Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Section of Interventional Radiology, University of Chicago, Chicago, IL, USA.
Br J Radiol. 2021 Mar 1;94(1119):20200752. doi: 10.1259/bjr.20200752. Epub 2021 Jan 7.
To study the efficacy and safety of repeat transarterial radioembolization (TARE) to similar hepatic arterial territories.
Between 3/2011 and 4/2019, 26 patients (25 males and 1 Female, Mean Age: 65 yo, SD: 11.7 yo, Range: 18-83.0 yo) received TARE with Y90 glass microspheres to treat recurrent or residual primary disease in similar hepatic arterial lobe or segments. Tumor response was evaluated by imaging using the modified-RECIST criteria. Incidence of RILD and adverse events were categorized by a standardized scale using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0.
Mean cumulative activity after the first treatment was 2.50 GBq (SD:1.04 GBq, Range:0.61-4.93 GBq) and second treatment was 2.27 GBq (SD:1.01 GBq, Range:0.92-5.46 GBq). Mean interval time between initial and repeat treatments was 9.6 months (Range: 1-53 months). Tumor responses were complete, partial, or progression in 73% ( = 19/26), 23% ( = 6/26), and 4% ( = 1/26) in repeat treatment patients, respectively. The incidence of RILD was 0%. Toxicity after first and second treatment was seen in 19% ( = 5/26) & 23% ( = 6/26) patients, respectively, and were all of CTCAE Grade 2. No significant predictors of treatment toxicity for repeat treatment were identified except increased MELD score ( = 0.04). Kaplan-Meier survival analysis in patients with repeat treatment showed a median survival of 15.0 months (95% CI 8.8-21.1 months) and 19.0 months (95% CI 8.1-29.9 months) in patients who only received one treatment with a value of 0.485.
Repeat TARE with glass microspheres was an effective and safe treatment strategy for disease management in patients with residual or recurrent disease to the similar hepatic arterial territories without any major treatment related toxicity.
Although safety and efficacy of repeat radioembolism has been studied, no study has focused on repeat treatment to similar hepatic arterial territories. The current study shows that repeat treatment to the same hepatic arterial territory is as safe as single treatment to the same territory.
研究重复经肝动脉放射性栓塞（TARE）至相似肝动脉区域的疗效和安全性。
2011 年 3 月至 2019 年 4 月，26 例患者（25 名男性，1 名女性，平均年龄 65 岁，标准差 11.7 岁，范围 18-83.0 岁）接受 Y90 玻璃微球 TARE 治疗，以治疗相似肝叶或肝段的原发性疾病残留或复发。采用改良 RECIST 标准评估肿瘤反应。采用通用不良事件术语标准（CTCAE）v.4.0 对放射性肝损伤（RILD）和不良事件的发生率进行分类。
首次治疗后平均累积活度为 2.50GBq（SD：1.04GBq，范围：0.61-4.93GBq），第二次治疗为 2.27GBq（SD：1.01GBq，范围：0.92-5.46GBq）。初始治疗与重复治疗之间的平均间隔时间为 9.6 个月（范围：1-53 个月）。重复治疗患者的肿瘤反应分别为完全缓解、部分缓解或进展，分别为 73%（=19/26）、23%（=6/26）和 4%（=1/26）。RILD 的发生率为 0%。首次和第二次治疗后的毒性分别见于 19%（=5/26）和 23%（=6/26）的患者，均为 CTCAE 分级 2 级。除 MELD 评分增加（=0.04）外，未发现重复治疗毒性的显著预测因素。对接受重复治疗的患者进行 Kaplan-Meier 生存分析显示，中位生存时间为 15.0 个月（95%CI 8.8-21.1 个月）和 19.0 个月（95%CI 8.1-29.9 个月），仅接受一次治疗的患者 值为 0.485。
玻璃微球重复 TARE 是一种有效且安全的治疗策略，可用于管理残留或复发性疾病患者的相似肝动脉区域的疾病，无任何主要与治疗相关的毒性。
虽然已经研究了重复放射性栓塞的安全性和有效性，但尚无研究关注重复治疗至相似的肝动脉区域。目前的研究表明，对同一肝动脉区域进行重复治疗与对同一区域进行单次治疗一样安全。
