Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
Department of Radiation Oncology, Brody School of Medicine, East Carolina University , Greenville, NC , USA.
Front Oncol. 2013 Dec 30;3:323. doi: 10.3389/fonc.2013.00323. eCollection 2013.
Yttrium-90 radioembolization (RE) is a locoregional therapy option for hepatocellular carcinoma (HCC). Sorafenib is a multikinase inhibitor used in HCC that can potentially affect the efficacy of RE by altering tumor vascularity or suppressing post-irradiation angiogenesis. The safety and efficacy of sorafenib followed by RE has not been previously reported.
Patients with HCC who received RE after sorafenib were included in this retrospective review. Overall survival, toxicity, and maximal radiographic response and necrosis criteria were examined.
Ten patients (15 RE administrations) fit the inclusion criteria. All were Barcelona Clinic Liver Cancer (BCLC) stage C. Median follow-up was 16.5 weeks. Median overall survival and radiographic progression-free survival were 30 and 28 weeks, respectively. Significant differences in overall survival were seen based on Child-Pugh class (p = 0.002) and radiographic response (p = 0.009). Three patients had partial response, six had stable disease, and one had progressive disease. Grade 1 or 2 acute fatigue, anorexia, and abdominal pain were common. Three patients had Grade 3 ascites in the setting of disease progression. Two patients had Grade 3 biochemical toxicity. One patient was sufficiently downstaged following RE and sorafenib to receive a partial hepatectomy.
Yttrium-90 RE in patients with HCC who have received sorafenib demonstrate acceptable toxicity and rates of radiographic response. However, the overall survival is lower than that reported in the literature on RE alone or sorafenib alone. This may be due in part to more patients in this study having advanced disease compared to these other study populations. Larger prospective studies are needed to determine whether the combination of RE and sorafenib is superior to either therapy alone.
钇-90 放射性栓塞（RE）是治疗肝细胞癌（HCC）的局部治疗选择。索拉非尼是一种用于 HCC 的多激酶抑制剂，通过改变肿瘤血管生成或抑制放疗后血管生成，可能会影响 RE 的疗效。索拉非尼治疗后继以 RE 的安全性和疗效尚未有报道。
本回顾性研究纳入了接受索拉非尼治疗后行 RE 的 HCC 患者。观察总生存期、毒性、最大影像学反应和坏死标准。
符合纳入标准的患者有 10 名（共行 15 次 RE）。所有患者均为巴塞罗那临床肝癌（BCLC）分期 C 期。中位随访时间为 16.5 周。中位总生存期和影像学无进展生存期分别为 30 周和 28 周。总生存期的显著差异与 Child-Pugh 分级（p=0.002）和影像学反应（p=0.009）有关。3 名患者部分缓解，6 名患者病情稳定，1 名患者疾病进展。1 级或 2 级急性疲劳、厌食和腹痛常见。3 名患者在疾病进展时出现 3 级腹水。2 名患者出现 3 级生化毒性。1 名患者在接受 RE 和索拉非尼治疗后肿瘤降期，接受了部分肝切除术。
接受索拉非尼治疗后 HCC 患者行钇-90 RE 治疗具有可接受的毒性和影像学反应率。然而，总生存期低于文献中单独接受 RE 或索拉非尼治疗的报道。这可能部分是由于本研究中更多患者的疾病处于晚期，与这些其他研究人群相比。需要更大规模的前瞻性研究来确定 RE 和索拉非尼联合治疗是否优于单独应用任何一种治疗。
