Selective internal radiation therapy for unresectable HCC: The SIRT downstaging study.

IF 5.6 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Hepatology Communications Pub Date : 2024-06-27 eCollection Date: 2024-07-01 DOI:10.1097/HC9.0000000000000475
Hélène Regnault, Julia Chalaye, Athena Galetto-Pregliasco, Clara Perrin, Haytham Derbel, Giuliana Amaddeo, Sébastien Mulé, Marie Lequoy, Hicham Kobeiter, Edouard Reizine, Emmanuel Itti, Christophe Duvoux, Alexis Laurent, Vincent Leroy, Daniele Sommacale, Diana Rasolonirina, Alain Luciani, Julien Calderaro, Vania Tacher, Raffaele Brustia
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引用次数: 0

Abstract

Background: Selective internal radiation therapy (SIRT) is recommended as a downstaging (DS) strategy for solitary unresectable HCC <8 cm. The aim of this study was to report the results of acquired experience in a tertiary center for all unresectable HCCs.

Methods: We conducted a retrospective, observational study using data collected from consecutive patients undergoing SIRT between October 2013 and June 2020. DS was considered achieved when a curative treatment could be proposed 6 months after SIRT.

Results: One hundred twenty-seven patients were included (male = 90%, 64 ± 11 y), of whom 112 (n = 88%) had cirrhosis. HCC was classified as BCLC stage C in 64 patients (50%), with a median diameter of 61 mm, an infiltrative pattern in 51 patients (40%), and portal vein invasion in 62 (49%) patients. Fifty patients (39%) achieved DS 6 months following SIRT, with 29 of them (23%) undergoing curative treatment in a median time of 4.3 months: 17 (13%) were transplanted, 11 (85%) had liver resection, and 1 patient had a radiofrequency ablation. The median overall survival of patients with or without DS was 51 versus 10 months, respectively (p < 0.001). In patients who achieved DS, progression-free survival was higher in patients who underwent surgery: 47 versus 11 months (p < 0.001). Four variables were independently associated with DS: age (OR: 0.96, 95% CI: [0.92, 0.99]; p = 0.032), baseline α-fetoprotein (OR: 1.00, 95% CI: [1.00, 1.00]; p = 0.034), HCC distribution (OR: 0.3, 95% CI: [0.11, 0.75]; p = 0.012), and ALBI grade (OR: 0.34. 95% CI: [0.14, 0.80]; p = 0.014).

Conclusions: These results suggest that SIRT in patients with unresectable HCC could be an effective treatment: DS was achieved for around 39% of the patients and more than half of these then underwent curative treatment.

选择性内放射治疗不可切除的 HCC:SIRT 降期研究
背景:选择性内放射治疗(SIRT选择性内放射治疗(SIRT)被推荐为单发不可切除 HCC 的降期(Downstaging,DS)策略:我们利用 2013 年 10 月至 2020 年 6 月期间接受 SIRT 治疗的连续患者的数据开展了一项回顾性观察研究。当 SIRT 6 个月后可提出治愈性治疗时,即认为达到了 DS:共纳入127例患者(男性=90%,64±11岁),其中112例(n=88%)患有肝硬化。64名患者(50%)的HCC被归类为BCLC C期,中位直径为61毫米,51名患者(40%)的HCC为浸润型,62名患者(49%)的HCC为门静脉侵犯。50 名患者(39%)在 SIRT 6 个月后达到 DS,其中 29 名患者(23%)在 4.3 个月的中位时间内接受了根治性治疗:17人(13%)进行了移植,11人(85%)进行了肝切除,1人进行了射频消融。有或没有 DS 的患者的中位总生存期分别为 51 个月和 10 个月(P < 0.001)。在获得 DS 的患者中,接受手术的患者无进展生存期更长:47个月对11个月(P < 0.001)。有四个变量与 DS 独立相关:年龄(OR:0.96,95% CI:[0.92, 0.99];P = 0.032)、基线α-胎儿蛋白(OR:1.00,95% CI:[1.00,1.00];P = 0.034)、HCC 分布(OR:0.3,95% CI:[0.11,0.75];P = 0.012)和 ALBI 分级(OR:0.34。95% CI:[0.14,0.80];P = 0.014):这些结果表明,SIRT 对不可切除的 HCC 患者可能是一种有效的治疗方法:约 39% 的患者达到了 DS,其中一半以上的患者随后接受了根治性治疗。
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来源期刊
Hepatology Communications
Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
8.00
自引率
2.00%
发文量
248
审稿时长
8 weeks
期刊介绍: Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction. ​
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