Radiology Department, Fatebenefratelli Hospital, Piazzale Principessa Clotilde, 3, 20121, Milan, Italy.
Department of Health Sciences, Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
Med Oncol. 2017 Sep 5;34(10):174. doi: 10.1007/s12032-017-1021-3.
The aim of this study was to evaluate the efficacy and the safety of Y90 radioembolization (Y90-RE) in patients with unresectable hepatocellular carcinoma (HCC) analysing our results and correlating them with independent prognostic factors for overall survival (OS) and for complications. Forty-three patients with advanced inoperable HCC including those with multiple bilobar lesions or portal vein thrombosis (PVT) treated with Y90-RE were reviewed. Treatment efficacy and safety were evaluated. Survival was calculated by the Kaplan-Meier method. Univariate analyses were performed for identifying potential prognostic factors. Radiologic response was evaluated with the modified Response Evaluation Criteria in Solid Tumours (mRECIST) criteria. Clinical toxicities were prospectively recorded. Median overall progression-free survival and OS were 27.7 and 16.8 months, respectively. Longer median OS was revealed in those without PVT (p = 0.0241) and those whose pre-treatment haemoglobin values was higher (p = 0.0471). According with mRECIST criteria, we observed a disease control rate of 69.2 and 61.9% at 3- and 6-month follow-up, respectively. Complications developed in 28 patients (65.1%), among which grade 2-3 events were reported in 17 patients. We noted that activity administered dose presented a correlation with intra-procedural toxicity (p = 0.039259) while common hepatic artery use as release site was associated with a most frequent presentation of remote adverse events. Y90-RE is an alternative treatment with a promising outcome for poor-risk advanced inoperable HCC. PVT and pre-treatment haemoglobin values can be predictors of efficacy. Activity administered dose and arterial release site can be predictors of safety.
本研究旨在评估不可切除肝细胞癌（HCC）患者接受钇 90 放射性栓塞（Y90-RE）治疗的疗效和安全性，分析我们的结果并将其与总生存期（OS）和并发症的独立预后因素相关联。回顾性分析了 43 例接受 Y90-RE 治疗的晚期不可切除 HCC 患者，包括多发病灶或门静脉血栓形成（PVT）患者。评估治疗效果和安全性。通过 Kaplan-Meier 法计算生存率。采用单因素分析确定潜在的预后因素。采用改良实体瘤反应评价标准（mRECIST）评价放射学反应。前瞻性记录临床毒性。中位总无进展生存期和 OS 分别为 27.7 和 16.8 个月。无 PVT（p=0.0241）和治疗前血红蛋白值较高的患者中位 OS 较长（p=0.0471）。根据 mRECIST 标准，我们在 3 个月和 6 个月随访时分别观察到 69.2%和 61.9%的疾病控制率。28 例患者（65.1%）出现并发症，其中 17 例为 2-3 级事件。我们注意到，给予的活度剂量与术中毒性相关（p=0.039259），而将肝总动脉作为释放部位与更常见的远处不良事件相关。Y90-RE 是一种有前途的治疗选择，适用于高危不可切除晚期 HCC。PVT 和治疗前血红蛋白值可作为疗效的预测因素。给予的活度剂量和动脉释放部位可作为安全性的预测因素。
