Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
Department of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
J Vasc Interv Radiol. 2019 Dec;30(12):1915-1923. doi: 10.1016/j.jvir.2019.06.003. Epub 2019 Jul 26.
To identify and characterize the delayed effects of transarterial radioembolization (TARE) on the liver.
A single-institution retrospective analysis was undertaken of all patients who received TARE between 2005 and 2014 and survived at least 1 year from the initial TARE (n = 106). Patients were evaluated for the presence or absence of radioembolization-induced chronic hepatotoxicity (RECHT) occurring at least 6 months after TARE. The mean age of patients was 63 years of age, and the malignancy most commonly treated was neuroendocrine tumor (54%). Adjudication of hepatic decompensation to RECHT versus alternative causes was performed by a multidisciplinary panel of specialists from hepatology, radiation oncology, and interventional radiology.
Eight patients were excluded from analysis because of liver transplantation (2) or incomplete data (6). RECHT occurred in 13 of 98 patients (13%), and 5 deaths (5%) occurred from hepatic decompensation. There were a total of 69 toxicity events in patients developing RECHT. The most common events were elevation of alkaline phosphatase (10), decrease in serum albumin (10), and development of ascites (9). RECHT patients had a higher intrahepatic tumor volume (P = .021) and a higher number of hepatic comorbidities leading to cirrhosis (P = .015).
Delayed radiation-induced hepatic toxicity occurred in 13% of patients following radioembolization, with 5 fatalities adjudicated to be a result of the treatment. Tumor involvement of greater than 50% of the liver and cirrhosis were predisposing factors for RECHT.
确定并描述经动脉放射性栓塞（TARE）对肝脏的延迟效应。
对 2005 年至 2014 年间接受 TARE 治疗且初始 TARE 后至少存活 1 年的所有患者（n=106）进行了单中心回顾性分析。评估患者是否存在 TARE 至少 6 个月后发生的放射性栓塞诱导的慢性肝毒性（RECHT）。患者的平均年龄为 63 岁，最常见的治疗恶性肿瘤为神经内分泌肿瘤（54%）。肝脏失代偿的判定归因于 RECHT 还是其他原因，由来自肝病学、放射肿瘤学和介入放射学的多学科专家小组进行。
由于肝移植（2 例）或数据不完整（6 例），有 8 例患者被排除在分析之外。98 例患者中有 13 例（13%）发生了 RECHT，5 例（5%）因肝性失代偿而死亡。发生 RECHT 的患者共有 69 例毒性事件。最常见的事件是碱性磷酸酶升高（10 例）、血清白蛋白下降（10 例）和腹水形成（9 例）。RECHT 患者的肝内肿瘤体积更大（P=0.021），导致肝硬化的肝脏合并症更多（P=0.015）。
在接受放射性栓塞治疗后，13%的患者出现了延迟性放射性肝毒性，其中 5 例死亡被判定为治疗的结果。肝脏受累超过 50%和肝硬化是发生 RECHT 的易感因素。
