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Páramo M, Santamaría E, Idoate MA, Rodríguez-Fraile M, Benito A, Collantes M, Quincoces G, Peñuelas I, Berasain C, Argemi J, Quiroga J, Sangro B, Bilbao JI, Iñarrairaegui M. A new animal model of atrophy-hypertrophy complex and liver damage following Yttrium-90 lobar selective internal radiation therapy in rabbits. Sci Rep 2022; 12:1777. [PMID: 35110610 PMCID: PMC8810801 DOI: 10.1038/s41598-022-05672-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Lobar selective internal radiation therapy (SIRT) is widely used to treat liver tumors inducing atrophy of the treated lobe and contralateral hypertrophy. The lack of animal model has precluded further investigations to improve this treatment. We developed an animal model of liver damage and atrophy–hypertrophy complex after SIRT. Three groups of 5–8 rabbits received transportal SIRT with Yttrium 90 resin microspheres of the cranial lobes with different activities (0.3, 0.6 and 1.2 GBq), corresponding to predicted absorbed radiation dose of 200, 400 and 800 Gy, respectively. Another group received non-loaded microspheres (sham group). Cranial and caudal lobes volumes were assessed using CT volumetry before, 15 and 30 days after SIRT. Liver biochemistry, histopathology and gene expression were evaluated. Four untreated rabbits were used as controls for gene expression studies. All animals receiving 1.2 GBq were euthanized due to clinical deterioration. Cranial SIRT with 0.6 GBq induced caudal lobe hypertrophy after 15 days (median increase 34% -ns-) but produced significant toxicity. Cranial SIRT with 0.3 GBq induced caudal lobe hypertrophy after 30 days (median increase 82%, p = 0.04). No volumetric changes were detected in sham group. Transient increase in serum transaminases was detected in all treated groups returning to normal values at 15 days. There was dose-dependent liver dysfunction with bilirubin elevation and albumin decrease. Histologically, 1.2 GBq group developed permanent severe liver damage with massive necrosis, 0.6 and 0.3 GBq groups developed moderate damage with inflammation and portal fibrosis at 15 days, partially recovering at 30 days. There was no difference in the expression of hepatocyte function and differentiation genes between 0.3 GBq and control groups. Cranial SIRT with 0.3 GBq of 90Y resin microspheres in rabbits is a reliable animal model to analyse the atrophy–hypertrophy complex and liver damage without toxicity.
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Affiliation(s)
- María Páramo
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Eva Santamaría
- Hepatology Program, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel A Idoate
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain
| | - Alberto Benito
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain
| | - Maria Collantes
- Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain.,Radiopharmacy, Radionanopharmacology and Translational Molecular Imaging Research Group, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gemma Quincoces
- Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain.,Radiopharmacy, Radionanopharmacology and Translational Molecular Imaging Research Group, Clínica Universidad de Navarra, Pamplona, Spain.,Radiopharmacy Unit, Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Iván Peñuelas
- Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain.,Radiopharmacy, Radionanopharmacology and Translational Molecular Imaging Research Group, Clínica Universidad de Navarra, Pamplona, Spain.,Radiopharmacy Unit, Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carmen Berasain
- Hepatology Program, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain
| | - Josepmaria Argemi
- Hepatology Program, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jorge Quiroga
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain.,Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain
| | - Bruno Sangro
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain.,Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain
| | - José I Bilbao
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain
| | - Mercedes Iñarrairaegui
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. .,Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain. .,Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.
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Salem R, Hunter RD. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma: a review. Int J Radiat Oncol Biol Phys 2006; 66:S83-8. [PMID: 16979447 DOI: 10.1016/j.ijrobp.2006.02.061] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Revised: 02/26/2006] [Accepted: 02/27/2006] [Indexed: 12/27/2022]
Abstract
To present a critical review of yttrium-90 (TheraSphere) for the treatment of hepatocellular carcinoma (HCC). Medical literature databases (Medline, Cochrane Library, and CANCERLIT) were searched for available literature concerning the treatment of HCC with TheraSphere. These publications were reviewed for scientific and clinical validity. Studies pertaining to the use of yttrium-90 for HCC date back to the 1960s. The results from the early animal safety studies established a radiation exposure range of 50-100 Gy to be used in human studies. Phase I dose escalation studies followed, which were instrumental in delineating radiation dosimetry and safety parameters in humans. These early studies emphasized the importance of differential arteriolar density between hypervascular HCC and surrounding liver parenchyma. Current trends in research have focused on advancing techniques to safely implement this technology as an alternative to traditional methods of treating unresectable HCC, such as external beam radiotherapy, conformal beam radiotherapy, ethanol ablation, trans-arterial chemoembolization, and radiofrequency ablation. Yttrium-90 (TheraSphere) is an outpatient treatment option for HCC. Current and future research should focus on implementing multicenter phase II and III trials comparing TheraSphere with other therapies for HCC.
