Yttrium-90 microspheres for the treatment of hepatocellular carcinoma
Yttrium-90 microspheres for the treatment of hepatocellular carcinoma
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DOI：
10.1053/j.gastro.2004.09.034
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发表时间：
2004-11-01
期刊：
影响因子：
29.4
通讯作者：
Goin, JE
中科院分区：
文献类型：
--
作者：
Geschwind, JFH;Salem, R;Goin, JE
不可切除的肝细胞癌极难治疗。TheraSphere由钇-90（一种纯β发射器）微球组成，将其注射到肝动脉中。本文综述了肝细胞癌患者接受钇-90微球治疗的安全性和生存率。从108名接受钇-90微球治疗的患者的数据库中选择80名患者，并使用Child-Pugh， Okuda和肝癌意大利计划评分系统进行分期。患者采用局部、局部和全肝入路治疗。采用Kaplan-Meier和Cox回归分析首次治疗后的生存率。不良事件和治疗并发症采用西南肿瘤学会毒性评分系统进行编码。患者接受的肝剂量从47至270 Gy不等。32例患者（40%）接受1次以上治疗。生存率与预处理肝癌意大利方案评分相关（P = 0.002），也与单个肝癌意大利方案成分、Child-Pugh分级、甲胎蛋白水平和肿瘤替代百分比相关。Okuda I期（n = 54）和II期（n = 26）患者的中位生存期和1年生存率分别为628天和63%，384天和51% （P = 0.02）。一名患者死于肝衰竭，判断可能与治疗有关。因此，在选定的肝细胞癌患者中，钇-90微球治疗是安全且耐受性良好的。在这些结果的基础上，一项随机对照试验是有必要的，通过使用意大利肝癌计划系统进行前瞻性分层随机化，比较钇-90微球治疗与经动脉化疗栓塞。
Unresectable hepatocellular carcinoma is extremely difficult to treat. TheraSphere consists of yttrium-90 (a pure beta emitter) microspheres, which are injected into the hepatic arteries. This article reviews the safety and survival of patients with hepatocellular carcinoma who were treated with yttrium-90 microspheres. Eighty patients were selected from a database of 108 yttrium-90 microsphere-treated patients and were staged by using Child-Pugh, Okuda, and Cancer of the Liver Italian Program scoring systems. Patients were treated with local, regional, and whole-liver approaches. Survival from first treatment was analyzed with Kaplan-Meier and Cox regression methods. Adverse events and complications of treatment were coded by using the Southwest Oncology Group toxicity scoring system. Patients received liver doses ranging from 47 to 270 Gy. Thirty-two patients (40%) received more than 1 treatment. Survival correlated with pretreatment Cancer of the Liver Italian Program scores (P = .002), as well as with the individual Cancer of the Liver Italian Program components, Child-Pugh class, alpha-fetoprotein levels, and percentage of tumor replacement. Patients classified as Okuda stage I (n = 54) and II (n = 26) had median survival durations and 1-year survival rates of 628 days and 63%, and 384 days and 51%, respectively (P = .02). One patient died of liver failure judged as possibly related to treatment. Thus, in selected patients with hepatocellular carcinoma, yttrium-90 microsphere treatment is safe and well tolerated. On the basis of these results, a randomized controlled trial is warranted comparing yttrium-90 microsphere treatment with transarterial chemoembolization by using the Cancer of the Liver Italian Program system for prospective stratified randomization.