肝细胞癌 (HCC) 的选择性内部放射治疗 (SIRT)：为英国多学科团

StephenW

肝细胞癌 (HCC) 的选择性内部放射治疗 (SIRT)：为英国多学科团队的临床实践提供信息

    http://orcid.org/0000-0003-0359-9795Helen L Reeves1,2、John Reicher3、Georgia Priona3、Derek M Manas4、Peter Littler3

    与英国泰恩河畔纽卡斯尔纽卡斯尔大学纽卡斯尔大学转化与临床研究所 Helen L Reeves 教授的通信； [email protected]

抽象的

目的 肝细胞癌（HCC）死亡人数正在以惊人的速度上升。许多患者不适合现有疗法。低响应率进一步阻碍了那些响应率的结果。选择性内部放射治疗 (SIRT) 带来了希望，尽管哪些患者比标准方法受益仍不清楚。

设计/方法作为质量/服务改进，我们对泰恩河畔纽卡斯尔医院国家卫生服务基金会信托 HCC 多学科团队接受 SIRT（2015-2020）治疗的连续患者进行了审计。评估了 2021 年 9 月 30 日的适应症、巴塞罗那临床肝癌 (BCLC) 分期、治疗反应、后续治疗和生存率

结果 51 名患者接受了 SIRT。三十天死亡率为零。影像学上三个月部分缓解、疾病稳定和疾病进展分别为 50%、22% 和 28%。总体中位生存期为 21 个月。有四个亚组：（1）BCLC-B：HCC>7 cm，对于单独的经动脉化疗栓塞（TACE）而言太大（n=21）； (2) BCLC-B：TACE 后 HCC 进展 (n=7)； (3) BCLC-C：肿瘤负荷大、门静脉分支血栓形成、非丙型肝炎病毒病因任意组合的HCC(n=16)； (4) BCLC-C：索拉非尼不合适（n=7）。在第 1 组中，5/21 (23.8%) 的患者降期为切除，33% 的患者接受了后续药物治疗，中位生存期>40 个月。在接受二线治疗的 BCLC-B 患者（第 2 组）中，中位生存期为 14.2 个月。在 BCLC–C 中，第 3 组的中位生存期为 20.2 个月，第 4 组为 4.2 个月。

结论 SIRT 治疗晚期 HCC 的结果令人鼓舞，通常将具有不良预测因素的患者与后续手术或药物治疗联系起来。 TACE 后或 BCLC-C 患者的作用需要进一步评估。
数据可用性声明

可根据合理要求提供数据。审计数据集的摘要包含在手稿中。不包括个人可识别的患者信息。为了保护他们的身份——考虑到少数患者，在确定的 NHS 信托基金的规定时间范围内接受特定治疗，没有提供实际数据集。
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http://dx.doi.org/10.1136/flgastro-2022-102137

StephenW

Selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC): informing clinical practice for multidisciplinary teams in England

    http://orcid.org/0000-0003-0359-9795Helen L Reeves1,2, John Reicher3, Georgia Priona3, Derek M Manas4, Peter Littler3

    Correspondence to Professor Helen L Reeves, Newcastle University Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, Tyne and Wear, UK; [email protected]

Abstract

Objective Hepatocellular carcinoma (HCC) deaths are rising alarmingly. Many patients are unsuitable for available therapies. Poor response rates further hamper outcomes for those that are. Selective internal radiation therapy (SIRT) offers hope, although which patients benefit over standard approaches remains unclear.

Design/method As a quality/service improvement, we audited consecutive patients treated with SIRT (2015-2020) by the Newcastle upon Tyne Hospitals National Health Service Foundation Trust HCC multidisciplinary team . Indications, Barcelona clinic liver cancer (BCLC) stage, treatment response, subsequent therapies and survival at 30 September 2021 were assessed

Results Fifty-one patients received SIRT. Thirty-day mortality was zero. Three months partial response, stable disease and progressive disease on imaging were 50%, 22% and 28%, respectively. Overall median survival was 21 months. There were four subgroups: (1) BCLC-B: HCC>7 cm too large for transarterial chemoembolisation (TACE) alone (n=21); (2) BCLC-B: HCC progressed post TACE (n=7); (3) BCLC-C: HCC with any combination of large tumour burden, branch portal vein thrombosis, non-hepatitis C virus aetiology (n=16); (4) BCLC-C: sorafenib inappropriate (n=7). In group 1, 5/21 (23.8%) of patients were downstaged to resection, 33% received subsequent medical therapies and median survival was >40 months. In BCLC-B patients treated second line (group 2), median survival was 14.2 months. In BCLC–C, median survival was 20.2 months for group 3 and 4.2 months for group 4.

Conclusion SIRT outcomes for advanced HCC, often bridging patients with adverse predictive factors to subsequent surgery or medical therapies, were encouraging. A role after TACE or for BCLC-C patients requires further assessment.
Data availability statement

Data are available upon reasonable request. The summary of the audit dataset is included in the manuscript. No individual identifiable patient information is included. To protect their identities—given the small numbers of patients, receiving a specific treatment in a defined time frame in an identified NHS Trust, the actual dataset is not provided.
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This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/flgastro-2022-102137

StephenW

https://fg.bmj.com/content/flgas ... 2-102137.1.full.pdf