Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma.

Abstract:

BACKGROUND & AIMS:Conventional transarterial chemoembolization (cTACE) is used to treat patients with hepatocellular carcinoma (HCC). Radioembolization is a minimally invasive procedure that involves implantation of radioactive micron-sized particles loaded with yttrium-90 (Y90) inside the blood vessels that supply a tumor. We performed a randomized, phase 2 study to compare the effects of cTACE and Y90 radioembolization in patients with HCC. METHODS:From October 2009 through October 2015, we reviewed patients with HCC of all Barcelona Clinic Liver Cancer (BCLC) stages for eligibility. Of these, 179 patients with BCLC stages A or B met our enrollment criteria and were candidates for cTACE or Y90 therapy. Patients were assigned randomly to groups that received Y90 therapy (n = 24; 50% Child-Pugh A) or cTACE (n = 21; 71% Child-Pugh A). The primary outcome was time to progression (TTP), evaluated by intention-to-treat analysis. Secondary outcomes included safety, rate of response (based on tumor size and necrosis criteria), and Kaplan-Meier survival time. We performed inverse probability of censoring weighting and competing risk analyses. RESULTS:Patients in the Y90 radioembolization group had significant longer median TTP (>26 mo) than patients in the cTACE group (6.8 mo; P = .0012) (hazard ratio, 0.122; 95% confidence interval [CI], 0.027-0.557; P = .007). This was confirmed by competing risk and inverse probability of censoring weighting analyses accounting for transplantation or death. A significantly greater proportion of patients in the cTACE group developed diarrhea (21%) than in the Y90 group (0%; P = .031) or hypoalbuminemia (58% in the cTACE group vs 4% in the Y90 group; P < .001). Similar proportions of patients in each group had a response to therapy, marked by necrosis (74% in the cTACE group vs 87% in the Y90 group) (P = .433). The median survival time, censored to liver transplantation, was 17.7 months for the cTACE group (95% CI, 8.3-not calculable) vs 18.6 months for the Y90 group (95% CI, 7.4-32.5) (P = .99). CONCLUSIONS:In a randomized phase 2 study of patients with HCC of BCLC stages A or B, we found Y90 radioembolization to provide significantly longer TTP than cTACE. Y90 radioembolization provides better tumor control and could reduce drop-out from transplant waitlists. ClinicalTrials.gov no. NCT00956930.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Salem R,Gordon AC,Mouli S,Hickey R,Kallini J,Gabr A,Mulcahy MF,Baker T,Abecassis M,Miller FH,Yaghmai V,Sato K,Desai K,Thornburg B,Benson AB,Rademaker A,Ganger D,Kulik L,Lewandowski RJ

doi

10.1053/j.gastro.2016.08.029

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

1155-1163.e2

issue

6

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(16)34971-X

journal_volume

151

pub_type

杂志文章,随机对照试验
  • Hydrogen ion concentration in the mucus layer on top of acid-stimulated and -inhibited rat gastric mucosa.

    abstract:BACKGROUND/AIMS:The gastric mucosa is covered by a continuous layer of bicarbonate-containing mucus gel; the question arises how acid, formed in the gastric glands, moves into the lumen. METHODS:The pH in the gastric mucus gel and gel thickness were measured in anesthetized rats with pH-sensitive microelectrodes (tip ...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(94)90075-2

    authors: Schade C,Flemström G,Holm L

    更新日期:1994-07-01 00:00:00

  • Patterns of Resistance-Associated Substitutions in Patients With Chronic HCV Infection Following Treatment With Direct-Acting Antivirals.

    abstract:BACKGROUND & AIMS:Little is known about substitutions that mediate resistance of hepatitis C virus (HCV) to direct-acting antivirals (DAAs), due to the small number of patients with treatment failure in approval studies. It is important to identify resistance patterns to select effective salvage treatments. METHODS:We...

