经动脉碘 131 碘化油治疗不可切除的肝细胞癌。

Intra-arterial iodine-131-lipiodol for unresectable hepatocellular carcinoma.

机构信息

Department of Surgery, St. George Hospital, Kogarah, University of New South Wales, Sydney, New South Wales, Australia.

出版信息

Cancer. 2010 Sep 1;116(17):4069-77. doi: 10.1002/cncr.25283.

DOI:10.1002/cncr.25283

PMID:20564150

Abstract

BACKGROUND

Hepatic artery administration of iodine-131-Lipiodol serves as a modality that delivers targeted radiation therapy to hepatocellular carcinoma. Its efficacy has been promising according to trials conducted in the adjuvant setting after hepatic resection. Further investigation of its role in the palliative setting is warranted.

METHODS

A retrospective review of 72 patients with unresectable hepatocellular carcinoma treated with iodine-131-Lipiodol and followed up by the St. George Hospital Sydney's hepatobiliary service was conducted. Efficacy of treatment was determined based on progression-free and overall survival as the endpoints using the Kaplan-Meier method.

RESULTS

Sixty men and 12 women with a mean age of 65 years (standard deviation = 11) underwent iodine-131-Lipiodol treatment. Chronic viral hepatitis was present in 29 (41%) patients. Fifty (69%) patients were Child-Pugh class A. Median progression-free survival was 6 months, and overall survival was 14 months; the 1-, 2-, and 3-year survival rates were 52%, 33% and 20%, respectively. Factors associated with survival include the American Joint Committee on Cancer stage (P = .03), Barcelona Clinic Liver Cancer stage (P = .05), Cancer of the Liver Italian Program score (P = .008), tumor size (P = .01), extrahepatic disease (P < .001), previous surgery (P = .02), and response to treatment (P < .001). The response to treatment was identified through a multivariate analysis as the single independent predictor for survival (hazard ratio, 3.5; 95% confidence interval, 2.2-5.4; P < .001).

CONCLUSIONS

Encouraging survival outcomes may be derived through administration of iodine-131-Lipiodol in patients with unresectable hepatocellular carcinoma. The overall success of treatment may be determined by the response to treatment.

摘要

背景

经肝动脉给予碘-131 碘化油作为一种向肝细胞癌提供靶向放射治疗的方式。根据肝切除术后辅助治疗的试验，其疗效很有前景。进一步研究其在姑息治疗中的作用是有必要的。

方法

对在悉尼圣乔治医院肝胆科接受碘-131 碘化油治疗并进行随访的 72 例不可切除的肝细胞癌患者进行回顾性分析。使用 Kaplan-Meier 方法，以无进展生存期和总生存期作为终点来确定治疗的疗效。

结果

60 名男性和 12 名女性，平均年龄为 65 岁（标准差=11），接受了碘-131 碘化油治疗。29 例（41%）患者存在慢性病毒性肝炎。50 例（69%）患者为 Child-Pugh 分级 A。中位无进展生存期为 6 个月，总生存期为 14 个月；1、2 和 3 年生存率分别为 52%、33%和 20%。与生存相关的因素包括美国癌症联合委员会分期（P=0.03）、巴塞罗那临床肝癌分期（P=0.05）、意大利癌症肝计划评分（P=0.008）、肿瘤大小（P=0.01）、肝外疾病（P＜0.001）、既往手术（P=0.02）和治疗反应（P＜0.001）。通过多变量分析，治疗反应被确定为生存的唯一独立预测因素（危险比，3.5；95%置信区间，2.2-5.4；P＜0.001）。