经动脉化疗栓塞后放疗与三明治治疗不可切除或消融性肝细

StephenW

Transarterial Chemoembolization Followed by Radiotherapy Versus Sandwich Treatment for Unresectable or Ablative Hepatocellular Carcinoma
Haimin Lin  1   2 , Huiyong Wu  3 , Ning Cong  2 , Bo Liu  4 , Chengxin Liu  2 , Dali Han  2
Affiliations
Affiliations

    1
    Department of Internal Medicine, Heping County People's Hospital, Yangming, Heping, Heyuan, Guangdong, China.
    2
    Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
    3
    Department of Interventional Therapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
    4
    Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.

    PMID: 33357168 DOI: 10.1177/1533033820983799

Abstract

Objective: Our objective is to assess whether the outcome of intrahepatic unresectable or ablative hepatocellular carcinoma (HCC) could be improved by supplemental transarterial chemoembolization (TACE) following initial treatment of TACE with 3-dimensional conformal radiotherapy (3DCRT), compared to TACE followed by 3DCRT alone.

Methods: We retrospectively analyzed intrahepatic unresectable or ablative HCC patients who underwent TACE, followed by 3DCRT with or without additional TACE, from June 2010 to December 2016 at our institution. Survival was assessed using the Kaplan-Meier method and compared with the log-rank test. Cox regression analyses were used to identify factors that influenced prognosis. Toxicity profiles were evaluated using CTCAE 4.0.

Results: 27 patients received TACE with 3DCRT (TR group) and 11 received additional TACE following TACE and 3DCRT (sandwich group), respectively. The median intrahepatic progression-free survival (IPFS), progression-free survival (PFS), and overall survival (OS) in the TR group and sandwich group were 5.4 months vs. 17 months (P = 0.018), 5.4 months vs. 17 months (P = 0.008), and 13.5 months vs. 29.2 months (P = 0.011), respectively. Multivariate Cox regression demonstrated that TACE followed by radiotherapy alone had a shorter IPFS (HR: 2.516, 95% CI (1.136-5.570), P = 0.023) and PFS (HR: 2.637, 95% CI (1.182-5.880), P = 0.018) compared with the sandwich treatment. Hepatitis B virus reactivation occurred in 1 patient in the sandwich group. Myleosuppresion was considered a grade 3/4 adverse event.

Conclusion: Unresectable or ablative HCC patients possibly benefit from the combination of TACE and 3DCRT followed by additional TACE therapy, compared with TACE followed by 3DCRT alone.

Keywords: hepatocellular carcinoma; radiotherapy; sandwich treatment; survival; transarterial chemoembolization.

StephenW

经动脉化疗栓塞后放疗与三明治治疗不可切除或消融性肝细胞癌
林海民1 2，吴慧勇3，宁聪2，刘波4，刘成新2，大理汉2
隶属关系
隶属关系

    1个
    和平县人民医院内科，广东河源和平县阳明市。
    2
    山东第一医科大学和山东医学科学院，山东省肿瘤医院放射肿瘤科，山东济南。
    3
    山东第一医科大学和山东医学科学院，山东省肿瘤医院介入治疗科，山东济南。
    4
    山东第一医科大学和山东医学科学院，山东省肿瘤医院，肿瘤内科，山东济南。

    PMID：33357168 DOI：10.1177 / 1533033820983799

抽象

目的：我们的目标是评估在进行3维保形放射治疗（3DCRT）的TACE初始治疗后，通过补充经动脉化学栓塞（TACE）可以改善肝内不可切除或消融性肝细胞癌（HCC）的结果，仅3DCRT。

方法：我们回顾性分析了2010年6月至2016年12月在我院接受过TACE，然后行3DCRT或不行TACE的肝内不可切除或消融性HCC患者的资料。使用Kaplan-Meier方法评估生存率，并将其与对数秩检验进行比较。使用Cox回归分析来确定影响预后的因素。毒性概况使用CTCAE 4.0进行评估。

结果：27例接受TACE和3DCRT治疗的患者（TR组）和11例接受TACE和3DCRT治疗的患者（三明治组）分别接受了额外的TACE治疗。 TR组和三明治组的中位肝内无进展生存期（IPFS），无进展生存期（PFS）和总生存期（OS）分别为5.4个月和17个月（P = 0.018），5.4个月和17个月月（P = 0.008）和13.5个月与29.2个月（P = 0.011）。多变量Cox回归显示，仅TACE继之以放疗，其IPFS（HR：2.516，95％CI（1.136-5.570），P = 0.023）和PFS（HR：2.637，9​​5％CI（1.182-5.880），P = 0.018）与三明治处理相比。三明治组中有1例患者发生了乙肝病毒再激活。骨髓抑制被认为是3/4级不良事件。

结论：与单独行3DCRT的TACE相比，无法手术或消融性HCC的患者可能受益于TACE和3DCRT联合其他TACE治疗。

关键词：肝细胞癌；放射疗法三明治处理；生存经动脉化疗栓塞。

StephenW

https://journals.sagepub.com/doi/pdf/10.1177/1533033820983799