估了肺剂量测定和 RP 的现有证据：在 PubMed、Embase、Cochrane 数据库和 Google Scholar 上对报告的 RP 病例进行了系统的文献综述。结果：30 名患者接受了树脂治疗，1 名患者接受了放射治疗：结果：30 名患者采用树脂治疗，16 名患者采用玻璃 Y90 微球治疗。2例患者未报告治疗设备。放射性栓塞术后中位 3 个月出现 RP。死亡率为 40%。玻璃组和树脂组的肝肺分流无明显差异（21.2±14% vs. 15.6±7.5%，P=0.24）。与树脂Y90微球相比，玻璃微球治疗患者肺部的辐射剂量明显更高（41.4±18.4 Gy vs. 21.5±9.9 Gy，p=0.003）：结论：树脂微球的剂量毒性阈值低于玻璃微球。既定的 30 Gy 剂量限值可能并不适用于所有病例和两种设备。应重新评估肺部可耐受的最大剂量，并纠正肝肺分流计算的缺陷。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular and Interventional Radiology 医学-核医学

CiteScore

4.30

自引率

10.30%

发文量

942

审稿时长

90 days

期刊介绍： JVIR, published continuously since 1990, is an international, monthly peer-reviewed interventional radiology journal. As the official journal of the Society of Interventional Radiology, JVIR is the peer-reviewed journal of choice for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians who seek current and reliable information on every aspect of vascular and interventional radiology. Each issue of JVIR covers critical and cutting-edge medical minimally invasive, clinical, basic research, radiological, pathological, and socioeconomic issues of importance to the field.