Large,multifocal or portal vein-invading hepatocellular carcinoma(HCC)downstaged by Y90 using personalized dosimetry:safety,pathological results and outcomes after surgery  

作　　者：Mohamad Azhar Meerun Carole Allimant Benjamin Rivière Astrid Herrero Fabrizio Panaro Eric Assenat Christophe Cassinotto Denis Mariano-Goulart Boris Guiu 

机构地区：[1]Department of Radiology,St-Eloi University Hospital,Montpellier,France [2]Department of Liver Pathology,St-Eloi University Hospital,Montpellier,France [3]Department of Liver Surgery,St-Eloi University Hospital,Montpellier,France [4]Department of Oncology,St-Eloi University Hospital,Montpellier,France [5]PhyMedExp,University of Montpellier,INSERM,CNRS,Montpellier,France [6]Department of Nuclear Medicine,CHU of Montpellier,Montpellier,France

出　　处：《Hepatobiliary Surgery and Nutrition》2023年第3期351-365,I0012,I0013,共17页肝胆外科与营养（英文）

摘　　要：Background:Transarterial radioembolization(TARE)has recently been recognized as a bridging/downstaging therapy to surgery for early hepatocellular carcinomas(HCCs)with high rates of complete pathological necrosis(CPN)on liver explants.In patients with portal vein tumoral thrombus(PVTT),multifocal or large tumors,TARE has mainly a palliative role and surgery remains controversial in this poor-prognosis population.Personalized dosimetry recently proved to outperform standard dosimetry used in prior negative Y90 randomized-controlled trials.Methods:In this retrospective study,we evaluated safety,radiological and pathological response and outcomes in HCC patients with PVTT,multifocal or large tumors,who underwent surgery after downstaging using TARE with Y90-loaded glass microspheres with personalized dosimetry.Results:Between December 2015 and October 2021,18 unresectable patients(14/18 with PVTT)had surgery(16 resections,2 liver transplantations)6.2 months(range,2-14.6 months)after a single Y90 treatment.No 90-day mortality was reported.Objective modified response criteria in solid tumors(mRECIST)response were noted in all but one patient.Complete and extensive(50-99%)necrosis was observed in 36%and 45%of tumors,respectively.The post-treatment tumor-absorbed dose significantly differed depending on the extent of pathological necrosis(P=0.045).Median overall survival and progression-free survival(PFS)were respectively of 61.8 months[95%CI:31.4 months-not reached(NR)]and 49.3 months(95%CI:14 months-NR).PFS was longer in patients with complete imaging response[median NR(none recurred or died)vs.21.5 months(95%CI:10.1 months-NR),P<0.001]and in those with complete pathological response[median NR vs.22.5 months(95%CI:10.1 months-NR),P<0.001].Conclusions:Y90 TARE using personalized dosimetry can provide high rates of imaging and pathological response in patients with PVTT,large or multifocal HCC.Subsequent surgery is safe and leads to outcomes far exceeding expectations in an otherwise poor prognosis population with no ch

关 键 词：Selective internal radiation therapy hepatocellular carcinoma(HCC) liver cancer RESECTION transplantation 

分 类 号：R735.7[医药卫生—肿瘤]