Stefanie Friedrich, Felix Busch, Martin Jonczyk, Gero Wieners, Georg Böning, Willie Magnus Lüdemann, Aymen Meddeb, Federico Collettini, Bernhard Gebauer
{"title":"与单一CT-HDRBT相比，联合ct引导的高剂量率近距离放射治疗(CT-HDRBT)和伊立替康微球经动脉化疗栓塞可改善不可切除的结直肠癌肝转移患者的局部肿瘤控制和无进展生存期。","authors":"Stefanie Friedrich, Felix Busch, Martin Jonczyk, Gero Wieners, Georg Böning, Willie Magnus Lüdemann, Aymen Meddeb, Federico Collettini, Bernhard Gebauer","doi":"10.5114/jcb.2023.125480","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To compare the effectivity and toxicity of monotherapy with computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) vs. combination therapy of transarterial chemoembolization with irinotecan (irinotecan-TACE) and CT-HDRBT in patients with large unresectable colorectal liver metastases (CRLM) with a diameter of > 3 cm.</p><p><strong>Material and methods: </strong>Forty-four retrospectively matched patients with unresectable CRLM were treated either with mono-CT-HDRBT or with a combination of irinotecan-TACE and CT-HDRBT (<i>n</i> = 22 in each group). Matching parameters included treatment, disease, and baseline characteristics. National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0) were used to evaluate treatment toxicity and the Society of Interventional Radiology classification was applied to analyze catheter-related adverse events. Statistical analysis involved Cox regression, Kaplan-Meier estimator, log-rank test, receiver operating characteristic curve analysis, Shapiro-Wilk test, Wilcoxon test, paired sample <i>t</i>-test, and McNemar test. <i>P</i>-values < 0.05 were deemed significant.</p><p><strong>Results: </strong>Combination therapy ensued longer median progression-free survival (PFS: 5/2 months, <i>p</i> = 0.002) and significantly lower local (23%/68%, <i>p</i> < 0.001) and intrahepatic (50%/95%, <i>p</i> < 0.001) progress rates compared with mono-CT-HDRBT after a median follow-up time of 10 months. Additionally, tendencies for longer local tumor control (LTC: 17/9 months, <i>p</i> = 0.052) were found in patients undergoing both interventions. After combination therapy, aspartate and alanine aminotransferase toxicity levels increased significantly, while total bilirubin toxicity levels showed significantly higher increases after monotherapy. No catheter-associated major or minor complications were identified in each cohort.</p><p><strong>Conclusions: </strong>Combining irinotecan-TACE with CT-HDRBT can improve LTC rates and PFS compared with mono-CT-HDRBT in patients with unresectable CRLM. The combination of irinotecan-TACE and CT-HDRBT shows satisfying safety profiles.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"15 1","pages":"15-26"},"PeriodicalIF":1.1000,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/f8/JCB-15-50206.PMC10034730.pdf","citationCount":"0","resultStr":"{\"title\":\"Combined CT-guided high-dose-rate brachytherapy (CT-HDRBT) and transarterial chemoembolization with irinotecan-loaded microspheres improve local tumor control and progression-free survival in patients with unresectable colorectal liver metastases compared with mono-CT-HDRBT.\",\"authors\":\"Stefanie Friedrich, Felix Busch, Martin Jonczyk, Gero Wieners, Georg Böning, Willie Magnus Lüdemann, Aymen Meddeb, Federico Collettini, Bernhard Gebauer\",\"doi\":\"10.5114/jcb.2023.125480\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To compare the effectivity and toxicity of monotherapy with computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) vs. combination therapy of transarterial chemoembolization with irinotecan (irinotecan-TACE) and CT-HDRBT in patients with large unresectable colorectal liver metastases (CRLM) with a diameter of > 3 cm.</p><p><strong>Material and methods: </strong>Forty-four retrospectively matched patients with unresectable CRLM were treated either with mono-CT-HDRBT or with a combination of irinotecan-TACE and CT-HDRBT (<i>n</i> = 22 in each group). Matching parameters included treatment, disease, and baseline characteristics. National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0) were used to evaluate treatment toxicity and the Society of Interventional Radiology classification was applied to analyze catheter-related adverse events. Statistical analysis involved Cox regression, Kaplan-Meier estimator, log-rank test, receiver operating characteristic curve analysis, Shapiro-Wilk test, Wilcoxon test, paired sample <i>t</i>-test, and McNemar test. <i>P</i>-values < 0.05 were deemed significant.