Servicio de Medicina Nuclear, Hospital Clínico Universitario, Valencia, Spain.
Servicio de Radiodiagnóstico, Hospital Clínico Universitario, Valencia, Spain.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2023 Jul-Aug;42(4):255-264. doi: 10.1016/j.remnie.2023.05.004. Epub 2023 Jun 1.
To determine the results of radioembolization transarterial (TARE), in the treatment of liver tumors, a retrospective evaluation was performed after 112 TARE with Y-microspheres administered in 82 patients in a single hospital, analyzing efficacy and safety, after a follow-up greater than or equal to 1 year post-TARE in all patients, and evaluating the possible relationship between treatment response and patient survival.
We have administered 57 single TARE and 55 multiple TARE in patients with hepatocellular carcinoma (53), liver metastases (25) and cholangiocarcinoma (4), with prior multidisciplinary evaluation, clinical, angiographic and gammagraphic (planar/SPECT/SPECT-CT with Tc-MAA), multicompartment model (MIRD equations), post-TARE screening (planar/SPECT/SPECT-CT), clinical and radiological follow-up, tumor response evaluation (mRECIST criteria) and Kaplan-Meier analysis to determine progression-free survival (PFS) and overall survival (OS).
Therapeutic intention was palliative (82%) and as bridge to liver transplantation/surgical resection (17%). We obtained response (R), complete or partial, in 65.9% of cases. One year after TARE 34.7% of patients with R and 19.2% of non-R were progression-free (P: .003), with OS of 80% for R and 37.5% for non-R (P: .001). Survival analysis showed median OS of 18 months (95% CI 15.7-20.3) for R and 9 months (95% CI 6.1-11.8) for non-R (P: .03). We found mild (27.6%) and severe (5.3%) side effects, all of them resolved, without higher incidence after multiple TARE.
TARE with Y-microspheres, in appropriately selected patients with liver tumors, provides therapeutic efficacy and low rate of toxicity, with higher PFS and OS in patients with TARE response compared to those who did not respond.
通过对在一家医院接受 112 例 Y 微球放射性栓塞治疗(TARE)的 82 例患者进行回顾性评估,分析疗效和安全性,所有患者在 TARE 后随访时间均大于等于 1 年,并评估治疗反应与患者生存之间的可能关系,以确定 TARE 在治疗肝肿瘤中的结果。
我们对 57 例单发 TARE 和 55 例多发 TARE 患者进行了治疗,这些患者的疾病包括肝细胞癌(53 例)、肝转移瘤(25 例)和胆管细胞癌(4 例),所有患者均经过多学科评估、临床、血管造影和伽马成像(平面/SPECT/SPECT-CT 与 Tc-MAA)、多室模型(MIRD 方程)、TARE 后筛查(平面/SPECT/SPECT-CT)、临床和影像学随访、肿瘤反应评估(mRECIST 标准)和 Kaplan-Meier 分析,以确定无进展生存期(PFS)和总生存期(OS)。
治疗目的为姑息性(82%)和作为肝移植/手术切除的桥梁(17%)。我们获得了 65.9%的完全或部分缓解(R)反应。在 TARE 后 1 年,R 组中有 34.7%的患者无进展,而非 R 组中仅有 19.2%的患者无进展(P:.003),R 组的 OS 为 80%,而非 R 组的 OS 为 37.5%(P:.001)。生存分析显示,R 组的中位 OS 为 18 个月(95%CI 15.7-20.3),而非 R 组的中位 OS 为 9 个月(95%CI 6.1-11.8)(P:.03)。我们发现轻度(27.6%)和重度(5.3%)不良反应,所有不良反应均得到缓解,且多发 TARE 后无更高的不良反应发生率。
在适当选择的肝肿瘤患者中,使用 Y 微球进行 TARE 治疗可提供治疗效果,并降低毒性发生率,与未缓解的患者相比,缓解的患者具有更高的 PFS 和 OS。