Pieper Claus Christian, Meyer Carsten, Wilhelm Kai E, Block Wolfgang, Nadal Jennifer, Ahmadzadehfar Hojjat, Willinek Winfried Albert, Schild Hans Heinz
Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany.
Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany.
J Vasc Interv Radiol. 2016 Sep;27(9):1305-1315. doi: 10.1016/j.jvir.2016.05.028. Epub 2016 Jul 22.
To determine value of transarterial radioembolization (TARE) for palliative treatment of unresectable liver-dominant breast metastases (LdBM) and to determine prognostic parameters.
Records of patients undergoing TARE for progressing LdBM between June 2006 and March 2015 were retrospectively reviewed; 44 female patients (mean age 56.1 y; range, 34.9-85.3 y) underwent 69 TAREs (56 resin-based, 13 glass-based). Of 44 patients, 42 had bilobar disease. Mean administered activity was 1.35 GBq ± 0.71. Median clinical and imaging follow-up times were 121 days (range, 26-870 d; n = 42 patients) and 93 days (range, 26-2,037 d; n = 38 patients). Clinical and biochemical toxicities, imaging response (according to Response Evaluation Criteria In Solid Tumors), time to progression, and overall survival (OS) were evaluated. Data were analyzed with stratification according to clinical and procedural parameters.
Toxicities included 1 cholecystitis (grade 2) and 1 duodenal ulceration (grade 3); no grade ≥ 4 clinical toxicities were noted. Objective response rate (complete + partial response) was 28.9% (11/38); disease control rate (response + stable disease) was 71.1% (27/38). Median time to progression of treated liver lobe was 101 days (range, 30-2,037 d). During follow-up, 34/42 patients died (median OS after first TARE: 184 d [range 29-2,331 d]). On multivariate analysis, baseline Eastern Cooperative Oncology Group (ECOG) status of 0 (P < .0001, hazard ratio [HR] = 0.146) and low baseline γ-glutamyltransferase (GGT) levels (P = .0146, HR = 0.999) were predictors of longer OS.
TARE can successfully delay progression of therapy-refractory LdBM with low complication rate. Nonelevated baseline ECOG status and low GGT levels were identified as prognostic factors.
确定经动脉放射性栓塞术（TARE）用于不可切除的以肝脏为主的乳腺转移瘤（LdBM）姑息治疗的价值，并确定预后参数。
回顾性分析2006年6月至2015年3月期间因LdBM进展而接受TARE治疗的患者记录；44例女性患者（平均年龄56.1岁；范围34.9 - 85.3岁）接受了69次TARE治疗（56次基于树脂，13次基于玻璃微球）。44例患者中，42例有双侧病变。平均给予的活度为1.35GBq±0.71。临床和影像随访时间中位数分别为121天（范围26 - 870天；n = 42例患者）和93天（范围26 - 2037天；n = 38例患者）。评估临床和生化毒性、影像反应（根据实体瘤疗效评价标准）、疾病进展时间和总生存期（OS）。根据临床和操作参数进行分层分析数据。
毒性反应包括1例胆囊炎（2级）和1例十二指肠溃疡（3级）；未观察到≥4级临床毒性反应。客观缓解率（完全缓解 + 部分缓解）为28.9%（11/38）；疾病控制率（缓解 + 疾病稳定）为71.1%（27/38）。治疗肝叶的疾病进展时间中位数为101天（范围30 - 2037天）。随访期间，34/42例患者死亡（首次TARE后的OS中位数：184天[范围29 - 2331天]）。多因素分析显示，东部肿瘤协作组（ECOG）基线状态为0（P <.0001，风险比[HR] = 0.146）和低基线γ-谷氨酰转移酶（GGT）水平（P =.0146，HR = 0.999）是OS较长的预测因素。
TARE可成功延缓难治性LdBM的进展，并发症发生率低。未升高的基线ECOG状态和低GGT水平被确定为预后因素。
