Radiation Segmentectomy: Potential Curative Therapy for Early Hepatocellular Carcinoma
Radiation Segmentectomy: Potential Curative Therapy for Early Hepatocellular Carcinoma
复制标题
DOI：
10.1148/radiol.2018171768
复制
发表时间：
2018-06-01
期刊：
影响因子：
19.7
通讯作者：
Salem, Riad
中科院分区：
文献类型：
--
作者：
Lewandowski, Robert J.;Gabr, Ahmed;Salem, Riad
目的：报告放射性肝段切除术（RS）治疗早期肝细胞癌（HCC）的长期疗效。作者假设，对于直径小于或等于5 cm且肝功能保留的孤立性肝癌患者，其结果与治愈性治疗相当。材料和方法：这项回顾性研究纳入了70名患者（中位年龄，71岁;范围，22-96岁），患有小于或等于5 cm的孤立性HCC，不适合经皮消融，在2003年至2016年期间接受了RS（剂量为190戈伊）。排除了随后接受治愈性肝移植的患者，以消除影响生存率的混杂变量。根据欧洲肝脏研究协会（EASL）和世界卫生组织（WHO）的指南，使用Kaplan-Meier方法估计进展时间和中位总生存期的放射学反应。根据EASL标准，63例患者（90%）显示缓解，其中41例（59%）显示完全缓解。根据WHO标准，50例患者（71%）达到缓解，其中11例（16%）达到完全缓解。使用EASL和WHO标准，6个月时的缓解率分别为86%和49%。中位至进展时间为2.4年（95%置信区间：2.1，5.7），72%的患者在5年时未发生靶病变进展。中位总生存期为6.7年（95%置信区间：3.1，6.7）; 1年、3年和5年的生存概率分别为98%、66%和57%。基线肿瘤大小小于或等于3 cm的患者（n = 45）的1年、3年和5年总生存率分别为100%、82%和75%，显著长于肿瘤大于3 cm的患者（P =.026）.结论：RS提供反应率、肿瘤控制、和生存结果与选定的肝功能保留的早期HCC患者的治愈性治疗相当。(C)RSNA，2018
Purpose: To report long-term outcomes of radiation segmentectomy (RS) for early hepatocellular carcinoma (HCC). The authors hypothesized that outcomes are comparable to curative treatments for patients with solitary HCC less than or equal to 5 cm and preserved liver function.Materials and Methods: This retrospective study included 70 patients (median age, 71 years; range, 22-96 years) with solitary HCC less than or equal to 5 cm not amenable to percutaneous ablation who underwent RS (dose of.190 Gy) between 2003 and 2016. Patients who underwent subsequent curative liver transplantation were excluded to eliminate this confounding variable affecting survival. Radiologic response of time to progression and median overall survival were estimated by using the Kaplan-Meier method per the guidelines of the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO).Results: Seventy patients were treated with RS over 14 years. Sixty-three patients (90%) showed response by using EASL criteria, of which 41 (59%) showed complete response. Fifty patients (71%) achieved response by using WHO criteria, of which 11 (16%) achieved complete response. Response rates at 6 months were 86% and 49% by using EASL and WHO criteria, respectively. Median time to progression was 2.4 years (95% confidence interval: 2.1, 5.7), with 72% of patients having no target lesion progression at 5 years. Median overall survival was 6.7 years (95% confidence interval: 3.1, 6.7); survival probability at 1, 3, and 5 years was 98%, 66%, and 57%, respectively. Overall survival probability at 1, 3, and 5 years was 100%, 82%, and 75%, respectively, in patients with baseline tumor size less than or equal to 3 cm (n = 45) and was significantly longer than in patients with tumors greater than 3 cm (P =.026).Conclusion: RS provides response rates, tumor control, and survival outcomes comparable to curative-intent treatments for selected patients with early-stage HCC who have preserved liver function. (C) RSNA, 2018