Segmental Yttrium-90 Radioembolization versus Segmental Chemoembolization for Localized Hepatocellular Carcinoma: Results of a Single-Center, Retrospective, Propensity Score-Matched Study

被引:65
作者
Padia, Siddharth A. [1 ]
Johnson, Guy E. [2 ]
Horton, Kathryn J. [4 ]
Ingraham, Christopher R. [2 ]
Kogut, Matthew J. [2 ]
Kwan, Sharon [2 ]
Vaidya, Sandeep [2 ]
Monsky, Wayne L. [2 ]
Park, James O. [6 ]
Bhattacharya, Renuka [5 ]
Hippe, Daniel S. [3 ]
Harris, William P. [4 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Div Intervent Radiol, Dept Radiol, 757 Westwood Plaza,Room 2125, Los Angeles, CA 90095 USA
[2] Univ Washington, Sect Intervent Radiol, Seattle, WA 98195 USA
[3] Univ Washington, Dept Radiol, Seattle, WA 98195 USA
[4] Univ Washington, Dept Med, Div Oncol, Seattle, WA USA
[5] Univ Washington, Dept Med, Div Gastroenterol & Hepatol, Seattle, WA USA
[6] Univ Washington, Dept Surg, Div Hepatobiliary Surg, Seattle, WA 98195 USA
关键词
PORTAL-VEIN THROMBOSIS; LONG-TERM SURVIVAL; LOCOREGIONAL THERAPY; ELUTING BEADS; RESECTION; OUTCOMES; MICROSPHERES; RECURRENCE; TRIALS; SAFETY;
D O I
10.1016/j.jvir.2017.02.018
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To compare segmental radioembolization with segmental chemoembolization for localized, unresectable hepatocellular carcinoma (HCC) not amenable to ablation. Materials and Methods: In a single-center, retrospective study (2010-2015), 101 patients with 132 tumors underwent segmental radioembolization, and 77 patients with 103 tumors underwent segmental doxorubicin-based drug-eluting embolic or conventional chemoembolization. Patients receiving chemoembolization had worse performance status (Eastern Cooperative Oncology Group 0, 76% vs 56%; P = .003) and Child-Pugh class (class A, 65% vs 52%; P = .053); patients receiving radioembolization had larger tumors (32 mm vs 26 mm; P < .001), more infiltrative tumors (23% vs 9%; P = .01), and more vascular invasion (18% vs 1%; P < .001). Toxicity, tumor response, tumor progression, and survival were compared. Analyses were weighted using a propensity score (PS). Results: Toxicity rates were low, without significant differences. Index and overall complete response rates were 92% and 84% for radioembolization and 74% and 58% for chemoembolization (P = .001 and P < .001). Index tumor progression at 1 and 2 years was 8% and 15% in the radioembolization group and 30% and 42% in the chemoembolization group (P < .001). Median progression-free and overall survival were 564 days and 1,198 days in the radioembolization group and 271 days and 1,043 days in the chemoembolization group (PS-adjusted P = .002 and P = .35; censored by transplant PS-adjusted P < .001 and P = .064). Conclusions: Segmental radioembolization demonstrates higher complete response rates and local tumor control compared with segmental chemoembolization for HCC, with similar toxicity profiles. Superior progression-free survival was achieved.
引用
收藏
页码:777 / 785
页数:9
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