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 

作者机构：Department of RadiologySt-Eloi University HospitalMontpellierFrance Department of Liver PathologySt-Eloi University HospitalMontpellierFrance Department of Liver SurgerySt-Eloi University HospitalMontpellierFrance Department of OncologySt-Eloi University HospitalMontpellierFrance PhyMedExpUniversity of MontpellierINSERMCNRSMontpellierFrance Department of Nuclear MedicineCHU of MontpellierMontpellierFrance 

出 版 物：《Hepatobiliary Surgery and Nutrition》 (肝胆外科与营养（英文）)

年 卷 期：2023年第12卷第3期

页      面：351-365,I0012,I0013页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Selective internal radiation therapy hepatocellular carcinoma(HCC) liver cancer resection transplantation 

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 *** 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 *** dosimetry recently proved to outperform standard dosimetry used in prior negative Y90 randomized-controlled ***: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 ***: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 *** 90-day mortality was *** modified response criteria in solid tumors(mRECIST)response were noted in all but one *** and extensive(50-99%)necrosis was observed in 36%and 45%of tumors,*** 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),P0.001]and in those with complete pathological response[median NR vs.22.5 months(95%CI:10.1 months-NR),P0.001].Conclusions:Y90 TARE using personalized dosimetry can provide high rates of imaging and pathological response in patients with PVTT,large or multifocal *** surgery is safe and leads to outcomes far exceeding expectations in a