neuroendocrine 的罐头成像模式肝的转移预言反应 yttruim-90 radioembolotherapy？

AIM:To evaluate the response to treatment in patients with neuroendocrine tumor liver metastases following yttrium-90 ( 90 Y) radioembolotherapy, as a function of image patterns at presentation for 90 Y radioembolotherapy. METHODS: The study cohort consisted of patients with hepatic metastatic neuroendocrine tumors treated with 90 Y at our institution during a two-year time period. Hepatic metastases were evaluated on a pretherapy study assessing relative arterial enhancement compared to liver, lesion size, necrosis of the lesion, and associated tumor burden in the liver. We used six response criteria: Response Evaluation Criteria in Solid Tumors (RECIST) size, World Health Organization (WHO) size, European Association for the Study of the Liver (EASL) necrosis guidelines, Choi size, Choi necrosis and combination of Choi size and necrosis. RESULTS: About 65 lesions in 17 patients met study criteria and formed the cohort. Statistically significant response was found for lesions 【 5 cm vs those ≥5 cm with RECIST (P = 0.04), WHO (P = 0.002) and combined Choi criteria (P = 0.02). Hyperenhancing lesions demonstrated greater response only with the Choi size criteria (P = 0.04). Lesions with ≤ 50% necrosis on the pre-scan had statistically significant greater response with the Choi necrosis criteria (P = 0.01). There was no statistical significance for response comparing lesions 【 2 cm vs ≥ 2 cm or in comparing the degrees of tumor burden. CONCLUSION: Based on our findings in this study, it is suggested that initial imaging findings, as listed above, are not a good predictor of response to 90 Y radioembolization.

Disease control and failure patterns of unresectable hepatocellular carcinoma following transarterial radioembolization with yttrium-90 microspheres and with/without sorafenib

BACKGROUND Impressive survival outcome of our previous study in unresectable hepatocellular carcinoma(HCC)patients undergoing yttrium-90 glass microspheres transarterial radioembolization(TARE)with/without sorafenib according to individuals’disease burden,i.e.,intrahepatic tumor load(IHT)and adverse disease features(ADFs)might partly be confounded by other treatments and underlying hepatic function.Therefore,a dedicated study focusing on treatment response and assessment of failure patterns might be a way to improve treatment outcome in addition to patient selection based on the disease burden.AIM To assess the tumor response,disease control and patterns of disease progression following TARE with/without sorafenib in unresectable HCC patients.METHODS This retrospective study was conducted in successful TARE procedures with available pre-and post-treatment imaging studies(n=169).Three treatment subgroups were(1)TARE only(TARE_alone)for IHT≤50%without ADFs,i.e.,macrovascular invasion,extrahepatic disease(EHD)and infiltrative/ill-defined HCC(n=63);(2)TARE with sorafenib(TARE_sorafenib)for IHT>50%and/or presence of ADFs(n=81);and(3)TARE only for patients who could not receive sorafenib due to contraindication or intolerance(TARE_no_sorafenib)(n=25).Objective response rate(ORR;consisted of complete response(CR)and partial response(PR)),disease control rate(DCR;consisted of CR,PR and stable disease)and failure patterns of treated,intrahepatic and extrahepatic sites were assessed using the modified response evaluation criteria in solid tumors.Time to progression(TTP)was calculated from TARE to the first radiologic progression at any site using Kaplan-Meier method.Identification of prognostic factors for TTP using the univariate Kaplan-Meier method and multivariate Cox proportional hazard model were performed in major population subgroups,TARE_alone and TARE_sorafenib.RESULTS The median radiologic follow-up time was 4.4 mo(range 0.5-48.8).In treated area,ORR was highest in TARE_sorafenib(53.1%),followed by TARE_alone(41.3%)and TARE_no_sorafenib(16%).In intrahepatic area,DCR remained highest in TARE_sorafenib(84%),followed by TARE_alone(79.4%)and TARE_no_sorafenib(44%).The overall DCR was highest in TARE_alone(79.4%),followed by TARE_sorafenib(71.6%)and TARE_no_sorafenib(40%).Dominant failure patterns were intrahepatic for both TARE_alone(44.5%)and TARE_sorafenib(38.4%).Extrahepatic progression was more common in TARE_sorafenib(32%)and TARE_no_sorafenib(40%)than in TARE_alone(12.7%).TTP was longest in TARE_alone(8.6 mo;95%CI:3.4-13.8),followed by TARE_sorafenib(5.1 mo;95%CI:4.0-6.2)and TARE_no_sorafenib(2.7 mo;95%CI:2.2-3.1).Pre-existing EHD(HR:0.37,95%CI:0.24-0.56,P<0.001)was a sole prognostic factor for TTP in TARE_sorafenib with no prognostic factor for TTP in TARE_alone.CONCLUSION TARE with/without sorafenib according to individuals’disease burden provided DCR approximately 70%with intrahepatic progression as dominant failure pattern.Extrahepatic progression was more common in procedures with initially high disease burden.