ABSTRACT
BACKGROUND: This paper describes the feasibility of intra-arterial high-activity administration of (188)Re-microspheres. METHODS: Patients with unresectable colorectal liver metastases or hepatocellular cancer (HCC) received single treatments with (188)Re-microspheres. The administered activity was calculated to give a liver dose of 100 Gy. From post-therapeutic scans and urine sampling, the dose to the liver, metastases and bladder was calculated. Toxicity was assessed up to 3 months after administration by means of the Common Terminology Criteria for Adverse Events v3.0 (Trotti et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 2003;13(3):176-81). Response was evaluated on CT. RESULTS: 13.6 +/- 4.7 GBq (188)Re-microspheres was administered selective in the feeding artery of the tumour to 10 patients (3 x HCC and 7 x colorectal liver metastases). There was a low urinary excretion rate of 8.9 +/- 3.8% of administered activity within 96 h. The absorbed dose to the tumour, normal liver (excluding the tumour) and bladder was 10.24 +/- 5.02 Gy/GBq (128 +/- 47 Gy), 3.94 +/- 2.52 Gy/GBq (50 +/- 33 Gy) and 0.27 +/- 0.20 Gy/GBq (2.4 +/- 1.9 Gy), respectively. There was an acceptable rate of toxicity in 30% of grades I and II, respectively, and 10% with grade III. There was reversible in the most patients within 14 days after treatment. The response was assessed on CT: two patients had a partial response (PR), five patients had stable disease and three patients had disease progression. CONCLUSION: Treatment of colorectal liver metastases or HCC using high activities of (188)Re-microspheres was well tolerated and a PR was seen in 2 of 10 patients. The treatment represents a therapeutic option in these patients.
Subject(s)
Carcinoma, Hepatocellular/radiotherapy , Colorectal Neoplasms/pathology , Embolization, Therapeutic , Liver Neoplasms/radiotherapy , Microspheres , Radioisotopes/therapeutic use , Rhenium/therapeutic use , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/metabolism , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/methods , Feasibility Studies , Female , Humans , Liver Neoplasms/metabolism , Liver Neoplasms/secondary , Male , Middle Aged , Radioisotopes/administration & dosage , Radioisotopes/adverse effects , Radiotherapy Planning, Computer-Assisted , Rhenium/administration & dosage , Rhenium/adverse effects , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Whenever the internal reorganization of hospitals demands the implementation of interdisciplinary healthcare concepts in terms of interdisciplinary competence centers, the structural conflicts caused by subordination of autonomous structural units into centralized functional entities will have to be considered and solved. The Dresden University Vascular Center is an example of an interdisciplinary medical center based on a statute setting up binding rules of standing cooperation. In this case, the positive effects of concentration have been utilized, while leaving all structural units involved autonomous. This requires strict separation and transparent allocation of responsibilities and continuous and committed efforts on management and operating levels as described in the statute. Of course, this kind of close collaboration cannot be prescribed but requires permanent commitment to the general objectives as laid down in the statute and their acceptance as personal work goals.