米兰标准内肝细胞癌患者中不进行肺分流估计的简化放射性栓塞术与常规放射性栓塞术的比较
Streamlining Radioembolization without Lung Shunt Estimation versus Regular Radioembolization in Patients with Hepatocellular Carcinoma within the Milan Criteria.
作者信息
Kim Hyo-Cheol, Suh Minseok, Paeng Jin Chul, Lee Jong Hyuk, Lee Myungsu, Chung Jin Wook, Choi Jin Woo
机构信息
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.
出版信息
J Vasc Interv Radiol. 2025 Jan;36(1):78-87.e1. doi: 10.1016/j.jvir.2024.10.007. Epub 2024 Oct 12.
PURPOSE
To assess the effectiveness and safety of streamlining transarterial radioembolization (S-TARE) without lung shunt fraction estimation using nuclear medicine imaging, compared with regular transarterial radioembolization (R-TARE), for patients with hepatocellular carcinoma (HCC) within the Milan criteria.
MATERIALS AND METHODS
Between January 2012 and December 2022, 100 consecutive patients with HCC within the Milan criteria underwent R-TARE (n = 38) or S-TARE (n = 62) and were retrospectively analyzed. Adverse events, complete response (CR) rates, and time to progression (TTP) by the modified Response Evaluation Criteria in Solid Tumours (mRECIST) and localized mRECIST following each treatment were compared using the Fisher exact test and Kaplan-Meier curve analyses with covariate adjustment.
RESULTS
Serious adverse events ≥ Grade 3 occurred in 3 (7.9%, 3/38) and 2 (3.2%, 2/62) patients following R-TARE and S-TARE, respectively (P = .365). No patients developed radiation pneumonitis. Among the 84 patients treated with glass microspheres, the CR rates were not significantly different after R-TARE (96.9%, 31/32) and S-TARE (90.4%, 47/52) (P = .400). There was no significant difference in TTP by mRECIST between R-TARE and S-TARE (unadjusted P = .400, adjusted P = .712). For patients with a single HCC, no significant difference was observed in TTP by localized mRECIST (unadjusted P = .090, adjusted P = .242). In the 16 patients treated with resin microspheres, the CR rates were 66.7% (4/6) for R-TARE and 90% (9/10) for S-TARE, respectively (P = .518).
CONCLUSIONS
S-TARE using yttrium-90 glass or resin microspheres was as effective and safe as R-TARE for HCC within the Milan criteria.
目的
评估在不使用核医学成像估计肺分流分数的情况下简化经动脉放射性栓塞术（S-TARE）与常规经动脉放射性栓塞术（R-TARE）相比，对符合米兰标准的肝细胞癌（HCC）患者的有效性和安全性。
材料与方法
2012年1月至2022年12月期间，100例连续符合米兰标准的HCC患者接受了R-TARE（n = 38）或S-TARE（n = 62）治疗，并进行回顾性分析。使用Fisher精确检验和带有协变量调整的Kaplan-Meier曲线分析比较每次治疗后的不良事件、完全缓解（CR）率以及根据实体瘤改良反应评估标准（mRECIST）和局部mRECIST得出的进展时间（TTP）。
结果
R-TARE和S-TARE治疗后分别有3例（7.9%，3/38）和2例（3.2%，2/62）患者发生≥3级严重不良事件（P = 0.365）。无患者发生放射性肺炎。在84例接受玻璃微球治疗的患者中，R-TARE和S-TARE后的CR率无显著差异（分别为96.9%，31/32和90.4%，47/52）（P = 0.400）。R-TARE和S-TARE之间根据mRECIST得出的TTP无显著差异（未调整P = 0.400，调整后P = 0.712）。对于单个HCC患者，根据局部mRECIST得出的TTP无显著差异（未调整P = 0.090，调整后P = 0.242）。在16例接受树脂微球治疗的患者中，R-TARE和S-TARE的CR率分别为66.7%（4/6）和90%（9/10）（P = 0.518）。
结论
对于符合米兰标准的HCC，使用钇-90玻璃或树脂微球的S-TARE与R-TARE一样有效且安全。
Zotero 插件