乳腺癌肝转移放射性栓塞疗效与辐射剂量的关系。
Relationship of radiation dose to efficacy of radioembolization of liver metastasis from breast cancer.
机构信息
Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Division of Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
出版信息
Eur J Radiol. 2021 Mar;136:109539. doi: 10.1016/j.ejrad.2021.109539. Epub 2021 Jan 12.
PURPOSE
To determine the relationship of tumoral and nontumoral radiation dose to response and toxicity after transarterial radioembolization (TARE) of breast cancer liver metastasis.
METHODS
This retrospective study evaluated all patients with breast cancer liver metastases treated with TARE (2/2011-6/2019). Extent of disease was measured as unilobar or bilobar on baseline PET/CT prior to TARE. Response was assessed for targeted regions with modified PERCIST criteria on first follow-up PET/CT. Tumoral and nontumoral liver dosimetry was evaluated by performing volumetric segmentation on post-TARE Bremsstrahlung SPECT/CT. ≥Grade 3 hepatotoxicity was defined as ≥grade 3 bilirubin/AST/ALT elevation or ascites requiring intervention. Fisher's exact tests, Wilcoxon rank sum tests, and Kaplan-Meier survival analysis were performed.
RESULTS
Among 64 women, 60 patients had pre- and post-TARE PET/CT, of whom 46/60 (77 %) achieved objective response (OR). Responders received higher tumoral dose with a median (interquartile range) of 167 (96-217) vs. 54 (45-62) Gy (p < 0.001). ≥Grade 3 hepatotoxicity occurred in 8/64 (12.5 %) and was associated with higher pre-treatment bilirubin levels of 0.9 (0.9-1.1) vs. 0.5 (0.4-0.7) mg/dL (p = 0.013). Median overall survival (OS) was 11 (95 % CI 10-19) months. Bilobar disease (Hazard Ratio [HR]: 2.77, 95 % CI 1.11-6.89, p = 0.028) and elevated pre-TARE AST (HR 1.02, 95 % CI 1.01-1.03, p < 0.001) were independently associated with shorter survival. ≥Grade 3 hepatotoxicity was associated with reduced survival (p < 0.001). OR was associated with longer OS of 17 months, compared with 10 months (p = 0.027).
CONCLUSION
In TARE for breast cancer liver metastasis, higher tumoral radiation dose (>79.5 Gy) was associated with OR, which was associated with longer survival. Pre-existing liver dysfunction was associated with hepatotoxicity, which was associated with decreased survival.
目的
确定乳腺癌肝转移经肝动脉化疗栓塞术（TARE）后肿瘤和非肿瘤辐射剂量与反应和毒性的关系。
方法
本回顾性研究评估了所有接受 TARE 治疗的乳腺癌肝转移患者（2011 年 2 月至 2019 年 6 月）。TARE 前基线 PET/CT 上测量疾病范围为单叶或双叶。第一次随访 PET/CT 时采用改良 PERCIST 标准评估靶向区域的反应。TARE 后 Bremsstrahlung SPECT/CT 进行容积分割评估肿瘤和非肿瘤肝脏剂量。定义≥3 级肝毒性为≥3 级胆红素/天冬氨酸转氨酶/丙氨酸转氨酶升高或需要干预的腹水。采用 Fisher 确切检验、Wilcoxon 秩和检验和 Kaplan-Meier 生存分析。
结果
在 64 名女性中，有 60 名患者进行了 TARE 前后的 PET/CT 检查，其中 46/60（77%）达到了客观缓解（OR）。应答者接受了更高的肿瘤剂量，中位数（四分位距）为 167（96-217）比 54（45-62）Gy（p<0.001）。64 例患者中有 8/64（12.5%）发生≥3 级肝毒性，与较高的治疗前胆红素水平 0.9（0.9-1.1）比 0.5（0.4-0.7）mg/dL 相关（p=0.013）。中位总生存期（OS）为 11（95%CI 10-19）个月。双侧疾病（危险比[HR]：2.77，95%CI 1.11-6.89，p=0.028）和升高的治疗前天冬氨酸转氨酶（HR 1.02，95%CI 1.01-1.03，p<0.001）与较短的生存期独立相关。≥3 级肝毒性与生存期缩短相关（p<0.001）。与 10 个月相比，OR 与更长的 OS 相关（17 个月，p=0.027）。
结论
在乳腺癌肝转移的 TARE 中，较高的肿瘤辐射剂量（>79.5 Gy）与 OR 相关，而 OR 与较长的生存期相关。存在肝功能障碍与肝毒性相关，而肝毒性与生存期缩短相关。
Zotero 插件