1 Department of Interventional Radiology, University of Washington, Seattle, WA.
2 Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
AJR Am J Roentgenol. 2018 Jan;210(1):175-182. doi: 10.2214/AJR.16.17573. Epub 2017 Nov 1.
The outcome for patients with unresectable hepatic sarcoma is poor with a median survival period of 12-16 months. The purpose of this study was to evaluate liver-directed transcatheter therapies for the treatment of hepatic sarcomas.
In a retrospective study, the cases of patients with primary and metastatic hepatic sarcoma treated by transcatheter embolization, chemoembolization, and Y radioembolization between 2004 and 2015 were identified. Response Evaluation Criteria in Solid Tumors version 1.1 response was assessed for the target tumor. Survival was assessed by means of Kaplan-Meier analysis.
Twenty-eight patients (17 [61%] men, 11 [39%] women; median age, 47 years) were included. Eighteen patients were treated electively. Two of the electively treated patients underwent embolization; eight, chemoembolization; six, radioembolization; and two, a combination of transcatheter treatments. Treatment was well tolerated; only one patient had grade 3 hepatic toxicity. The objective response rate of the index tumor was 61%, and the median overall survival period was 26.7 months. Ten patients underwent emergency embolization to control acute hemorrhage from tumor rupture. The median overall survival periods were 611 days for the patients with ruptured gastrointestinal stromal tumors (GIST) (n = 3) and 19 days for the patients with ruptured angiosarcoma (n = 7).
Liver-directed transcatheter therapies are safe and may have a role in the elective management of unresectable primary and metastatic liver sarcomas. Emergency embolization for ruptured GIST may be effective for stabilizing the patient's condition and allowing more definitive therapy in the future. However, emergency embolization has limited efficacy in treating patients with ruptured angiosarcoma, likely because of substantial venous bleeding at rupture and the aggressive behavior of this lesion.
无法切除的肝肉瘤患者的预后较差，中位生存期为 12-16 个月。本研究旨在评估经导管肝靶向治疗肝肉瘤的疗效。
在一项回顾性研究中，我们确定了 2004 年至 2015 年间经导管栓塞、化疗栓塞和 Y 放射性栓塞治疗的原发性和转移性肝肉瘤患者的病例。采用实体瘤反应评估标准 1.1 版评估靶肿瘤的反应。采用 Kaplan-Meier 分析评估生存情况。
共纳入 28 例患者（17 例男性[61%]，11 例女性[39%]；中位年龄为 47 岁）。18 例患者接受了选择性治疗。2 例选择性栓塞，8 例化疗栓塞，6 例放射性栓塞，2 例联合经导管治疗。治疗耐受性良好，仅有 1 例患者出现 3 级肝毒性。指数肿瘤的客观缓解率为 61%，中位总生存期为 26.7 个月。10 例患者因肿瘤破裂导致急性出血而行紧急栓塞。破裂胃肠间质瘤（GIST）患者（n=3）的中位总生存期为 611 天，破裂血管肉瘤患者（n=7）的中位总生存期为 19 天。
经导管肝靶向治疗安全，可能在不可切除的原发性和转移性肝肉瘤的选择性治疗中发挥作用。破裂 GIST 的紧急栓塞可能有助于稳定患者病情，并为未来提供更明确的治疗。然而，紧急栓塞治疗破裂血管肉瘤的疗效有限，可能是由于破裂时静脉出血较多以及该病变的侵袭性行为。
