Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2012 Jul;27(7):736-43. doi: 10.3346/jkms.2012.27.7.736. Epub 2012 Jun 29.
Combination treatment of trans-catheter arterial chemoembolization (TACE) and conformal radiation therapy (RT) reported promising results in patients with hepatocellular carcinoma (HCC), but, optimal interval was not determined. We hypothesized that a two-week interval between TACE and RT would be optimal. Therefore, we designed this study to evaluate the safety and efficacy of scheduled interval TACE followed by RT. HCC patients who were not eligible for standard therapies were enrolled for scheduled interval TACE followed by RT (START). Patients received TACE on the first day of treatment, and then RT was delivered after 14 days. The entire course of treatment took between four and five weeks. In 81 patients (96.4%), START was completed in the planned treatment period. RT was delayed in the remaining three patients because of decreased liver function or poor performance status after TACE. Of the 81 patients, objective response was observed in 57 patients (70.4%). One unexpected death occurred after START due to hepatic failure. Other toxicities were manageable. The median survival was 14.7 months. There was a significant difference in overall survival according to the response to START (P < 0.001). In conclusion, START is safe and feasible.
经导管动脉化疗栓塞（TACE）联合适形放疗（RT）治疗肝细胞癌（HCC）的疗效令人鼓舞，但最佳间隔时间尚未确定。我们假设 TACE 和 RT 之间的两周间隔时间是最佳的。因此，我们设计了这项研究来评估计划间隔 TACE 序贯 RT 的安全性和有效性。不适合标准治疗的 HCC 患者被纳入计划间隔 TACE 序贯 RT（START）。患者在治疗的第一天接受 TACE，然后在 14 天后进行 RT。整个治疗过程需要四到五周。在 81 名患者（96.4%）中，START 按计划治疗期完成。由于 TACE 后肝功能下降或一般状况较差，其余 3 名患者的 RT 被延迟。在 81 名患者中，57 名患者（70.4%）观察到客观缓解。1 例患者在 START 后因肝衰竭意外死亡。其他毒性反应可控制。中位生存期为 14.7 个月。根据 START 的反应，总生存率有显著差异（P < 0.001）。总之，START 是安全可行的。
