Lemaire Mégane, Lucidi Valerio, Bouazza Fikri, Katsanos Georgios, Vanderlinden Bruno, Levillain Hugo, Delatte Philippe, Garcia Camilo A, Vouche Michael, Galdon Maria Gomez, Demetter Pieter, Deleporte Amélie, Hendlisz Alain, Flamen Patrick, Donckier Vincent
Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
Abdominal Surgery, Hôpital Erasme, Université Libre de Bruxelles, Belgium; Centre de Chirurgie Hépato-Biliaire de l'ULB, Université Libre de Bruxelles, Belgium.
HPB (Oxford). 2018 Jul;20(7):641-648. doi: 10.1016/j.hpb.2018.01.006. Epub 2018 Feb 24.
BACKGROUND/PURPOSE: Preoperative selective internal radiation therapy (SIRT) may improve the results of partial hepatectomy (PH) or radiofrequency destruction (RF) for hepatocellular carcinoma (HCC) in patients with cirrhosis. The aim of this study was to evaluate the feasibility and safety of this combined approach.
Patients with cirrhosis and HCC selected for PH or RF were prospectively included and systematically proposed for preoperative SIRT. Feasibility and safety of SIRT and post-SIRT PH or RF were assessed.
Thirty patients were included. SIRT was contraindicated in seven, due to lack of access to tumour artery or to hepato-pulmonary shunts. SIRT was performed in 23 patients without significant complications. Post-SIRT, surgery was refuted in seven patients, due to tumour progression or the patient's deteriorating condition. After surgery, major complications were observed in 2/16 patients (12.5%) and one patient died 52 days post-surgery. A major tumour pathological response was seen in most patients who underwent surgery after SIRT.
On intention-to-treat basis, the overall feasibility of combining preoperative SIRT and surgery was limited. Preoperative SIRT did not increase expected operative morbidity, but post-SIRT, a third of patients were refuted for surgery. Accurate selection criteria and potential long-term oncological benefit of this approach remains to be determined. ClinicalTrials.gov NCT01686880.
背景/目的：术前选择性内放射治疗（SIRT）可能会改善肝硬化患者肝细胞癌（HCC）行肝部分切除术（PH）或射频消融（RF）的治疗效果。本研究旨在评估这种联合治疗方法的可行性和安全性。
前瞻性纳入因PH或RF而入选的肝硬化合并HCC患者，并系统地建议其接受术前SIRT。评估SIRT以及SIRT后PH或RF的可行性和安全性。
共纳入30例患者。7例因无法进入肿瘤动脉或存在肝肺分流而禁忌行SIRT。23例患者接受了SIRT，且无明显并发症。SIRT后，7例患者因肿瘤进展或病情恶化而未进行手术。术后，16例患者中有2例（12.5%）出现严重并发症，1例患者术后52天死亡。大多数接受SIRT后手术的患者出现了明显的肿瘤病理反应。
基于意向性分析，术前SIRT与手术联合的总体可行性有限。术前SIRT并未增加预期的手术发病率，但SIRT后，三分之一的患者未进行手术。这种方法准确的选择标准和潜在的长期肿瘤学获益仍有待确定。ClinicalTrials.gov NCT01686880。