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Affiliation(s)
- Riad Salem
- Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA.
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Kawashita M, Shineha R, Kim HM, Kokubo T, Inoue Y, Araki N, Nagata Y, Hiraoka M, Sawada Y. Preparation of ceramic microspheres for in situ radiotherapy of deep-seated cancer. Biomaterials 2003; 24:2955-63. [PMID: 12742735 DOI: 10.1016/s0142-9612(03)00094-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Radiotherapy is one of the most effective treatments for cancers. However, external irradiation provides only small doses to deep-seated cancers, and often causes damage to healthy tissues. It has been reported that 20-30 microm diameter 17Y(2)O(3)-19Al(2)O(3)-64SiO(2) (mol%) glass microspheres are useful for the in situ irradiation of cancers. Yttrium-89 (89Y) in this glass can be neutron bombarded to form the beta-emitter 90Y (half-life=64.1h). When injected in the vicinity of the cancer, such activated glass microspheres can provide a large localized dose of beta-radiation. The Y(2)O(3) content of the glass in the microspheres is limited to only 17 mol%. Chemically durable microspheres with a higher Y(2)O(3) content need to be developed. Phosphorus-31 (31P) with 100% natural abundance can also be activated by neutron bombardment to form the beta-emitter 32P (half-life=14.3d). Chemically durable microspheres containing a high phosphorus content are expected to be more effective for cancer treatment. We prepared pure Y(2)O(3) and YPO(4) microspheres using a high-frequency induction thermal plasma melting technique, and investigated the resulting structure and chemical durability. We successfully prepared smooth, highly spherical polycrystalline Y(2)O(3) and YPO(4) microspheres with diameters in the range 20-30 microm. Both the Y(2)O(3) and YPO(4) microspheres showed high chemical durability in saline solutions buffered at pH=6 and 7. These microspheres are expected to be more effective than the conventional glass microspheres for the in situ radiotherapy of cancer.
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Affiliation(s)
- Masakasu Kawashita
- Department of Material Chemistry, Graduate School of Engineering, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan.
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Yan ZP, Lin G, Zhao HY, Dong YH. An experimental study and clinical pilot trials on yttrium-90 glass microspheres through the hepatic artery for treatment of primary liver cancer. Cancer 1993; 72:3210-5. [PMID: 8242543 DOI: 10.1002/1097-0142(19931201)72:11<3210::aid-cncr2820721113>3.0.co;2-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Yttrium-90 (90-Y) glass microsphere is a new kind of radiation microsphere for internal radiation therapy of primary liver cancer (PLC). The study was carried out by administration of 35 microns nondegradable 90-Y glass microsphere through the hepatic artery for treatment of PLC. METHODS Six rabbits were injected with 185-1480 megabecquerels (MBq) of 90-Y glass microspheres, and three rabbits were injected with 35-300 mg of 89-Y glass microspheres for the toxic test. Eighteen patients received 2442-5550 MBq of 90-Y glass microspheres for the treatment of PLC. Whole blood counts, liver function, and imaging examination were performed. Pathologic examinations were performed on all rabbits. RESULTS All rabbits were apparently well after absorbing 114.1-845.2 Gy 90-Y glass microspheres in the liver but showed transient degeneration of hepatocytes and portal fibrosis histologically. The mean absorbed dose in liver tissue of patients with PLC was 30.33 Gy, whereas that in tumor tissue was 88 Gy and the highest in tumor tissue, 186.36 Gy. The mean tumor:liver tissue ratio was 3:1; the highest, 14:1. Fourteen patients were still alive after half a year's follow-up and 6 of these 14 were still alive after 1 year. CONCLUSIONS The rabbits could tolerate up to eight-fold of the upper limit of clinical dose (100 Gy). Good responses to the radiation therapy of 90-Y glass microspheres in patients with localized and hypervascular or vascular mass were achieved. Contraindications for the therapy were presence of massive hepatic arterioportal shunt and cancer emboli in the main portal vein. It is safe and applicable to deliver 90-Y glass microspheres in large doses through the hepatic artery for internal radiation treatment of PLC.
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Affiliation(s)
- Z P Yan
- Department of Radiology, Zhong Shan Hospital, Shanghai Medical University, China
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