肝癌的 DSM-TACE：不适合其他全身或局部区域治疗的患者的肿瘤反应评估。

DSM-TACE of HCC: Evaluation of Tumor Response in Patients Ineligible for Other Systemic or Loco-Regional Therapies.

机构信息

Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany.

Department of Gastroenterology and Hepatology, University Hospital Essen, Germany.

出版信息

Rofo. 2020 Sep;192(9):862-869. doi: 10.1055/a-1111-9955. Epub 2020 Mar 4.

DOI:10.1055/a-1111-9955

PMID:32131109

Abstract

PURPOSE

To analyze tumor response, survival and safety in patients with non-resectable hepatocellular carcinoma (HCC) treated with transarterial hepatic chemoembolization using degradable starch microspheres (DSM-TACE) combined with doxorubicin who had no local interventional or systemic therapy alternative according to an interdisciplinary conference.

MATERIALS AND METHODS

In this retrospective study, 28 patients (23 male, 5 female, median age 67 years) with unresectable HCC, serum bilirubin levels < 3 mg/dl and contraindications to Sorafenib, RFA, SIRT or cTACE were included. DSM-TACE was performed using Embocept S (15 ml) and doxorubicin (50 mg/25 ml) three times every 4-6 weeks. Patients were initially staged using the Barcelona Clinic Liver Cancer System (BCLC). Basic liver function was evaluated with the MELD-score. Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST).

RESULTS

DSM-TACE could be technically successfully performed in all 28 patients. At control imaging after three treatments, the overall rates of complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were 14.3 %, 25 %, 39.3 % and 21.4 %, respectively, according to mRECIST. With regard to BCLC stages, the results were as follows (CR, PR, PD): BCLC A (n = 8): 7.1 %, 7.1 %, 10.7 %, 1.2 %; BCLC B (n = 12): 0 %, 10.7 %, 17.9 %, 14.3 %; BCLC C (n = 5): 0 %, 3.6 %, 10.7 %, 3.6 %; BCLC D (n = 3): 3.6 %, 3.6 %, 0 %, 3.6 %. According to this, DSM-TACE showed an overall good median survival of 682 days, although the patients' survival was strictly dependent on BCLC stage.

CONCLUSION

DSM-TACE is a safe and promising treatment alternative for patients with unresectable HCC who are ineligible for other loco-regional therapies.

KEY POINTS

· DSM-TACE is a safe treatment alternative for patients ineligible for other local or systemic treatments.. · DSM-TACE did not influence the MELD-score in our study population.. · Patients treated with DSM-TACE showed an overall good median survival of 682 days, strictly dependent on BCLC stage..

CITATION FORMAT

· Haubold J, Reinboldt MP, Wetter A et al. DSM-TACE of HCC: Evaluation of Tumor Response in Patients Ineligible for Other Systemic or Loco-Regional Therapies. Fortschr Röntgenstr 2020; 192: 862 - 869.

摘要

目的

分析根据多学科会议，对于无局部介入或全身治疗选择的不可切除肝细胞癌（HCC）患者，使用可降解淀粉微球（DSM-TACE）联合阿霉素进行经动脉肝化疗栓塞术（TACE）的肿瘤反应、生存和安全性。

材料和方法

在这项回顾性研究中，纳入了 28 名（23 名男性，5 名女性，中位年龄 67 岁）不可切除 HCC、血清胆红素水平 < 3mg/dl 且不符合索拉非尼、RFA、SIRT 或 cTACE 适应证的患者。DSM-TACE 使用 Embocept S（15ml）和阿霉素（50mg/25ml）每 4-6 周进行三次。患者最初根据巴塞罗那临床肝癌系统（BCLC）分期。采用 MELD 评分评估基本肝功能。采用改良实体瘤反应评价标准（mRECIST）评估肿瘤反应。

结果

28 名患者均能成功进行 DSM-TACE 技术操作。在三次治疗后的对照影像学检查中，根据 mRECIST，完全缓解（CR）、部分缓解（PR）、稳定疾病（SD）和疾病进展（PD）的总体比例分别为 14.3%、25%、39.3%和 21.4%。关于 BCLC 分期，结果如下（CR、PR、PD）：BCLC A（n=8）：7.1%、7.1%、10.7%、1.2%；BCLC B（n=12）：0%、10.7%、17.9%、14.3%；BCLC C（n=5）：0%、3.6%、10.7%、3.6%；BCLC D（n=3）：3.6%、3.6%、0%、3.6%。根据这些结果，尽管患者的生存严格取决于 BCLC 分期，但 DSM-TACE 显示出总体良好的中位生存时间为 682 天。