钇-90玻璃基微球放射性栓塞治疗乙型肝炎病毒所致肝细胞癌：安全性、有效性和生存率
Yttrium-90 Glass-Based Microsphere Radioembolization in the Treatment of Hepatocellular Carcinoma Secondary to the Hepatitis B Virus: Safety, Efficacy, and Survival.
作者信息
Biederman Derek M, Titano Joseph J, Lee Karen M, Pierobon Elisa S, Schwartz Myron, Facciuto Marcelo E, Gunasekaran Ganesh, Florman Sander, Fischman Aaron M, Patel Rahul S, Tabori Nora E, Nowakowski Francis S, Kim Edward
机构信息
Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
出版信息
J Vasc Interv Radiol. 2015 Nov;26(11):1630-8. doi: 10.1016/j.jvir.2015.07.019. Epub 2015 Aug 28.
PURPOSE
To evaluate outcomes of yttrium-90 radioembolization performed with glass-based microspheres in the treatment of hepatocellular carcinoma (HCC) secondary to the hepatitis B virus (HBV).
MATERIALS AND METHODS
A total of 675 patients treated between January 2006 and July 2014 were reviewed, of which 45 (age 62 y ± 10; 91% male) received glass-based radioembolization for HCC secondary to HBV. All patients were stratified according to previous therapy (naive, n = 14; 31.1%), Child-Pugh class (class A, n = 41; 91%), Eastern Cooperative Oncology Group (ECOG) performance status (PS; < 1, n = 21; 47%), solitary (n = 26; 58%) and unilobar (n = 37; 82%) tumor distribution, tumor size < 5 cm (n = 29; 64%), portal vein thrombosis (n = 14; 31%), α-fetoprotein level > 400 ng/mL (n = 17; 38%), and Barcelona Clinic Liver Cancer stage (A, n = 8; B, n = 9; C, n = 28).
RESULTS
A total of 50 radioembolization treatments were performed, with a 100% technical success rate (median target dose, 120 Gy). Clinical toxicities included pain (16%), fatigue (12%), and nausea (4%). Grade 3/4 laboratory toxicities included bilirubin (8%) and aspartate aminotransferase (4%) toxicities. Observed toxicities were independent of treatment dose. The objective response rates were 55% per modified Response Evaluation Criteria In Solid Tumors and 21% per World Health Organization criteria, and the disease control rate was 63%. Disease progression was secondary to new, nontarget HCC in 45% of cases. Median time to progression and overall survival were 6.0 mo (95% confidence interval [CI], 4.4-8.0 mo) and 19.3 mo (95% CI, 11.2-22.7 mo), respectively. Multivariate analysis demonstrated ECOG PS ≥ 1 and AFP level > 400 ng/mL to be independent predictors of inferior overall survival.
CONCLUSIONS
Glass-based radioembolization for HCC secondary to HBV can be safely performed, with favorable target lesion response and overall survival.
目的
评估使用玻璃基微球进行钇-90放射性栓塞治疗乙型肝炎病毒（HBV）所致肝细胞癌（HCC）的疗效。
材料与方法
回顾了2006年1月至2014年7月期间接受治疗的675例患者，其中45例（年龄62岁±10岁；91%为男性）因HBV所致HCC接受了玻璃基放射性栓塞治疗。所有患者根据既往治疗情况（初治，n = 14；31.1%）、Child-Pugh分级（A级，n = 41；91%）、东部肿瘤协作组（ECOG）体能状态（PS；<1，n = 21；47%）、孤立性（n = 26；58%）和单叶（n = 37；82%）肿瘤分布、肿瘤大小<5 cm（n = 29；64%）、门静脉血栓形成（n = 14；31%）、甲胎蛋白水平>400 ng/mL（n = 17；38%）以及巴塞罗那临床肝癌分期（A期，n = 8；B期，n = 9；C期，n = 28）进行分层。
结果
共进行了50次放射性栓塞治疗，技术成功率达100%（中位靶剂量，120 Gy）。临床毒性包括疼痛（16%）、疲劳（12%）和恶心（4%）。3/4级实验室毒性包括胆红素（8%）和天冬氨酸转氨酶（4%）毒性。观察到的毒性与治疗剂量无关。根据实体瘤改良疗效评价标准，客观缓解率为55%，根据世界卫生组织标准为21%，疾病控制率为63%。45%的病例疾病进展继发于新的非靶标HCC。中位进展时间和总生存期分别为6.0个月（95%置信区间[CI]，4.4 - 8.0个月）和19.3个月（95%CI，11.2 - 22.7个月）。多因素分析表明，ECOG PS≥1和AFP水平>400 ng/mL是总生存期较差的独立预测因素。
结论
对于HBV所致HCC，使用玻璃基放射性栓塞治疗可安全进行，靶病变反应良好，总生存期可观。
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