Department of Hematology/Oncology, University of North Carolina School of Medicine, 3009 Old Clinic Building, CB 7305, Chapel Hill, NC 27599, USA.
J Vasc Interv Radiol. 2010 Sep;21(9):1377-84. doi: 10.1016/j.jvir.2010.04.027. Epub 2010 Aug 5.
Patients with portal vein thrombosis (PVT) and hepatocellular carcinoma (HCC) have limited treatment options because of increased disease burden and diminished hepatic perfusion. Yttrium-90 ((90)Y) microspheres may be better tolerated than chemoembolization in these patients. The present study reviews the safety and efficacy of (90)Y microspheres in HCC with major PVT.
A retrospective review of HCC with main (n = 10) or first-branch (n = 12) PVT treated with (90)Y microspheres (N = 22) was conducted. Cancer of the Liver Italian Program (CLIP) scores ranged from 2 to 5, with 18% of patients having a score of 4 or greater. Imaging response at 8-12 was based on Response Evaluation Criteria In Solid Tumors. Overall survival (OS) was estimated by the Kaplan-Meier method.
A total of 32 microsphere treatments (26 glass, six resin) were administered to 22 patients. Common grade 1/2 toxicities included abdominal pain (38%), nausea (28%), and fatigue (22%). Four posttreatment hospitalizations occurred, all less than 48 hours in duration. One death occurred 10 days after therapy. The partial response rate was 8% and progressive disease was seen in 42% of patients. Stable disease was achieved in 50% of treatments. Median OS was 7 months from initial treatment. Patients with Child-Pugh class A disease had a median OS of 7.7 months; those with class B/C disease had an OS of 2.7 months (P = .01). Median OS for patients with CLIP scores of 2/3 was 7 months, versus 1.3 months for those with scores of 4/5 (P = .04).
Yttrium-90 microspheres are tolerated in patients with HCC and major PVT. Compared with chemoembolization, rates of severe adverse events appear low. Radiographic response rates are low. The median OS of 7 months is promising and warrants further study versus systemic therapy.
门静脉血栓形成（PVT）和肝细胞癌（HCC）患者由于疾病负担增加和肝灌注减少，治疗选择有限。钇-90（90Y）微球在这些患者中的耐受性可能优于化疗栓塞。本研究回顾了 90Y 微球在伴有主要 PVT 的 HCC 中的安全性和疗效。
对接受 90Y 微球治疗（90Y）的 HCC 伴主支（n=10）或第一分支（n=12）PVT（n=22）的患者进行回顾性分析。癌症意大利方案（CLIP）评分范围为 2 至 5 分，其中 18%的患者评分≥4 分。8-12 时的影像学反应根据实体瘤反应评价标准进行评估。采用 Kaplan-Meier 法估计总生存期（OS）。
共对 22 例患者进行了 32 次微球治疗（26 次玻璃微球，6 次树脂微球）。常见的 1/2 级毒性包括腹痛（38%）、恶心（28%）和疲劳（22%）。4 例患者在治疗后住院，均不足 48 小时。1 例患者在治疗后 10 天死亡。部分缓解率为 8%，42%的患者出现疾病进展。50%的治疗方法达到了稳定疾病。从初始治疗开始，中位 OS 为 7 个月。Child-Pugh 分级为 A 级的患者中位 OS 为 7.7 个月，分级为 B/C 级的患者 OS 为 2.7 个月（P=0.01）。CLIP 评分为 2/3 的患者中位 OS 为 7 个月，评分为 4/5 的患者中位 OS 为 1.3 个月（P=0.04）。
90Y 微球在伴有大 PVT 的 HCC 患者中耐受性良好。与化疗栓塞相比，严重不良事件的发生率似乎较低。影像学反应率较低。7 个月的中位 OS 很有希望，值得进一步研究与系统治疗相比。
