Padia Siddharth A, Kwan Sharon W, Roudsari Bahman, Monsky Wayne L, Coveler Andrew, Harris William P
Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119.
Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119.
J Vasc Interv Radiol. 2014 Jul;25(7):1067-73. doi: 10.1016/j.jvir.2014.03.030. Epub 2014 May 14.
To assess the safety and efficacy of yttrium-90 ((90)Y) radioembolization when performed in a superselective fashion for patients with unresectable hepatocellular carcinoma (HCC).
This retrospective study included 20 patients with unresectable HCC. Median Model for End-Stage Liver Disease score was 10.5 (range, 6-25), with 8 of 20 patients (40%) classified Child-Pugh class B and 1 of 20 patients (5%) classified class C cirrhosis. Segmental tumor-associated portal vein thrombus was present in 12 patients (60%), and a transjugular intrahepatic portosystemic shunt was present in 4 patients (20%). Median tumor diameter was 3.9 cm (range, 2.5-7.1 cm). All patients underwent superselective (90)Y radioembolization targeted to a single liver segment using glass microspheres.
Median dose to the treated segment was 254 Gy, and median dose to the tumor was 536 Gy. No grade 3-4 hepatotoxicity occurred. The most common clinical toxicities were fatigue (30%), abdominal pain (10%), and postembolization syndrome (10%). Follow-up imaging demonstrated complete European Association for the Study of the Liver response of the index tumor in 19 of 20 patients (95%) and stable disease in 1 of 20 patients (5%). In patients with complete response, local tumor recurrence rate was 5.3% (1 of 19 patients). Median time to progression was 319 days. Overall survival was 90% (18 of 20 patients) with a median follow-up period of 275 days (range, 32-677 d).
When performed in a segmental fashion, (90)Y radioembolization demonstrates high response rates and low local tumor recurrence rates. Complete imaging response can be achieved in patients with locally aggressive disease. This study demonstrates no clinically significant hepatotoxicity, despite moderate liver dysfunction in many patients.
评估钇-90（90Y）放射性栓塞术以超选择性方式用于不可切除肝细胞癌（HCC）患者时的安全性和有效性。
这项回顾性研究纳入了20例不可切除HCC患者。终末期肝病评分中位数为10.5（范围6 - 25），20例患者中有8例（40%）为Child-Pugh B级，20例患者中有1例（5%）为C级肝硬化。12例患者（60%）存在节段性肿瘤相关门静脉血栓，4例患者（20%）存在经颈静脉肝内门体分流。肿瘤直径中位数为3.9 cm（范围2.5 - 7.1 cm）。所有患者均使用玻璃微球对单个肝段进行超选择性90Y放射性栓塞术。
治疗肝段的剂量中位数为254 Gy，肿瘤剂量中位数为536 Gy。未发生3 - 4级肝毒性。最常见的临床毒性反应为疲劳（30%）、腹痛（10%）和栓塞后综合征（10%）。随访影像学检查显示，20例患者中有19例（95%）的靶肿瘤达到完全欧洲肝脏研究协会反应，20例患者中有1例（5%）病情稳定。在完全缓解的患者中，局部肿瘤复发率为5.3%（19例患者中的1例）。疾病进展的中位时间为319天。总生存率为90%（20例患者中的18例），中位随访期为275天（范围32 - 677天）。
以节段性方式进行时，90Y放射性栓塞术显示出高反应率和低局部肿瘤复发率。对于局部侵袭性疾病患者可实现完全影像学反应。本研究表明，尽管许多患者存在中度肝功能障碍，但未出现具有临床意义的肝毒性。
