Yttrium-90 radiation segmentectomy for hepatic metastases: A multi-institutional study of safety and efficacy
Yttrium-90 radiation segmentectomy for hepatic metastases: A multi-institutional study of safety and efficacy
复制标题
DOI：
10.1002/jso.26223
复制
发表时间：
2020-09-17
影响因子：
2.5
通讯作者：
Shin, David
中科院分区：
文献类型：
--
作者：
Padia, Siddharth A.;Johnson, Guy E.;Shin, David
背景与目的本研究评估了不能切除或消融的肝转移瘤患者接受Y-90(Y-90)放射节段切除的疗效。资料与方法6年多来，36例53个肿瘤患者接受了节段性放射栓塞术。患者不适合手术切除或热消融。恶性肿瘤包括结直肠癌转移(31%)、神经内分泌肿瘤(28%)、肉瘤(19%)和其他(22%)。81%的患者之前接受过全身化疗。继续进行全身化疗。评估毒性、肿瘤反应、肿瘤进展和生存期。结果肿瘤平均大小3.6 cm(1.2~6.1 cm)。不良事件发生率很低，没有与肝脏相关的3级或4级毒性不良事件通用术语标准。靶区肿瘤疗效评价标准实体瘤疾病控制率为92%(部分缓解28%，稳定%)。14例肿瘤强化患者，改良实体瘤靶区疗效评价标准的客观有效率为100%。在12个月的中位随访期内，28%的治疗肿瘤发生了靶肿瘤进展。术后6个月和12个月的总生存率分别为96%和83%。结论Y-90放射节段切除治疗肝转移瘤具有肿瘤控制率高、毒性小的优点。对于不适合手术切除的转移性肝脏恶性肿瘤患者，应考虑放射节段切除。
Background and Objectives This study assessed the outcomes of Yttrium-90 (Y-90) radiation segmentectomy for hepatic metastases unamenable to resection or ablation. Materials and Methods Over 6 years, 36 patients with 53 tumors underwent segmental radioembolization. Patients were not candidates for surgical resection or thermal ablation. Malignancies included metastases from colorectal cancer (31%), neuroendocrine tumors (28%), sarcoma (19%), and others (22%). Eighty-one percent of patients had undergone prior treatment with systemic chemotherapy. Ongoing systemic chemotherapy was continued. Toxicity, tumor response, tumor progression, and survival were assessed. Results The median tumor size was 3.6 cm (range 1.2-6.1 cm). Adverse event rates were low, with no hepatic-related Common Terminology Criteria for Adverse Events Grade 3 or 4 toxicity. Target tumor Response Evaluation Criteria in Solid Tumors disease control rate was 92% (28% partial response, 64% stable disease). For patients with enhancing tumors (n = 14), modified Response Evaluation Criteria in Solid Tumors target tumor objective response rate was 100%. During a median follow-up of 12 months, target tumor progression occurred in 28% of treated tumors. Overall survival was 96% and 83% at 6 and 12 months, respectively. Conclusions Y-90 radiation segmentectomy for hepatic metastases demonstrates high rates of tumor control and minimal toxicity. Radiation segmentectomy should be considered for patients with metastatic hepatic malignancy who are not candidates for surgical resection.