Department of Radiology, Seoul National University Hospital, Seoul, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
J Vasc Interv Radiol. 2024 Feb;35(2):203-212. doi: 10.1016/j.jvir.2023.10.011. Epub 2023 Oct 21.
To evaluate the safety and effectiveness of ablative radioembolization for large hepatocellular carcinoma (HCC) while preserving a small future liver remnant (FLR).
Twenty-five patients with large HCC of ≥5 cm requiring treatment for >60% of the total liver volume and having well-preserved liver function were treated with ablative glass microsphere radioembolization at a single institution from January 2017 to December 2021. Radioembolization was performed with a mean absorbed dose of >150 Gy, and the FLR per nontumor liver volume (NTLV) was set at >30%. Changes in liver function, adverse events, duration of response (DoR) in a treated area, time-to-progression (TTP), and overall survival (OS) were retrospectively investigated.
The largest tumor diameter and planned dose per treated volume were 11.4 cm ± 3.9 and 242.3 Gy ± 63.6 (169.4 Gy ± 45.9 per whole liver volume), respectively. All patients remained at Child-Pugh Class A for 90 days. No patient experienced Grade 3‒4 hyperbilirubinemia or new ascites. One patient (lung dose, 27.8 Gy) developed radiation pneumonitis requiring transient steroid treatment. According to the posttreatment dosimetry, the tumorous and nontumorous liver absorbed doses were 418.8 Gy ± 227.4 and 69.0 Gy ± 32.1, respectively. The median DoR in a treated area and TTP were 22.0 and 17.1 months, respectively. The 5-year OS rate was 83.2%.
Ablative radioembolization of large HCC of ≥5 cm can be performed safely and effectively in patients with preserved liver function when FLR/NTLV exceeds 30%.
评估消融性放射性栓塞治疗大肝癌（HCC）的安全性和有效性，同时保留较小的未来肝残留（FLR）。
2017 年 1 月至 2021 年 12 月，在一家机构对 25 例需要治疗大于总肝体积 60%的大 HCC（≥5cm）且肝功能良好的患者进行了消融性玻璃微球放射性栓塞治疗。放射性栓塞治疗的平均吸收剂量>150Gy，非肿瘤性肝体积（NTLV）与 FLR 的比值>30%。回顾性研究了肝功能变化、不良事件、治疗区域的缓解持续时间（DoR）、无进展时间（TTP）和总生存期（OS）。
最大肿瘤直径和计划治疗体积剂量分别为 11.4cm±3.9cm 和 242.3Gy±63.6Gy（169.4Gy±45.9Gy 每整个肝体积）。所有患者在 90 天内仍保持 Child-Pugh 分级 A。无患者出现 3-4 级高胆红素血症或新腹水。1 例（肺剂量 27.8Gy）患者发生放射性肺炎，需短暂使用类固醇治疗。根据治疗后剂量学，肿瘤和非肿瘤性肝脏的吸收剂量分别为 418.8Gy±227.4Gy 和 69.0Gy±32.1Gy。治疗区域的中位 DoR 和 TTP 分别为 22.0 个月和 17.1 个月。5 年 OS 率为 83.2%。
当 FLR/NTLV 超过 30%时，保留肝功能的患者可安全有效地进行消融性放射性栓塞治疗大 HCC（≥5cm）。
