Clinical factors related to recurrence after hepatic arterial concurrent chemoradiotherapy for advanced but liver-confined hepatocellular carcinoma.
Clinical factors related to recurrence after hepatic arterial concurrent chemoradiotherapy for advanced but liver-confined hepatocellular carcinoma.
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DOI：
10.1093/jrr/rrt034
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发表时间：
2013-11-01
影响因子：
2
通讯作者：
Seong J
中科院分区：
文献类型：
--
作者：
Cha H;Yoon HI;Lee IJ;Koom WS;Han KH;Seong J
在索拉非尼时代之前，晚期但局限于肝细胞癌（HCC）是通过肝脏定向治疗来治疗的。我们组已进行肝动脉同步放化疗（CCRT），取得了显着的局部控制效果，但经常失败。本研究的目的是分析肝脏定向疗法 CCRT 治疗 HCC 的失败模式并找出预测临床因素。对 2001 年 5 月至 2009 年 11 月期间接受 CCRT 治疗的 138 名 HCC 患者进行了回顾性分析。基于方案的 CCRT 采用局部放疗 (RT) 和同步 5-氟尿嘧啶 (5-FU) 肝动脉灌注化疗 (HAIC)，随后每月进行 HAIC（5-FU 和顺铂）。失败模式分为三组：内场、肝内-外场和肝外失败。 RT 后 3 个月时，34.0% 的患者出现治疗失败。分别有 12 名（8.6%）、26 名（18.7%）和 27 名（19.6%）患者出现内场、肝内-外场和肝外衰竭。内场、外场和肝外衰竭的中位无进展生存期分别为 22.4、18 和 21.5 个月。对于内场失败，CCRT 治疗前的病史是一个重要因素 (P = 0.020)。 CCRT 前由维生素 K 缺失或拮抗剂 II 诱导的甲胎蛋白和凝血酶原水平是肝外衰竭的重要因素 (P = 0.029)。 CCRT 后治疗失败在 HCC 患者中很常见，并且肝内-外场和肝外失败比内场失败更常见。 CCRT 前治疗史和 CCRT 前肿瘤标志物水平被确定为可以预测治疗失败的危险因素。对于存在危险因素的患者需要加强治疗。
Before the sorafenib era, advanced but liver-confined hepatocellular carcinoma (HCC) was treated by liver-directed therapy. Hepatic arterial concurrent chemoradiotherapy (CCRT) has been performed in our group, giving substantial local control but frequent failure. The aim of this study was to analyze patterns of failure and find out predictive clinical factors in HCC treated with a liver-directed therapy, CCRT. A retrospective analysis was done for 138 HCC patients treated with CCRT between May 2001 and November 2009. Protocol-based CCRT was performed with local radiotherapy (RT) and concurrent 5-fluorouracil (5-FU) hepatic arterial infusion chemotherapy (HAIC), followed by monthly HAIC (5-FU and cisplatin). Patterns of failure were categorized into three groups: infield, intrahepatic-outfield and extrahepatic failure. Treatment failure occurred in 34.0% of patients at 3 months after RT. Infield, intrahepatic-outfield and extrahepatic failure were observed in 12 (8.6%), 26 (18.7%) and 27 (19.6%) patients, respectively. Median progression-free survival for infield, outfield and extrahepatic failure was 22.4, 18 and 21.5 months, respectively. For infield failure, a history of pre-CCRT treatment was a significant factor (P = 0.020). Pre-CCRT levels of alpha-fetoprotein and prothrombin induced by vitamin K absence or antagonist-II were significant factors for extrahepatic failure (P = 0.029). Treatment failures after CCRT were frequent in HCC patients, and were more commonly intrahepatic-outfield and extrahepatic failures than infield failure. A history of pre-CCRT treatment and levels of pre-CCRT tumor markers were identified as risk factors that could predict treatment failure. More intensified treatment is required for patients presenting risk factors.
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影响因子：
158.5
作者：
Llovet, Josep M.;Ricci, Sergio;Bruix, Jordi
通讯作者：
Bruix, Jordi
影响因子：
3.5
作者：
Fujiyama, S;Tanaka, M;Tomita, K
通讯作者：
Tomita, K
索拉非尼对亚太地区晚期肝细胞癌患者的疗效和安全性：一项 III 期随机、双盲、安慰剂对照试验
影响因子：
51.1
作者：
Cheng, Ann-Lii;Kang, Yoon-Koo;Guan, Zhongzhen
通讯作者：
Guan, Zhongzhen
影响因子：
6.4
作者：
Peng, SY;Chen, WJ;Hsu, HC
通讯作者：
Hsu, HC
DOI：
10.1016/s0360-3016(96)00528-7
发表时间：
1997-01-15
影响因子：
7
作者：
Robertson, JM;Lawrence, TS;Ensminger, WD
通讯作者：
Ensminger, WD