Transarterial chemoembolization in soft-tissue sarcoma metastases to the liver - The use of imaging biomarkers as predictors of patient survival
Transarterial chemoembolization in soft-tissue sarcoma metastases to the liver - The use of imaging biomarkers as predictors of patient survival
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DOI：
10.1016/j.ejrad.2014.11.034
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发表时间：
2015-03-01
影响因子：
3.3
通讯作者：
Geschwind, Jean Francois
中科院分区：
文献类型：
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作者：
Chapiro, Julius;Duran, Rafael;Geschwind, Jean Francois
背景资料：由于缺乏可靠的临床数据，肝脏转移性软组织肉瘤患者的临床管理变得复杂。本研究评估的安全性，生存结果以及肿瘤反应的影像学生物标志物的作用，在转移性软组织肉瘤（mSTS）的肝脏治疗与传统的经动脉化疗栓塞（cTACE）。材料/方法：本回顾性分析包括30例mSTS的肝脏与cTACE治疗。评价安全性、术后总生存期（OS）和无进展生存期（PFS）。使用RECIST、改良（m）RECIST和EASL指南评估每例患者的肿瘤缓解。此外，还对增强的肿瘤体积进行了3D定量（定量[q] EASL）。对于每种方法，患者被分类为反应者（R）和无反应者（NR），并使用Kaplan-Meier和多变量考克斯比例风险比（HR）analysis.Results：无III级或IV级毒性报告，在总共77个程序（平均值，2.6/患者）。中位OS为21.2个月（95% CI，13.4-28.9），PFS为6.3个月（95% CI，4.4-8.2）。根据EASL、mRECIST和gEASL，基于增强的技术分别将11例（44%）、12例（48%）和12例（48%）患者确定为R。RECIST未实现分层。多变量分析确定根据mRECIST和gEASL的肿瘤缓解是改善患者生存率的可靠预测因素（分别为p = 0.019; HR 0.3 [0.1-0.8]和P=0.006; HR 0.2 [0.1-0.6]）。结论：本研究证实了cTACE作为肝脏mSTS患者安全挽救治疗选择的作用。基于增强的肿瘤缓解评估技术相对于基于大小的标准的优势证实了mRECIST和gEASL是动脉内治疗后的首选方法。(C)2015年由爱思唯尔爱尔兰有限公司发布
Background: The clinical management of patients with metastatic soft-tissue sarcoma of the liver is complicated by the paucity of reliable clinical data. This study evaluated the safety profile, survival outcome as well as the role of imaging biomarkers of tumor response in metastatic soft-tissue sarcoma (mSTS) of the liver treated with conventional transarterial chemoembolization (cTACE).Materials/methods: This retrospective analysis included 30 patients with mSTS of the liver treated with cTACE. The safety profile, overall survival (OS) and progression-free survival (PFS) after the procedure were evaluated. Tumor response in each patient was assessed using RECIST, modified (m) RECIST and EASL guidelines. In addition, a 3D quantification of the enhancing tumor volume (quantitative [q] EASL) was performed. For each method, patients were classified as responders (R) and non-responders (NR), and evaluated using Kaplan-Meier and multivariate Cox proportional hazard ratio (HR) analysis.Results: No Grade III or IV toxicities were reported in a total of 77 procedures (mean, 2.6/patient). Median OS was 21.2 months (95% CI, 13.4-28.9) and PFS was 6.3 months (95% CI, 4.4-8.2). The enhancement-based techniques identified 11(44%), 12(48%) and 12(48%) patients as R according to EASL, mRECIST and gEASL, respectively. No stratification was achieved with RECIST. Multivariate analysis identified tumor response according to mRECIST and gEASL as reliable predictors of improved patient survival (p = 0.019; HR 0.3 [0.1-0.8] and P=0.006; HR 0.2 [0.1-0.6], respectively).Conclusion: This study confirmed the role of cTACE as a safe salvage therapy option in patients with mSTS of the liver. The demonstrated advantages of enhancement-based tumor response assessment techniques over size-based criteria validate mRECIST and gEASL as preferable methods after intraarterial therapy. (C) 2015 Published by Elsevier Ireland Ltd.