Department of Radiology, Section of Interventional Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, IL, USA.
Eur J Nucl Med Mol Imaging. 2017 Dec;44(13):2195-2202. doi: 10.1007/s00259-017-3792-3. Epub 2017 Aug 15.
To assess safety/efficacy of yttrium-90 radioembolization (Y90) in patients with recurrent hepatocellular carcinoma (HCC) following curative surgical resection.
With IRB approval, we searched our prospectively acquired database for patients that were treated with Y90 for recurrent disease following resection. Baseline characteristics and bilirubin toxicities following Y90 were evaluated. Intention-to-treat overall survival (OS) and time-to-progression (TTP) from Y90 were assessed.
Forty-one patients met study inclusion criteria. Twenty-six (63%) patients had undergone minor (≤3 hepatic segments) resection while 15 (37%) patients underwent major (>3 hepatic segments) resections. Two patients (5%) had biliary-enteric anastomoses created during surgical resection. The median time from HCC resection to the first radioembolization was 17 months (95% CI: 13-37). The median number of Y90 treatment sessions was 1 (range: 1-5). Ten patients received (entire remnant) lobar Y90 treatment while 31 patients received selective (≤2 hepatic segments) treatment. Grades 1/2/3/4 bilirubin toxicity were seen in nine (22%), four (10%), four (10%), and zero (0%) patients following Y90. No differences in bilirubin toxicities were identified when comparing lobar with selective approaches (P = 0.20). No post-Y90 infectious complications were identified. Median TTP and OS were 11.3 (CI: 6.5-15.5) and 22.1 months (CI: 10.3-31.3), respectively.
Radioembolization is a safe and effective method for treating recurrent HCC following surgical resection, with prolonged TTP and promising survival outcomes.
评估钇-90 放射性栓塞（Y90）在根治性手术切除后复发的肝细胞癌（HCC）患者中的安全性/疗效。
在获得机构审查委员会批准的情况下，我们在我们前瞻性获得的数据库中搜索了接受 Y90 治疗以治疗切除后复发的患者。评估了 Y90 治疗后的基线特征和胆红素毒性。评估了 Y90 后的意向治疗总生存期（OS）和无进展时间（TTP）。
41 名患者符合研究纳入标准。26 名（63%）患者接受了小（≤3 个肝段）切除术，而 15 名（37%）患者接受了大（>3 个肝段）切除术。两名患者（5%）在手术切除期间有胆肠吻合术。从 HCC 切除到第一次放射性栓塞的中位时间为 17 个月（95%CI：13-37）。Y90 治疗次数的中位数为 1（范围：1-5）。10 名患者接受了（整个残肝）叶 Y90 治疗，而 31 名患者接受了选择性（≤2 个肝段）治疗。Y90 治疗后出现 1/2/3/4 级胆红素毒性的患者分别为 9 名（22%）、4 名（10%）、4 名（10%）和 0 名（0%）。叶状与选择性方法相比，胆红素毒性无差异（P=0.20）。Y90 后未发现感染性并发症。中位 TTP 和 OS 分别为 11.3（CI：6.5-15.5）和 22.1 个月（CI：10.3-31.3）。
放射性栓塞是治疗根治性手术切除后复发 HCC 的一种安全有效的方法，具有延长的 TTP 和有前途的生存结果。
