Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Cardiovasc Intervent Radiol. 2012 Oct;35(5):1094-101. doi: 10.1007/s00270-011-0292-x. Epub 2011 Nov 9.
This study was designed to determine the technical feasibility, safety, efficacy, and potential to downstage patients to within transplantation criteria when treating patients with hepatocellular carcinoma (HCC) of the caudate lobe using Y90 radioembolization.
During a 4-year period, 8 of 291 patients treated with radioembolization for unresectable HCC had disease involving the caudate lobe. All patients were followed for treatment-related clinical/biochemical toxicities, serum tumor marker response, and treatment response. Imaging response was assessed with the World Health Organization (WHO) and European Association for the Study of the Liver (EASL) classification schemes. Pathologic response was reported as percent necrosis at explantation.
Caudate lobe radioembolization was successfully performed in all eight patients. All patients presented with both cirrhosis and portal hypertension. Half were United Network for Organ Sharing (UNOS) stage T3 (n = 4, 50%). Fatigue was reported in half of the patients (n = 4, 50%). One (13%) grade 3/4 bilirubin toxicity was reported. One patient (13%) showed complete tumor response by WHO criteria, and three patients (38%) showed complete response using EASL guidelines. Serum AFP decreased by more than 50% in most patients (n = 6, 75%). Four patients (50%) were UNOS downstaged from T3 to T2, three of who underwent transplantation. One specimen showed histopathologic evidence of 100% complete necrosis, and two specimens demonstrated greater than 50% necrosis.
Radioembolization with yttrium-90 appears to be a feasible, safe, and effective treatment option for patients with unresectable caudate lobe HCC. It has the potential to downstage patients to transplantation.
本研究旨在确定使用 Y90 放射性栓塞治疗尾状叶肝细胞癌（HCC）患者的技术可行性、安全性、疗效和将患者降期至符合移植标准的潜力。
在 4 年期间，291 例接受不可切除 HCC 放射性栓塞治疗的患者中有 8 例存在尾状叶疾病。所有患者均接受了与治疗相关的临床/生化毒性、血清肿瘤标志物反应和治疗反应的随访。采用世界卫生组织（WHO）和欧洲肝脏研究协会（EASL）分类方案评估影像学反应。病理反应以离体时的坏死百分比报告。
8 例患者均成功进行了尾状叶放射性栓塞。所有患者均有肝硬化和门静脉高压。半数为联合器官共享网络（UNOS）分期 T3（n=4，50%）。有半数患者（n=4，50%）出现乏力。报告了 1 例（13%）3/4 级胆红素毒性。1 例（13%）患者按 WHO 标准完全缓解肿瘤，3 例（38%）患者按 EASL 指南完全缓解。大多数患者（n=6，75%）的血清 AFP 下降超过 50%。4 例（50%）患者从 T3 降期为 T2，其中 3 例接受了移植。1 份标本显示组织病理学上有 100%完全坏死的证据，2 份标本显示大于 50%的坏死。
钇-90 放射性栓塞似乎是一种可行、安全、有效的不可切除尾状叶 HCC 患者治疗选择。它有可能将患者降期至符合移植标准。
