Biederman Derek M, Posham Raghuram, Durrani Raisa J, Titano Joseph J, Patel Rahul S, Tabori Nora E, Nowakowski Francis S, Fischman Aaron M, Lookstein Robert A, Kim Edward
Icahn School of Medicine at Mount Sinai, Department of Vascular and Interventional Radiology, One Gustave Levy Place, New York, NY 10029-6574, USA.
Clin Imaging. 2018 Jan-Feb;47:34-40. doi: 10.1016/j.clinimag.2017.07.011. Epub 2017 Jul 20.
To evaluate the outcomes of radioembolization (RE) as a therapy for unresectable hepatocellular carcinoma (HCC) in patients with marginal functional hepatic reserve.
A retrospective review of 471 patients (1/2010-7/2015) treated with RE (Therasphere, BTG, UK) was performed. A total of 36 patients (mean age: 66.1±9.3, male: 86.1%) underwent therapy for HCC with a MELD≥15 (median: 16, range: 15-22). Baseline demographics of the study cohort were as follows: etiology (HCV: 26, 72.2%), cirrhosis (n=32, 88.9%), ECOG 0 (n=16, 44.4%), Child-Pugh class (A=15, B=19, C=2), unilobar distribution (n=27, 75%), AFP>200 (n=11, 30.6%), portal vein thrombosis (PVT, n=7, 19.4%), metastasis (n=3, 8.3%). Outcomes analyzed included CTCAEv4.03 laboratory toxicities (120-day), imaging response (mRECIST), progression-free survival (PFS), and overall survival (OS).
A total of 42 treatments were performed with mean dose of 2.02±1.23GBq. The cumulative grade 3/4 toxicity was 28% overall and 21% for bilirubin at 120-days. The objective response and disease control rates were 48.3% (14/29) and 69% (20/29) respectively. The median (95% CI) PFS was 5.9 (4.4-7.7) months. Ten (27.8%) patients received additional locoregional therapy at a median (IQR) of 138 (102-243) days post RE. The mean (95% CI) OS was 21.9 (14.8-29.0) months. The absence of PVT was associated with improved OS (p=0.005) Disease control at 90-days was also associated with an OS benefit (p=0.037).
Patients with unresectable HCC and marginal functional hepatic reserve treated with RE had favorable objective response and disease control rates, both predictive of overall survival.
评估放射性栓塞（RE）治疗肝功能储备临界的不可切除肝细胞癌（HCC）患者的疗效。
对471例（2010年1月至2015年7月）接受RE（Therasphere，BTG，英国）治疗的患者进行回顾性研究。共有36例患者（平均年龄：66.1±9.3岁，男性：86.1%）因MELD≥15（中位数：16，范围：15 - 22）接受HCC治疗。研究队列的基线人口统计学数据如下：病因（丙型肝炎病毒：26例，72.2%）、肝硬化（n = 32例，88.9%）、东部肿瘤协作组（ECOG）0级（n = 16例，44.4%）、Child-Pugh分级（A = 15例，B = 19例，C = 2例）、单叶分布（n = 27例，75%）、甲胎蛋白>200（n = 11例，30.6%）、门静脉血栓形成（PVT，n = 7例，19.4%）、转移（n = 3例，8.3%）。分析的结局指标包括CTCAEv4.03实验室毒性（120天）、影像反应（mRECIST）、无进展生存期（PFS）和总生存期（OS）。
共进行了42次治疗，平均剂量为2.02±1.23GBq。120天时，总体3/4级累积毒性为28%，胆红素相关的为21%。客观缓解率和疾病控制率分别为48.3%（14/29）和69%（20/29）。PFS的中位数（95%CI）为5.9（4.4 - 7.7）个月。10例（27.8%）患者在RE后中位数（IQR）138（从102至243）天接受了额外的局部区域治疗。OS的均值（95%CI）为21.9（14.8 - 29.0）个月。无PVT与OS改善相关（p = 0.005）。90天时的疾病控制也与OS获益相关（p = 0.037）。
接受RE治疗的不可切除HCC且肝功能储备临界的患者具有良好的客观缓解率和疾病控制率，两者均为总生存期的预测指标。
