Factors impacting survival after transarterial radioembolization in patients with hepatocellular carcinoma: Results from the prospective CIRT study
| Autor: | Frank Kolligs, Dirk Arnold, Rita Golfieri, Maciej Pech, Bora Peynircioglu, Thomas Pfammatter, Maxime Ronot, Bruno Sangro, Niklaus Schaefer, Geert Maleux, Graham Munneke, Helena Pereira, Bleranda Zeka, Niels de Jong, Thomas Helmberger, Thomas Albrecht, Olivier D’Archambeau, Tugsan Balli, Sadik Bilgic, Allan Bloom, Roberto Cioni, Roman Fischbach, Patrick Flamen, Laurent Gerard, Gerd Grözinger, Marcus Katoh, Michael Koehler, Jan Robert Kröger, Christiane Kuhl, Franco Orsi, Murat Özgün, Peter Reimer, Axel Schmid, Alessandro Vit |
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| Přispěvatelé: | CIRT Principal Investigators, Albrecht, T., D'Archambeau, O., Balli, T., Bilgic, S., Bloom, A., Cioni, R., Fischbach, R., Flamen, P., Gerard, L., Grözinger, G., Katoh, M., Koehler, M., Kröger, J.R., Kuhl, C., Orsi, F., Özgün, M., Reimer, P., Ronot, M., Schmid, A., Vit, A., University of Zurich, de Jong, Niels |
| Rok vydání: | 2023 |
| Předmět: |
Hepatology
10042 Clinic for Diagnostic and Interventional Radiology 2724 Internal Medicine 2723 Immunology and Allergy Gastroenterology Internal Medicine Immunology and Allergy 610 Medicine & health 2721 Hepatology 2715 Gastroenterology ALBI albumin-bilirubin BCLC Barcelona Clinic Liver Cancer BSA body surface area CIRSE Cardiovascular and Interventional Radiological Society of Europe CIRT CIRSE Registry for SIR-Spheres Therapy ECOG Eastern Cooperative Oncology Group HCC hepatocellular carcinoma HR hazard ratio INR international normalized ratio IPTW inverse probability of treatment weighting OS overall survival PFS progression-free survival PVT portal vein thrombosis REILD radioembolization-induced liver disease SIRT TACE transcatheter arterial chemoembolization TARE transarterial radioembolization Y90 Yttrium-90 dosimetry hPFS hepatic progression-free survival liver mBSA modified body surface area observational radioembolization registry |
| Zdroj: | JHEP reports, vol. 5, no. 2, pp. 100633 |
| DOI: | 10.5167/uzh-226047 |
| Popis: | Transarterial radioembolization (TARE) with Yttrium-90 resin microspheres is an established treatment option for patients with hepatocellular carcinoma (HCC). However, optimising treatment application and patient selection remains challenging. We report here on the effectiveness, safety and prognostic factors, including dosing methods, associated with TARE for HCC in the prospective observational CIRT study. We analysed 422 patients with HCC enrolled between Jan 2015 and Dec 2017, with follow-up visits every 3 months for up to 24 months after first TARE. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every 3-month follow-up visit. We used the multivariable Cox proportional hazard model and propensity score matching to identify independent prognostic factors for effectiveness outcomes. The median OS was 16.5 months, the median PFS was 6.1 months, and the median hepatic PFS was 6.7 months. Partition model dosimetry resulted in improved OS compared to body surface area calculations on multivariable analysis (hazard ratio 0.65; 95% CI 0.46-0.92; p = 0.0144), which was confirmed in the exact matching propensity score analysis (hazard ratio 0.56; 95% CI 0.35-0.89; p = 0.0136). Other independent prognostic factors for OS were ECOG-performance status >0 (p = 0.0018), presence of ascites (p = 0.0152), right-sided tumours (p = 0.0002), the presence of portal vein thrombosis (p = 0.0378) and main portal vein thrombosis (p = 0.0028), ALBI grade 2 (p = 0.0043) and 3 (p = 0.0014). Adverse events were recorded in 36.7% of patients, with 9.7% of patients experiencing grade 3 or higher adverse events. This large prospective observational dataset shows that TARE is an effective and safe treatment in patients with HCC. Using partition model dosimetry was associated with a significant improvement in survival outcomes. Transarterial radioembolization (TARE) is a form of localised radiation therapy and is a potential treatment option for primary liver cancer. We observed how TARE was used in real-life clinical practice in various European countries and if any factors predict how well the treatment performs. We found that when a more complex but personalised method to calculate the applied radiation activity was used, the patient responded better than when a more generic method was used. Furthermore, we identified that general patient health, ascites and liver function can predict outcomes after TARE. NCT02305459. |
| Databáze: | OpenAIRE |
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