</p><p><strong>Results: </strong>Combination therapy ensued longer median progression-free survival (PFS: 5/2 months, <i>p</i> = 0.002) and significantly lower local (23%/68%, <i>p</i> < 0.001) and intrahepatic (50%/95%, <i>p</i> < 0.001) progress rates compared with mono-CT-HDRBT after a median follow-up time of 10 months. Additionally, tendencies for longer local tumor control (LTC: 17/9 months, <i>p</i> = 0.052) were found in patients undergoing both interventions. After combination therapy, aspartate and alanine aminotransferase toxicity levels increased significantly, while total bilirubin toxicity levels showed significantly higher increases after monotherapy. No catheter-associated major or minor complications were identified in each cohort.</p><p><strong>Conclusions: </strong>Combining irinotecan-TACE with CT-HDRBT can improve LTC rates and PFS compared with mono-CT-HDRBT in patients with unresectable CRLM. The combination of irinotecan-TACE and CT-HDRBT shows satisfying safety profiles.</p>\",\"PeriodicalId\":51305,\"journal\":{\"name\":\"Journal of Contemporary Brachytherapy\",\"volume\":\"15 1\",\"pages\":\"15-26\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2023-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/f8/JCB-15-50206.PMC10034730.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Contemporary Brachytherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5114/jcb.2023.125480\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Contemporary Brachytherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5114/jcb.2023.125480","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Combined CT-guided high-dose-rate brachytherapy (CT-HDRBT) and transarterial chemoembolization with irinotecan-loaded microspheres improve local tumor control and progression-free survival in patients with unresectable colorectal liver metastases compared with mono-CT-HDRBT.
Purpose: To compare the effectivity and toxicity of monotherapy with computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) vs. combination therapy of transarterial chemoembolization with irinotecan (irinotecan-TACE) and CT-HDRBT in patients with large unresectable colorectal liver metastases (CRLM) with a diameter of > 3 cm.
Material and methods: Forty-four retrospectively matched patients with unresectable CRLM were treated either with mono-CT-HDRBT or with a combination of irinotecan-TACE and CT-HDRBT (n = 22 in each group). Matching parameters included treatment, disease, and baseline characteristics. National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0) were used to evaluate treatment toxicity and the Society of Interventional Radiology classification was applied to analyze catheter-related adverse events. Statistical analysis involved Cox regression, Kaplan-Meier estimator, log-rank test, receiver operating characteristic curve analysis, Shapiro-Wilk test, Wilcoxon test, paired sample t-test, and McNemar test. P-values < 0.05 were deemed significant.
Results: Combination therapy ensued longer median progression-free survival (PFS: 5/2 months, p = 0.002) and significantly lower local (23%/68%, p < 0.001) and intrahepatic (50%/95%, p < 0.001) progress rates compared with mono-CT-HDRBT after a median follow-up time of 10 months. Additionally, tendencies for longer local tumor control (LTC: 17/9 months, p = 0.052) were found in patients undergoing both interventions. After combination therapy, aspartate and alanine aminotransferase toxicity levels increased significantly, while total bilirubin toxicity levels showed significantly higher increases after monotherapy. No catheter-associated major or minor complications were identified in each cohort.
Conclusions: Combining irinotecan-TACE with CT-HDRBT can improve LTC rates and PFS compared with mono-CT-HDRBT in patients with unresectable CRLM. The combination of irinotecan-TACE and CT-HDRBT shows satisfying safety profiles.
期刊介绍：
The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.
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