Facing the three checklists in front of him, 44-year-old Lin Yunsheng cried for 15 minutes. This Hainan farmer, suffering from liver cancer, felt the power of advancement in medical technology for the first time. Although he still doesn't quite understand what "glass microspheres

Looking at the three checklists in front of him, 44-year-old Lin Yunsheng cried for 15 minutes.

This Hainan farmer, who was suffering from liver cancer, felt the power of advancement in medical technology for the first time. Although he still doesn't quite understand what "glass microspheres" are, one month after it was injected into his body, the diameter of his liver tumor shrank from 4 cm before surgery to 1.8 cm, and it completely lost its activity. .

Lin Yunsheng is a patient with liver cancer. To be more precise, he is a patient with late-stage liver cancer recurrence. At the beginning of last year, he was diagnosed with liver cancer for the first time. Because the tumor was not large and had not spread or metastasized, he underwent surgery to remove the primary lesion at the Hainan Provincial Cancer Hospital. One year after the surgery, in March this year, a new tumor grew on the edge of Lin Yunsheng’s liver where he had been resected, indicating that the liver cancer had recurred.

The high recurrence rate has always been the main factor affecting the prognosis of liver cancer. Studies have shown that the probability of liver cancer recurrence within one year after surgery is close to 50%, and the probability of recurrence within five years reaches 70%. Recurrence, resection, recurrence, and re-resection are the clinically preferred options. But this time, Lin Yunsheng hesitated.

Lin Yunsheng is not a Hainan farmer in the traditional sense. He usually does odd jobs to support his family. He does manual labor and cannot earn more than 10,000 yuan a year. He has three children, his youngest daughter is still in kindergarten, and his family of five lives in a temporary house built by the government. During the first surgery, the family was patched together and had tens of thousands of dollars in foreign debt. They thought that when he recovered, he would be able to support the family again.

's short-term relapse completely shattered this fragile family. In order to no longer burden his family, Lin Yunsheng refused to accept the surgical plan anyway. The hospital had no choice but to transfer him to the interventional department, where they planned to perform minimally invasive liver interventional embolization surgery. This treatment is not expensive and will not cause much damage to the body, but it is also difficult to control the growth of tumors. It is a palliative solution.

Coincidentally, on the second day after Lin Yunsheng was transferred to the interventional department, a piece of news spread like wildfire in the Hainan Provincial Cancer Hospital - the world's first radioactive glass microsphere system (hereinafter referred to as "Y90 glass microsphere") was obtained The Hainan Provincial Food and Drug Administration has approved that it can be used in the treatment of liver malignant tumors in Boao Super Hospital, and there is a charity fund to provide financial assistance to the first batch of treated patients.

This may be the luckiest thing that happened to Lin Yunsheng in his life. Because he met all the conditions and was a subsistence household, Lin Yunsheng was selected to become the first batch of patients in China to receive Y90 glass microsphere treatment.

△The first batch of Y90 glass microsphere clinical application ethics application

Nuclear weapons for reversing liver cancer

Before talking about Y90 glass microspheres, we must first understand what Y90 microsphere therapy is.

In essence, Y90 microsphere therapy belongs to radiotherapy, which uses high-energy radiation to achieve the effect of killing tumor cells. The difference is that traditional radiotherapy relies on large medical linear accelerators to irradiate human tumor tissue from outside the body. Y90 microsphere therapy transports radioactive substances to the vicinity of tumors through vascular intervention, killing tumor tissue at close range from the human body. Since this radioactive substance is called Y90 and its individual size is between 20-60 microns, this therapy is called Y90 microsphere therapy.

As early as 1999, Y90 microsphere therapy was approved for marketing in the United States for the treatment of unresectable liver cancer. Since then, this therapy has been approved for marketing in many countries in the European Union, North America, and Asia, but its indications have never left liver tumors. This is related to the physiological characteristics of the liver. Once a tumor grows in the liver, the tumor will draw nutrients from the blood supply of hepatic artery , while healthy liver tissue obtains blood through portal vein .This also means that when the hepatic artery is used as a channel for transporting Y90, radioactive substances will hardly damage other normal tissues of the human body and will only accurately attack tumor cells.

△ Schematic diagram of Y90 glass microspheres

Over the past 20 years, Y90 microsphere therapy has differentiated into two forms: glass microspheres and resin microspheres. In February this year, Y90 resin microspheres were approved for marketing in China and are suitable for patients with colorectal cancer liver metastasis. Three months later, the glass microspheres were introduced by the interventional surgery team of Hainan Provincial Cancer Hospital and were approved for "pilot trial" in the Hainan Medical Pilot Zone. The indications include primary liver cancer and metastatic liver cancer, and the coverage has been further expanded.

Director Niu Huimin of the Interventional Department of Hainan Provincial Cancer Hospital is Lin Yunsheng’s attending physician. Since 2016, he has been committed to the introduction of yttrium-90 glass microspheres by taking advantage of the pilot policy of Hainan Medical Pilot Zone. After the news came, Niu Huimin immediately thought of this unfortunate patient. "We have carefully evaluated the patient's condition. His tumor size and body parameters are in line with the treatment indications for Y90 glass microspheres. Traditional interventional embolization can only prolong his survival, but Y90 glass microspheres are likely to make him The difference between obtaining clinical cure of and is huge. "

Compared with Y90 resin microspheres, the biggest advantage of Y90 glass microspheres is that they have greater activity and higher treatment efficiency. Generally speaking, a glass microsphere contains about 2500Bq of energy, which is more than 50 times that of resin microspheres. This means that if you want to achieve the same therapeutic effect, the number of injected glass microspheres must be much smaller than that of resin microspheres. For patients, this can reduce the risk of complications ; for doctors, the operation will be safer.

