Yu Chun-Yen, Huang Po-Hsun, Tsang Leo Leung-Chit, Hsu Hsien-Wen, Lim Wei-Xiong, Weng Ching-Chun, Huang Tung-Liang, Hsu Chien-Chin, Chen Chao-Long, Ou Hsin-You, Cheng Yu-Fan
Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Hepatocell Carcinoma. 2023 Jan 11;10:17-26. doi: 10.2147/JHC.S385478. eCollection 2023.
The purpose of this study was to assess the safety and efficacy of Yttrium-90 radioembolization using in unresectable hepatocellular carcinoma.
From 2017 to 2021, 32 patients with unresectable hepatocellular carcinoma, with mean tumor diameter about 7cm (21 males, 11 females; median age, 57.5 years of age), treated with Yttrium-90 radioembolization using resin microspheres were reviewed at pre-Yttrium-90 and post-Yttrium-90 follow-up. Tumor response was assessed according to the modified Response Evaluation Criteria in Solid Tumors. Outcomes including overall survival and progression-free survival were reported.
Median follow-up was 18 months. At follow-up examinations at 3-, 6-, and 12-months follow-up, the overall survival rates were 94%, 87% and 59%, and the progression-free survival rates were 78%, 64% and 60%, respectively. Complete response, partial response, stable disease, and progressive disease were noted in 7 (21.9%), 14 (43.7%), 4 (12.5%), and 7 (21.9%) patients, respectively. The disease control rate was 78.1%, the objective response rate was 65.6%, and the successful downstage rate was 34.4% (11 of 32). Nine of thirty-two patients underwent resection or transplantation after Yttrium-90 radioembolization with 2-year overall survival being 100%. No serious adverse events occurred after Yttrium-90 treatment. Worse overall survival was related to the larger tumor, higher stage, Eastern Cooperative Oncology Group performance status, and Child-Pugh score. And worse progression-free survival was related to the higher tumor burden, and pre-Yttrium-90 serum α-fetoprotein level >100.
Yttrium-90 Radioembolization can control hepatocellular carcinoma well even in advanced diseases. Patients successfully downstaging/bridging to resection or transplantation have excellent overall survival.
本研究的目的是评估钇-90放射性栓塞术治疗不可切除肝细胞癌的安全性和有效性。
回顾性分析2017年至2021年期间32例接受树脂微球钇-90放射性栓塞术治疗的不可切除肝细胞癌患者，平均肿瘤直径约7cm（男性21例，女性11例；中位年龄57.5岁），在钇-90治疗前和治疗后进行随访。根据改良的实体瘤疗效评价标准评估肿瘤反应。报告总生存期和无进展生存期等结果。
中位随访时间为18个月。在3个月、6个月和12个月的随访检查中，总生存率分别为94%、87%和59%，无进展生存率分别为78%、64%和60%。完全缓解、部分缓解、疾病稳定和疾病进展的患者分别为7例（21.9%）、14例（43.7%）、4例（12.5%）和7例（21.9%）。疾病控制率为78.1%，客观缓解率为65.6%，成功降期率为34.4%（32例中的11例）。32例患者中有9例在钇-90放射性栓塞术后接受了切除或移植，2年总生存率为100%。钇-90治疗后未发生严重不良事件。较差的总生存期与较大的肿瘤、更高的分期、东部肿瘤协作组体能状态和Child-Pugh评分有关。较差的无进展生存期与更高的肿瘤负荷以及钇-90治疗前血清甲胎蛋白水平>100有关。
钇-90放射性栓塞术即使在晚期疾病中也能很好地控制肝细胞癌。成功降期/过渡到切除或移植的患者总生存期良好。
