Selective Internal Radiation Therapy for Hepatocellular Carcinoma: Experience from a Hospital in Hong Kong
YP Tai, CH Cheung, KM Cheung, HC Cheng, RKC Ngan, PCH Kwok
Hong Kong J Radiol 2017;20:213-9
DOI: 10.12809/hkjr1716905
Purpose: To report the outcomes and prognostic factors of overall survival after selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC).
Methods: Consecutive patients who underwent SIRT for HCC at Queen Elizabeth Hospital between December 2006 and February 2016 were retrospectively reviewed.
Results: 51 male and 11 female patients aged 42 to 90 (median, 66) years were deemed suitable to receive SIRT. Most were hepatitis B carriers and had an Eastern Cooperative Oncology Group performance score of ≤1 and Child-Pugh class A cirrhosis. About half of the patients had portal vein thrombosis and an alpha-fetoprotein level of >200 ng/ml. 30.7% of patients were at Barcelona Clinic Liver Cancer stage B and 64.5% at stage C. 50% of tumours were ≥8 cm at the longest diameter. The median dose received by the tumour was 130 Gy. Three months after SIRT, 1.7% had a complete response, 43.3% had a partial response, 26.7% had stable disease, and 28.3% had progressive disease. The 1-year local control rate was 12.3%. The 1-year overall survival was 30.6%. The median time to tumour progression was 3 months and the median overall survival was 6 months. In multivariate analysis, Child-Pugh class, portal vein thrombosis, and post-SIRT intervention were significant prognostic factors for overall survival.
Conclusion: SIRT is an effective and safe treatment for intermediate- to advanced-stage HCC. It achieves good local control with minimal toxicity although the outcome is unsatisfactory in terms of new intrahepatic or distant recurrence. HCC patients with Child-Pugh class A cirrhosis, no portal vein thrombosis, and an ability to undergo subsequent treatments have longer survival.
Authors’ affiliations:
YP Tai, CH Cheung, KM Cheung, HC Cheng, RKC Ngan: Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
PCH Kwok: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
中文摘要
選擇性內部放射治療肝細胞癌：香港一間醫院的經驗
戴燕萍、張振雄、張嘉文、鄭海清、顏繼昌、郭昶熹
目的：報告選擇性內部放射治療（SIRT）肝細胞癌（HCC）的結果和總生存預後因素。
方法：回顧性分析2006年12月至2016年2月期間在伊利沙伯醫院接受SIRT的連續患者。
結果：51名男性和11名女性患者，年齡42至90（中位數，66）歲的患者經評估適合接受SIRT。他們 大多數是乙型肝炎帶菌者、東方合作腫瘤組評分為≤1和Child-Pugh A級肝硬化。大約一半的患者有 門靜脈血栓和甲胎蛋白水平>200 ng/ml。30.7%的患者在巴塞羅那診所肝癌B期，64.5%在C期。50% 的腫瘤最長直徑≥8厘米。腫瘤接受的中位劑量為130 Gy。SIRT後，1.7%有完全反應，43.3%有部分 反應，26.7%腫瘤穩定和28.3%腫瘤惡化。一年局部控制率為12.3%。一年總生存率為30.6%。腫瘤 惡化的中位時間為3個月，中位總生存期為6個月。在多變量分析中，Child-Pugh分級，門靜脈血栓 和SIRT後干預是總體生存的重要預後因素。
結論：SIRT是治療中晚期HCC的有效和安全的方法。它具有良好的局部控制和較少毒性，但其在新 的肝內或遠處復發中的效果不好。Child-Pugh A型肝硬化、沒有門靜脈血栓以及能接受後續治療的 HCC患者有較好的生存結果。