Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.
Cardiovasc Intervent Radiol. 2022 Oct;45(10):1485-1493. doi: 10.1007/s00270-022-03250-8. Epub 2022 Aug 26.
Tumors involving the caudate lobe present a unique therapeutic challenge due to their complex anatomy and the safety and efficacy of locoregional therapy can be variable. The purpose of this study is to analyze the outcomes of radiation segmentectomy for primary caudate lobe tumors.
Eight patients [5 women and 3 men; median age = 69 y (range 50-79)] that underwent transarterial radioembolization (TARE) using yttrium-90 (Y90) glass microspheres for primary caudate lobe tumors (hepatocellular carcinoma = 6, intrahepatic cholangiocarcinoma = 2) from August 2017 to March 2021 were retrospectively analyzed. Descriptive statistics, treatment parameters, tumor response (using modified response evaluation criteria in solid tumors), adverse events [using common terminology criteria for adverse events (CTCAE)], and survival outcomes were evaluated.
Eight primary caudate lobe tumors with a median size of 2.2 cm [interquartile range (IQR), 1.7-3.3] and Child-Pugh class A liver function underwent TARE of the caudate lobe. The median radiation dose was 596 Gy (IQR 356-1585), median total activity was 0.84 GBq (IQR 0.56-1.31), median specific activity was 473 Bq/sphere (IQR 226-671), and the median number of Y90 microspheres used was 1.4 million (IQR 1.2-3.4). All complications were CTCAE grade 1, and no clinically significant hilar plate complications were observed. In targeted tumors, complete response was seen in all patients. At a median follow-up period of 16.6 months (IQR 6.6-21.6) 75% (6/8) of patients were alive with no in-field progression.
Radiation segmentectomy of primary caudate lobe tumors appears effective and is well tolerated in this limited case series within the described treatment parameters.
Level 4, Case Series.
由于尾状叶肿瘤的复杂解剖结构，以及局部区域治疗的安全性和有效性存在差异，因此对尾状叶肿瘤的治疗具有独特的挑战性。本研究旨在分析原发性尾状叶肿瘤放射切除术的结果。
对 2017 年 8 月至 2021 年 3 月期间接受钇 90（Y90）玻璃微球经肝动脉放射栓塞术（TARE）治疗的 8 例原发性尾状叶肿瘤（肝细胞癌=6 例，肝内胆管细胞癌=2 例）患者进行回顾性分析。采用描述性统计、治疗参数、肿瘤反应（采用实体瘤反应评价标准修订版）、不良事件（采用常见不良事件术语标准（CTCAE））和生存结局进行评价。
8 例原发性尾状叶肿瘤，肿瘤大小中位数为 2.2cm（四分位距，1.7-3.3），肝功能 Child-Pugh 分级为 A 级，行尾状叶 TARE 治疗。放射剂量中位数为 596Gy（四分位距，356-1585），总活度中位数为 0.84GBq（四分位距，0.56-1.31），比活度中位数为 473Bq/微球（四分位距，226-671），使用的 Y90 微球中位数为 140 万个（四分位距，120-340 万个）。所有并发症均为 CTCAE 1 级，未观察到有临床意义的肝门板并发症。在靶肿瘤中，所有患者均达到完全缓解。中位随访期为 16.6 个月（四分位距，6.6-21.6），75%（6/8）的患者存活且无肿瘤场内进展。
在本研究描述的治疗参数范围内，原发性尾状叶肿瘤的放射切除术效果显著，且患者耐受性良好。
4 级，病例系列。
