Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois 60611, USA.
Gastroenterology. 2011 Feb;140(2):497-507.e2. doi: 10.1053/j.gastro.2010.10.049. Epub 2010 Oct 30.
BACKGROUND & AIMS: Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC.
We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed.
Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42).
Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.
化疗栓塞是治疗肝细胞癌 (HCC) 的几种标准治疗方法之一。钇-90 微球放射栓塞是一种新型的经动脉放射治疗方法。我们对这些治疗方法在 HCC 患者中的疗效进行了比较分析。
我们收集了 463 例在 9 年内接受经动脉局部区域治疗（化疗栓塞或放射栓塞）的患者的数据。我们排除了不适合比较的患者，并对 245 例患者的数据进行了分析（化疗栓塞 122 例，放射栓塞 123 例）。患者随访观察毒性迹象；所有患者均在基线和随访时间点进行影像学分析。总生存期是主要观察终点。次要终点包括安全性、缓解率和无进展生存期。进行了单因素和多因素分析。
化疗栓塞后更常出现腹痛和转氨酶活性升高（P <.05）。放射栓塞治疗的患者缓解率高于化疗栓塞（分别为 49%和 36%，P =.104），这一趋势具有统计学意义。虽然放射栓塞后无进展生存期长于化疗栓塞（分别为 13.3 个月和 8.4 个月，P =.046），但中位生存时间无统计学差异（分别为 20.5 个月和 17.4 个月，P =.232）。在中间期疾病患者中，接受化疗栓塞（17.5 个月）和放射栓塞（17.2 个月，P =.42）的两组患者生存时间相似。
接受化疗栓塞或钇-90 微球放射栓塞治疗的 HCC 患者的生存时间相似。放射栓塞的无进展生存期长于化疗栓塞，毒性低于化疗栓塞。基于样本量的事后分析表明，需要进行超过 1000 例患者的随机研究，才能确定这两种治疗方法的患者生存时间是否等效。
