Prognostic factors and prevention of radioembolization-induced liver disease
Prognostic factors and prevention of radioembolization-induced liver disease
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DOI：
10.1002/hep.26191
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发表时间：
2013-03-01
期刊：
影响因子：
13.5
通讯作者：
Sangro, Bruno
中科院分区：
文献类型：
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作者：
Gil-Alzugaray, Belen;Chopitea, Ana;Sangro, Bruno
放射栓塞术(RE)所致肝病(REILD)被定义为在RE后1-2个月出现黄疸和腹水，且无肿瘤进展或胆管闭塞。我们的目的是研究REILD在大量患者队列中的发生率，以及在治疗设计、活动计算和常规使用熊去氧胆酸和小剂量类固醇(改良方案)过程中引入的一系列变化的影响。2003年至2011年期间，260例肝肿瘤患者接受了RE治疗(标准方案：75例，改良方案：185例)。REILD仅见于肝硬变患者或在RE前接受全身化疗的非肝硬变患者。在全球范围内，改良方案组REILD的发生率从22.7%降至5.4%，重度REILD的发生率从13.3%降至2.2%(P<；0.0001)。两组3个月的疾病控制率基本相同(66.7%和67.2%，P=0.93)，治疗效果不受影响。在非肝硬变患者中，RE后2个月内接受化疗和接受标准方案治疗是REILD的独立预测因素。在肝硬变中，小肝脏的存在(总体积1.2 mg/dL)和选择性治疗独立地与REILD相关。结论：REILD是一种罕见但相关的并发症，当肝硬变或化疗前后的肝组织暴露在放射性微球的照射下时，会出现REILD。我们设计了一种综合治疗方案，减少了REILD的频率和严重程度。(2013年《国际肝病》)
Radioembolization (RE)-induced liver disease (REILD) has been defined as jaundice and ascites appearing 1 to 2 months after RE in the absence of tumor progression or bile duct occlusion. Our aims were to study the incidence of REILD in a large cohort of patients and the impact of a series of changes introduced in the processes of treatment design, activity calculation, and the routine use of ursodeoxycholic acid and low-dose steroids (modified protocol). Between 2003 and 2011, 260 patients with liver tumors treated by RE were studied (standard protocol: 75, modified protocol: 185). REILD appeared only in patients with cirrhosis or in noncirrhosis patients exposed to systemic chemotherapy prior to RE. Globally, the incidence of REILD was reduced in the modified protocol group from 22.7% to 5.4% and the incidence of severe REILD from 13.3% to 2.2% (P < 0.0001). Treatment efficacy was not jeopardized since 3-month disease control rates were virtually identical in both groups (66.7% and 67.2%, P = 0.93). Exposure to chemotherapy in the 2-month period following RE and being treated by the standard protocol were independent predictors of REILD among noncirrhosis patients. In cirrhosis, the presence of a small liver (total volume 1.2 mg/dL), and treatment in a selective fashion were independently associated with REILD. Conclusion: REILD is an uncommon but relevant complication that appears when liver tissue primed by cirrhosis or prior and subsequent chemotherapy is exposed to the radiation delivered by radioactive microspheres. We designed a comprehensive treatment protocol that reduces the frequency and the severity of REILD. (HEPATOLOGY 2013)