Ablative Transarterial Radioembolization Improves Survival in Patients with HCC and Portal Vein Tumor Thrombus
| Autor: | Peter T. W. Kim, David M. Liu, Stephen G.F. Ho, Leandro Cardarelli-Leite, Darren Klass, John Chung, Vladimir Marquez, F. Chou, Henry Walton, Anastasia Hadjivassiliou, Howard John Lim |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Carcinoma Hepatocellular medicine.medical_treatment Brachytherapy Lower risk 030218 nuclear medicine & medical imaging Cohort Studies 03 medical and health sciences 0302 clinical medicine medicine Humans Radiology Nuclear Medicine and imaging Yttrium Radioisotopes Aged Proportional Hazards Models Retrospective Studies Aged 80 and over Venous Thrombosis Performance status business.industry Portal Vein Hazard ratio Liver Neoplasms Middle Aged medicine.disease Survival Analysis Venous thrombosis Treatment Outcome Tolerability Hepatocellular carcinoma Female Radiology Liver function Hepatectomy Cardiology and Cardiovascular Medicine business |
| Zdroj: | Cardiovascular and interventional radiology. 43(3) |
| ISSN: | 1432-086X |
| Popis: | Patients with hepatocellular carcinoma and portal vein tumor thrombus have a poor prognosis and limited therapeutic options. We sought to compare survival, tolerability, and safety in such patients treated with conventional yttrium-90 transarterial radioembolization dosimetric techniques or ablative transarterial radioembolization. This retrospective, single-center cohort study included patients with hepatocellular carcinoma and right, left, and/or main portal vein tumor thrombus, preserved liver function (Child–Pugh class ≤ B7), and good performance status (Eastern Cooperative Oncology Group score ≤ 1) treated with yttrium-90 microspheres from 2011 to 2018 with ablative intent transarterial radioembolization (A-TARE), or conventional technique (cTARE). Statistical models were used to compare overall survival, post-treatment survival, toxicities, and prognosticators of response. Fifty-seven patients were included (21 [36.8%] ablative and 36 [63.2%] conventional intent). Median overall survival was 15.7 months. Compared to conventional treatment, ablative radioembolization was associated with longer median overall survival (45.3 vs 18.2 months; P = 0.003), longer post-treatment survival (19.1 vs 4.9 months; P = 0.005), a 70% lower risk of death (hazard ratio 0.30; 95% confidence interval, 0.13–0.70; P = 0.005), and improved 4-year survival (53.9% vs 11.2%). Overall survival did not differ significantly between treatment with resin and glass microspheres (27.5 vs 22.2 months; P = 0.62). Acceptable hepatic toxicities were observed after yttrium-90 administration, without statistical differences between the groups. In patients with advanced hepatocellular carcinoma and portal vein tumor thrombus, A-TARE is associated with longer survival than cTARE. Neither modality is associated with deleterious effects on liver function. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink