Tabone Marco, Calvo Amedeo, Russolillo Nadia, Langella Serena, Carbonatto Paolo, Lo Tesoriere Roberto, Richetta Elisa, Pellerito Riccardo, Ferrero Alessandro
Department of Gastroenterology, Mauriziano Hospital, Turin, Italy.
Department of Interventional Radiology, Mauriziano Hospital, Turin, Italy.
J Gastrointest Oncol. 2020 Feb;11(1):84-90. doi: 10.21037/jgo.2019.06.01.
Only one third of patients with hepatocellular carcinoma can benefit from curative treatments at the time of first diagnosis. Tumor downstaging by radioembolization may enable initially unresectable hepatocellular carcinoma (HCC) to be treated with surgery lengthening survival.
From June 2011 through June 2014, all patients with a first diagnosis of unresectable HCC with intrahepatic portal vein thrombosis were treated in our center with radioembolization using 90-yttrium resin microspheres. A 3-year enrollment period and a 5-year follow-up were planned to adequately investigate survivals.
Twenty-four patients were enrolled, five were downstaged to surgery, eight did not reach downstaging but achieved partial response or stable disease, and eleven showed HCC progression despite radioembolization. High tumor absorbed radiation doses (454 . 248 and 138 Gy, P=0.005) and low serum AFP levels (53 . 1,447 and 4,603 ng/mL, P=0.05) were the variables significantly associated with successful downstaging. Mean and median survivals were 54, 30 and 11 months and 70, 24 and 11 months in the three groups respectively. No severe side effects were registered.
In our center, about 20% of patients with locally advanced unresectable hepatocellular carcinoma were successfully downstaged to surgery after radioembolization. This strategy increases survival and is associated with an excellent safety profile.
只有三分之一的肝细胞癌患者在首次诊断时能够从根治性治疗中获益。通过放射栓塞使肿瘤降期可能会使最初无法切除的肝细胞癌（HCC）能够接受手术治疗，从而延长生存期。
从2011年6月至2014年6月，我们中心对所有首次诊断为无法切除且伴有肝内门静脉血栓形成的HCC患者采用90钇树脂微球进行放射栓塞治疗。计划进行3年的入组期和5年的随访，以充分研究生存率。
共纳入24例患者，5例降期至可手术切除，8例未达到降期但获得部分缓解或疾病稳定，11例尽管接受了放射栓塞仍显示HCC进展。高肿瘤吸收辐射剂量（454.248和138 Gy，P = 0.005）和低血清甲胎蛋白水平（53.1,447和4,603 ng/mL，P = 0.05）是与成功降期显著相关的变量。三组的平均生存期和中位生存期分别为54、30和11个月以及70、24和11个月。未记录到严重的副作用。
在我们中心，约20%的局部晚期无法切除的肝细胞癌患者在放射栓塞后成功降期至可手术切除。该策略可提高生存率且安全性良好。
