Kulik Laura M, Atassi Bassel, van Holsbeeck Lodewijk, Souman Tameem, Lewandowski Robert J, Mulcahy Mary F, Hunter Russell D, Nemcek Albert A, Abecassis Michael M, Haines Kenneth G, Salem Riad
Division of Hepatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois, USA.
J Surg Oncol. 2006 Dec 1;94(7):572-86. doi: 10.1002/jso.20609.
To present the clinical data of 35 patients with T3 unresectable hepatocellular carcinoma (HCC) that were treated with (90)Y with the specific intent of downstaging to resection, radiofrequency ablation (RFA) candidate, United Network for Organ Sharing (UNOS) stage T2 or liver transplantation.
One hundred fifty patients with unresectable HCC were treated with (90)Y microspheres. Of these, 35 patients were UNOS stage T3 at the time of treatment. Patients were followed for clinical toxicities, alterations in model for end-stage-liver disease (MELD) score, tumor response, downstaging to RFA, resection, transplantation, and survival.
Nineteen of 34 patients (56%) were successfully downstaged from T3 to T2 following treatment. 11 of 34 (32%) patients treated were downstaged to target lesions measuring 3.0 cm or less. Twenty-three of 35 (66%) were downstaged to either T2 status, lesion < 3.0 cm (RFA candidate), or resection. Seventeen of 34 (50%) had an objective tumor response by WHO criteria. Eight patients (23%) were successfully downstaged and underwent OLT following treatment. 1, 2, and 3-year survival was 84%, 54%, and 27%, respectively. Median survival by Kaplan-Meier analysis for the entire cohort was 800 days.
These data suggest that intra-arterial (90)Y microspheres can be used as a bridge to transplantation, surgical resection, or RFA.
呈现35例T3期不可切除肝细胞癌（HCC）患者的临床数据，这些患者接受了钇-90（90Y）治疗，其特定目的是降期以进行切除、成为射频消融（RFA）候选者、达到器官共享联合网络（UNOS）T2期或进行肝移植。
150例不可切除HCC患者接受了钇-90微球治疗。其中，35例患者在治疗时为UNOS T3期。对患者进行临床毒性、终末期肝病模型（MELD）评分变化、肿瘤反应、降期至RFA、切除、移植及生存情况的随访。
34例患者中有19例（56%）在治疗后成功从T3期降为T2期。34例接受治疗的患者中有11例（32%）降期至目标病灶直径≤3.0 cm。35例患者中有23例（66%）降期至T2期、病灶<3.0 cm（成为RFA候选者）或可进行切除。34例患者中有17例（50%）根据世界卫生组织标准有客观肿瘤反应。8例患者（23%）在治疗后成功降期并接受了肝移植。1年、2年和3年生存率分别为84%、54%和27%。通过Kaplan-Meier分析得出整个队列的中位生存期为800天。
这些数据表明，动脉内钇-90微球可作为通向移植、手术切除或RFA的桥梁。
