Currie Brian M, Nadolski Gregory, Mondschein Jeffrey, Dagli Mandeep, Sudheendra Deepak, Stavropoulos S William, Soulen Michael C
Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
J Vasc Interv Radiol. 2020 Oct;31(10):1627-1635. doi: 10.1016/j.jvir.2020.05.019.
To compare the manifestations of chronic liver injury following transarterial chemoembolization with those of transarterial radioembolization (TARE) in patients with neuroendocrine tumor (NET).
This study consisted of an Institutional Review Board-approved single-institution retrospective analysis of NET patients who received transarterial chemoembolization from 2006 to 2016 and TARE from 2005 to 2014 and survived at least 1 year from the initial treatment. Patients receiving only transarterial chemoembolization (n = 63) or TARE (n = 28) were evaluated for the presence or absence of durable hepatic toxicities occurring at least 6 months after initial treatment. The definitions and grades of liver injury were adapted from Common Terminology Criteria for Adverse Events version 4.0 and were characterized by the presence of laboratory or clinical toxicities of Grade 3 or above.
Chronic hepatic toxicity occurred in 14 of 63 transarterial chemoembolization patients (22%) with a total of 26 Grade 3-4 events, in whom elevation of bilirubin was the most common toxicity, compared to 8 of 28 TARE patients (29%) with a total of 16 Grade 3-4 and 2 Grade 5 events, in whom ascites were the most frequent toxicity. There were more laboratory toxicities in the transarterial chemoembolization group (65% vs 38%, P = .11) and fewer Grade 4-5 injuries (6% vs 27% of patients, P = .06). There was also a significantly higher number of patients who experienced intrahepatic progression of disease in the transarterial chemoembolization cohort than in the TARE patients (75% vs 43%, respectively; P = .005).
Delayed hepatotoxicity from transarterial chemoembolization and TARE occurred in 22% and 29% of patients, respectively, from 6 months to several years following treatment. Transarterial chemoembolization-related toxicities on average were less severe and manifested primarily as laboratory derangements, compared to TARE toxicities which consisted of clinical hepatic decompensation.
比较经动脉化疗栓塞术与经动脉放射性栓塞术（TARE）治疗神经内分泌肿瘤（NET）患者后慢性肝损伤的表现。
本研究为单机构回顾性分析，经机构审查委员会批准，纳入2006年至2016年接受经动脉化疗栓塞术以及2005年至2014年接受TARE治疗且自初始治疗后存活至少1年的NET患者。仅接受经动脉化疗栓塞术（n = 63）或TARE（n = 28）的患者被评估在初始治疗后至少6个月是否出现持续性肝毒性。肝损伤的定义和分级采用《不良事件通用术语标准》第4.0版，以3级或以上实验室或临床毒性的存在为特征。
63例经动脉化疗栓塞术患者中有14例（22%）发生慢性肝毒性，共出现26次3 - 4级事件，其中胆红素升高是最常见的毒性反应；相比之下，28例TARE患者中有8例（29%）发生慢性肝毒性，共出现16次3 - 4级事件和2次5级事件，其中腹水是最常见的毒性反应。经动脉化疗栓塞术组的实验室毒性更多（65%对38%，P = 0.11），4 - 5级损伤更少（患者的6%对27%，P = 0.06）。经动脉化疗栓塞术队列中出现疾病肝内进展的患者数量也显著高于TARE患者（分别为75%对43%；P = 0.005）。
经动脉化疗栓塞术和TARE的迟发性肝毒性分别在治疗后6个月至数年发生在22%和29%的患者中。与TARE毒性（表现为临床肝失代偿）相比，经动脉化疗栓塞术相关毒性平均较轻，主要表现为实验室指标紊乱。