For Lin Yunsheng, receiving Y90 glass microsphere treatment is also the most "economical" option. First of all, with the cost assistance from the charity fund, he only needs to bear the cost of some basic examinations and hospitalization, and these are within the scope of medical insurance reimbursement. Secondly, Y90 glass microspheres are only a minimally invasive surgery. He can go down to the ground on the same day of the surgery. The recovery period is very short, and he can take up the family again as quickly as possible.

International samples of precision diagnosis and treatment

May 24 was the day of Lin Yunsheng’s surgery.

According to the hospital's surgical records, the operation officially started at 10:30 a.m.; at 11:09, a microcatheter was inserted into the blood supply artery of the patient's liver tumor , and glass microspheres were injected; the injection was completed at 11:14. The patient remained awake throughout the operation, his vital signs were stable, and there were no adverse reactions.

A minimally invasive surgery that took 44 minutes can definitely be called a "quick solution", but few people know how complex and sophisticated a systematic project is behind it.

△Niu Huimin during the operation

The battle started at the Hainan Provincial Cancer Hospital half a month before the operation.

There, Lin Yunsheng first had to undergo a series of examinations including ultrasound CT, blood tests, liver function indicators and tumor marker . The results of these examinations determined whether he could receive Y90 glass microsphere treatment. Immediately afterwards, he had to undergo an interventional surgery. The doctor punctured the femoral artery to find the blood supply artery of his liver tumor and the abnormal shunt blood vessels, and performed embolization. Then, a three-dimensional image of the tumor is obtained through CBCT scanning, and the ratio of drug perfusion into the tumor and normal tissue is obtained. Finally, technetium-99 is injected into the blood vessel, and the Y90 dose required for infusion is measured by the nuclear medicine device SPECT-CT.

Things are not over yet. Since the manufacturer of Y90 glass microspheres is located in Canada, and when transported from Canada to Hainan, the drug itself will experience a decay period. This requires the hospital to determine the operation time in advance and work backwards based on the attenuation rate to calculate the dosage of product that needs to be ordered from the manufacturer.Taking Lin Yunsheng's surgery as an example, the dose of Y90 glass microspheres he required was 1.27GBq, and the hospital finally ordered a dose of 12GBq.

All the above preoperative preparations account for more than 80% of the entire Y90 glass microsphere treatment, and they are also the essence of this personalized and precise diagnosis and treatment method.

"It is equivalent to saying that before the formal operation, we have done a real-life scenario rehearsal in advance. When to operate, which blood vessel to enter through, and how many doses of glass microspheres to inject are all determined in advance. For example For example, if the scheduled operation time is 10 o'clock, it must not be postponed to 11 o'clock, because the drug itself is attenuating, and any change in factors will affect the effect of the operation," Niu Huimin said.

is more than just one more project

Back to the beginning of the story.

The reexamination results one month later showed that Lin Yunsheng’s tumor size had shrunk from 4 cm in diameter to 1.82 cm, and had completely lost its activity, which meant that all the tumor cells had been eliminated. On the other hand, his liver function and blood parameters were normal, and the treatment did not cause any side effects.

In fact, he was discharged from the hospital on the third day after the operation. Unlike last year when he lay in bed for three months, he could do some simple farm work like feeding chickens and pigs as soon as he got home, and he looked like a normal person. Sometimes when he meets acquaintances in the village, he changes his past gloominess and takes the initiative to "report" his condition.

△The patient returned to the hospital for review

So far, including Lin Yunsheng, Hainan Boao Super Hospital has performed 6 cases of Y90 glass microsphere surgery, all of which have achieved the expected results.

"This technology has been used internationally for many years, but it is still blank in our country due to various reasons. This time Y90 glass microspheres can be tried first in Hainan, which accounts for 50% of new cases and mortality in the world every year. For such a big country, it is of great significance," said Teng Gaojun, academician of the Chinese Academy of Sciences and president of the Zhongda Hospital affiliated to Southeast University, who previously led many domestic tertiary hospitals to participate in the Y90 glass microspheres. Systematic clinical trials have laid a solid foundation for promoting the application of this technology in the mainland.

More accurate figures come from the 2020 Global Cancer Report - this year, there were 910,000 new cases of liver cancer worldwide, and China accounted for 410,000 cases. There are 830,000 liver cancer deaths worldwide, of which 390,000 are in China. The reason for the high mortality rate is that there are no nerves in the liver and it does not feel pain. Therefore, once diagnosed, it is often at an advanced stage and there is no chance of surgery. According to domestic statistics, the 5-year survival rate of Chinese liver cancer patients is only 12%.

Selective internal radiation therapy represented by Y90 glass microspheres is providing these patients with the possibility of long-term survival and even complete cure. Teng Gaojun said that the application of Y90 microsphere therapy is not only for liver cancer that cannot be removed by surgery. If it is relatively early, it can be used for radical staged treatment or bridging treatment required before liver transplantation. There are also a large number of drug treatments, targeted treatments, immunotherapy and that may have synergistic effects with Y90 microsphere therapy.

"In this sense, the successful introduction of Y90 microsphere therapy not only adds another item to our interventional treatment , but more importantly, it brings hope of life to countless of our patients."

( To protect patient privacy, "Lin Yunsheng" is a pseudonym in this article)