TARE-Y90安全，对无法切除的小儿肝脏肿瘤有效

StephenW

TARE-Y90 safe, effective for unresectable pediatric liver tumors

Aguado A, et al. Pediatr Blood Cancer. 2018;doi:10.1002/pbc.27510.
November 8, 2018

Transarterial radioembolization with yttrium-90 safely and effectively treated unresectable primary malignant liver tumors in pediatric patients as an alternative therapy bridge to surgical resection or liver transplant, according to data published in Pediatric Blood and Cancer.
Allison S. Aguado, MD

“The therapy has been around for about 20 years in adults, but it has been seldomly used in children,” Allison S. Aguado, MD, from the Nemours Alfred I. duPont Hospital for Children in Delaware, told Healio Gastroenterology and Liver Disease. “We want to try and get more children able to have their tumor resected or liver transplanted. Resection is preferred to transplant, though, because they don’t have to go through life-long immunotherapy and care following the transplant and some transplant may fail during a child’s life.”

Yttrium-90 is a beta-emitting isotope with high-energy radiation that travels an average of 2.5 mm and a maximum of approximately 11 mm. In contrast with external beam radiation that is not typically used in children due to the damage it can cause to normal liver tissue, transarterial radioembolization with yttrium-90 (TARE-Y90) deposits the radiation in the target tissue and only a small amount of tissue around it, according to Aguado.

The study comprised 10 pediatric patients with a median age at treatment of 5.5 years (range, 2-18 years). At treatment baseline, all patients previously received chemotherapy and had either liver disease that was unresectable, metastatic or both.

Based on RECIST 1.1 criteria of all target lesions, eight patients had stable disease and one patient had progressive disease. Based on mRECIST criteria, two patients had a partial response, four had stable disease, and one had progressive disease. Overall, six patients had progressive disease, all of whom had pulmonary metastatic progression, two had progression of hepatic disease, and one had progression of nodal disease.

TARE-Y90 was well-tolerated with five patients experiencing no side effects. The most common side effect was fatigue and two patients experienced fevers with no evidence of infection. One patient who had near-complete replacement of the treated lobe by tumor experienced abdominal pain, elevated aspartate aminotransferase and lipase, and thrombocytopenia.

“The therapy is mostly performed as an outpatient procedure,” Aguado explained. “If patients have good liver function prior to the procedure, they’re usually able to maintain their liver function after. This is in comparison to adults who often have cirrhosis or underlying liver disease, whereas children typically do not have underlying liver complications.”
Median patient survival from initial diagnosis was 12.5 months (range, 10-28 months). Median patient survival after treatment with TARE-Y90 was 4 months (range, 2-20 months). Three patients whose retreatment was well-tolerated demonstrated the longest survival times (range, 17-20 months).

“Hepatoblastoma is becoming more common and we’re seeing an increased incidence related to premature birth and low birth weight,” Aguado said. “As we’re delivering children earlier and earlier, hepatoblastoma is becoming more common. It is still an uncommon tumor, but we’re seeing it more often than we did 20 years ago.”

Aguado explained that, while it’s fortunate that liver tumors are rare in children — about 1% to 2% per year — confirmation of TARE-Y90’s safety and efficacy will simply require time to increase case numbers. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

StephenW

TARE-Y90安全，对无法切除的小儿肝脏肿瘤有效

Aguado A，et al。 Pediatr血癌。 2018; DOI：10.1002 / pbc.27510。
2018年11月8日

根据儿科血液和癌症发表的数据，钇-90的经动脉放射性栓塞可安全有效地治疗儿科患者不能切除的原发性恶性肝肿瘤，作为手术切除或肝移植的替代疗法桥梁。
Allison S. Aguado，MD

“这种疗法在成人中已经存在了大约20年，但它很少被用于儿童，”来自特拉华州Nemours Alfred I. duPont儿童医院的医学博士Allison S. Aguado告诉Healio Gastroenterology and Liver Disease。 “我们希望尝试让更多的孩子能够切除肿瘤或移植肝脏。然而，切除术比移植更受欢迎，因为它们不需要在移植后进行终身免疫疗法和护理，并且一些移植可能在孩子的一生中失败。

钇-90是一种β发射同位素，具有高能辐射，平均行进2.5 mm，最大约11 mm。与由于其可能对正常肝组织造成的损伤而在儿童中通常不使用的外部束辐射相比，使用钇-90（TARE-Y90）的经动脉放射性栓塞将辐射沉积在靶组织中并且仅沉积少量组织据Aguado说，它周围。

该研究包括10名儿科患者，治疗中位年龄为5.5岁（范围2-18岁）。在治疗基线时，所有患者先前接受过化疗并且患有无法切除的肝脏疾病，转移性或两者兼而有之。

根据所有目标病变的RECIST 1.1标准，8名患者病情稳定，1名患者患有进行性疾病。根据mRECIST标准，两名患者有部分反应，四名患者病情稳定，一名患有进行性疾病。总体而言，6名患者患有进行性疾病，所有患者均有肺转移进展，2名患者有肝病进展，1名患者有淋巴结疾病进展。

TARE-Y90耐受性良好，5名患者没有副作用。最常见的副作用是疲劳，两名患者出现发烧，没有感染迹象。一名患者通过肿瘤接近完全取代治疗的肺部，经历腹痛，天冬氨酸转氨酶和脂肪酶升高，以及血小板减少症。

“治疗主要是作为门诊手术进行，”Aguado解释道。 “如果患者在手术前具有良好的肝功能，那么他们通常能够维持肝功能。这与经常患有肝硬化或潜在肝脏疾病的成年人相比，而儿童通常没有潜在的肝脏并发症。“
初始诊断的中位患者存活期为12.5个月（范围10-28个月）。 用TARE-Y90治疗后患者的中位存活时间为4个月（范围2-20个月）。 3例再治疗耐受良好的患者表现出最长的存活时间（范围为17-20个月）。

“肝母细胞瘤正变得越来越普遍，我们发现与早产和低出生体重相关的发病率增加，”Aguado说。 “由于我们越来越早地送孩子，肝母细胞瘤正变得越来越普遍。 它仍然是一种罕见的肿瘤，但我们比20年前更频繁地看到它。“

Aguado解释说，虽然幸运的是肝脏肿瘤在儿童中很罕见 - 每年约1％至2％ - 确认TARE-Y90的安全性和有效性只需要时间来增加病例数。 - Talitha Bennett

披露：作者报告没有相关的财务披露。

人事天命

这个治疗方法大陆还没有，香港和台湾有

老虎仔2020

这个方法对小肝癌有效吗？