Selective Internal Radiation Therapy for Hepatocellular Carcinoma Across the Barcelona Clinic Liver Cancer Stages.

Autor: Moctezuma-Velazquez C; Division of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutricion 'Salvador Zubiran', Avenida Vasco de Quiroga No 15, Seccion XVI, Tlalpan, 14080, Mexico City, Mexico., Montano-Loza AJ; Division of Gastroenterology and Liver Unit, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada., Meza-Junco J; Department of Medical Oncology, Cross Cancer Institute, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada., Burak K; Liver Unit, University of Calgary, 1403 - 29 St. N.W., Calgary, AB, T2N 2T9, Canada., Ma M; Division of Gastroenterology and Liver Unit, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada., Bain VG; Division of Gastroenterology and Liver Unit, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada., Kneteman N; Division of Transplantation, Department of Surgery, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada., Sarlieve P; Department of Radiology and Diagnostic Imaging, Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada., Owen RJ; Department of Radiology and Diagnostic Imaging, Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada. rowen@ualberta.ca.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2021 Mar; Vol. 66 (3), pp. 899-911. Date of Electronic Publication: 2020 Apr 12.
DOI: 10.1007/s10620-020-06245-y
Abstrakt: Background: Hepatocellular carcinoma (HCC) is the second most common lethal cancer, and there is a need for effective therapies. Selective internal radiation therapy (SIRT) has been increasingly used, but is not supported by guidelines due to a lack of solid evidence.
Aims: Determine the efficacy and safety of SIRT in HCC across the Barcelona Clinic Liver Cancer (BCLC) stages A, B, and C.
Methods: Consecutive patients that received SIRT between 2006 and 2016 at two centers in Canada were evaluated.
Results: We analyzed 132 patients, 12 (9%), 62 (47%), and 58 (44%) belonged to BCLC stages A, B, and C; mean age was 61.2 (SD ± 9.2), and 89% were male. Median survival was 12.4 months (95% CI 9.6-16.6), and it was different across the stages: 59.7 (95% CI NA), 12.8 (95% CI 10.2-17.5), and 9.3 months (95% CI 5.9-11.8) in BCLC A, B, and C, respectively (p = 0.009). Independent factors associated with survival were previous HCC treatment (HR 2.01, 95% CI 1.23-3.27, p = 0.005), bi-lobar disease (HR 2.25, 95% CI 1.30-3.89, p = 0.003), ascites (HR 1.77, 95% CI 0.99-3.13, p = 0.05), neutrophil-to-lymphocyte ratio (HR 1.11, 95% CI 1.02-1.20, p = 0.01), Albumin-Bilirubin (ALBI) grade-3 (HR 2.69, 95% CI 1.22-5.92, p = 0.01), tumor thrombus (HR 2.95, 95% CI 1.65-5.24, p < 0.001), and disease control rate (HR 0.62, 95% CI 0.39-0.96, p = 0.03). Forty-four (33%) patients developed severe adverse events, and ALBI-3 was associated with higher risk of these events.
Conclusions: SIRT has the potential to be used across the BCLC stages in cases with preserved liver function. When using it as a rescue treatment, one should consider variables reflecting liver function, HCC extension, and systemic inflammation, which are associated with mortality.
Databáze: MEDLINE
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