树脂与玻璃钇90微球在肝细胞癌治疗中的比较：疗效、安全性与技术考量

Comparison of Resin versus Glass Yttrium-90 Microspheres in the Treatment of Hepatocellular Carcinoma: Efficacy, Safety, and Technical Considerations

摘要: 肝细胞癌(HCC)是全球高发的恶性肿瘤，多数患者确诊时已处于中晚期，亟需更有效的局部治疗手段。选择性内放射治疗(SIRT)通过肝动脉输送载有钇-90 (Y-90)的微球，实现对肿瘤的高剂量内照射。目前临床广泛应用的两类微球——树脂微球(SIR-Spheres)与玻璃微球(TheraSphere)，在物理特性、剂量分布、技术工艺及临床疗效上存在显著差异。本文系统比较了两种微球在HCC治疗中的疗效、安全性及技术考量。物理特性方面，树脂微球多孔、密度较低，处方活性较低；玻璃微球结构致密、比活度高，可实现更高的肿瘤吸收剂量。临床疗效方面，两者在客观缓解率与疾病控制率上总体可比，但在特定亚组中存在分化：大肿瘤(≥5 cm)患者可能更受益于树脂微球，而合并门静脉癌栓者使用玻璃微球显示出更长的总生存期和更低毒性。安全性方面，树脂微球术后栓塞综合征更常见，放射性肝损伤风险与非肿瘤肝组织剂量相关；玻璃微球因沉积更稳定，非靶向播散风险较低。剂量学研究表明，分区模型较传统体表面积法具有更优的生存预测效能，且术前99mTc-MAA显像与实际微球分布存在偏差，需结合术后成像验证。针对特殊人群，门静脉癌栓与大肿瘤患者需个体化选择微球类型与剂量策略。当前研究仍面临微球异质性影响临床试验可比性、成本效益分析缺失等问题。未来应推动生物标志物指导的精准选择及人工智能辅助剂量优化。综上，树脂与玻璃Y-90微球在HCC治疗中各有优势，临床决策应基于肿瘤负荷、肝功能、门静脉状态及治疗目标，通过多学科团队协作实现个体化治疗。

Abstract: Hepatocellular Carcinoma (HCC) is a highly prevalent malignancy worldwide, with most patients diagnosed at intermediate to advanced stages, underscoring the urgent need for more effective locoregional therapies. Selective Internal Radiation Therapy (SIRT) delivers Yttrium-90 (Y-90)-loaded microspheres via the hepatic artery, enabling high-dose internal irradiation of tumors. The two clinically available microsphere types—resin (SIR-Spheres) and glass (TheraSphere)—exhibit substantial differences in physical properties, dosimetric distribution, manufacturing techniques, and clinical outcomes. This review systematically compares the efficacy, safety, and technical considerations of resin versus glass Y-90 microspheres in HCC treatment. Regarding physical characteristics, resin microspheres are porous with lower density and prescribed activity, whereas glass microspheres possess a dense structure, higher specific activity, and achieve greater tumor-absorbed doses. In terms of clinical efficacy, objective response rates and disease control rates are generally comparable; however, subgroup analyses reveal differential outcomes: resin microspheres may confer superior survival benefits in patients with large tumors (≥5 cm), while glass microspheres demonstrate prolonged overall survival and reduced toxicity in those with portal vein tumor thrombosis. Safety profiles differ, with resin microspheres associated with a higher incidence of post-embolization syndrome and radiation-induced liver disease correlated with non-tumoral liver dose; glass microspheres exhibit more stable deposition and lower risk of non-target embolization. Dosimetric evidence supports the superiority of partition model over traditional body surface area method for survival prediction, and discrepancies between pre-treatment 99mTc-MAA imaging and actual microsphere distribution necessitate post-procedural verification. For special populations, including patients with portal vein invasion or large tumors, individualized selection of microsphere type and dosing strategy is essential. Current challenges include microsphere heterogeneity confounding trial comparability and a paucity of cost-effectiveness analyses. Future directions emphasize biomarker-guided precision selection and artificial intelligence-assisted dosimetry optimization. In conclusion, resin and glass Y-90 microspheres offer distinct advantages in HCC management; clinical decision-making should integrate tumor burden, liver function, portal vein status, and therapeutic goals within a multidisciplinary framework to achieve personalized treatment.