    journal_title:Gastroenterology

    pub_type: 杂志文章,多中心研究

    doi:10.1053/j.gastro.2017.11.007

    authors: Dietz J,Susser S,Vermehren J,Peiffer KH,Grammatikos G,Berger A,Ferenci P,Buti M,Müllhaupt B,Hunyady B,Hinrichsen H,Mauss S,Petersen J,Buggisch P,Felten G,Hüppe D,Knecht G,Lutz T,Schott E,Berg C,Spengler U,von Ha

    更新日期:2018-03-01 00:00:00

  • Celiac sprue and Crohn's disease: an association causing severe growth retardation.

    abstract::Celiac sprue and Crohn's disease have very rarely been documented in the same patient. We report a case involving an adolescent male with known Crohn's disease who had extreme wasting, growth retardation, intractable diarrhea, and delay in development of secondary sexual characteristics. Peroral jejunal biopsy showed ...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:

    authors: Euler AR,Ament ME

    更新日期:1977-04-01 00:00:00

  • PDGFRA germline mutation in a family with multiple cases of gastrointestinal stromal tumor.

    abstract::Familial gastrointestinal stromal tumor (GIST) is a rare autosomal dominant genetic disorder associated with KIT germline mutations. In sporadic forms of the disease, somatic mutations target either KIT or PDGFRA genes. In a kindred in which 5 individuals had GIST, no germline mutation in KIT coding sequence has been ...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/j.gastro.2003.10.079

    authors: Chompret A,Kannengiesser C,Barrois M,Terrier P,Dahan P,Tursz T,Lenoir GM,Bressac-De Paillerets B

    更新日期:2004-01-01 00:00:00

  • Organoid Models of Human Gastrointestinal Development and Disease.

    abstract::We have greatly advanced our ability to grow a diverse range of tissue-derived and pluripotent stem cell-derived gastrointestinal (GI) tissues in vitro. These systems, broadly referred to as organoids, have allowed the field to move away from the often nonphysiological, transformed cell lines that have been used for d...

    journal_title:Gastroenterology

    pub_type: 杂志文章,评审

    doi:10.1053/j.gastro.2015.12.042

    authors: Dedhia PH,Bertaux-Skeirik N,Zavros Y,Spence JR

    更新日期:2016-05-01 00:00:00

  • Prospective evaluation of early morphological changes in pelvic ileal pouches.

    abstract:BACKGROUND/AIMS:Little is known about the evolution of morphological changes in pelvic ileal-pouch mucosa. This study evaluates prospectively the sequence of early morphological, histochemical, and phenotypic features in pouch mucosal biopsy specimens. METHODS:Twenty-two patients with pelvic ileal pouches constructed ...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(94)90169-4

    authors: Apel R,Cohen Z,Andrews CW Jr,McLeod R,Steinhart H,Odze RD

    更新日期:1994-08-01 00:00:00

  • Silencing of USP18 potentiates the antiviral activity of interferon against hepatitis C virus infection.

    abstract:BACKGROUND & AIMS:Modulation of the host innate immune response is an attractive means of inhibiting hepatitis C virus (HCV) replication. Having previously determined that expression of the interferon-sensitive gene (ISG)15 protease USP18 is increased in the liver biopsy specimens of patients who do not respond to inte...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/j.gastro.2006.08.043

    authors: Randall G,Chen L,Panis M,Fischer AK,Lindenbach BD,Sun J,Heathcote J,Rice CM,Edwards AM,McGilvray ID

    更新日期:2006-11-01 00:00:00

  • Effect of phenobarbital on biliary lipid metabolism in normal man.

    abstract::The efficacy of phenobarbital in altering biliary lipid composition in normal man was investigated by determining parameters of biliary lipid metabolism in 8 human subjects without biliary tract disease before and after oral phenobarbital administration at a dose of approximately 3 mg per kg per day for 25 to 54 days....

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:

    authors: Ginsberg RL,Garnick MB

    更新日期:1977-06-01 00:00:00

  • Long-term antigen challenge results in progressively diminished mucosal mast cell degranulation in rats.

    abstract:BACKGROUND & AIMS:The effects of short-term antigenic activation of mast cells on the gastrointestinal tract have been well characterized, but little is known about the effects of long-term exposure to antigen on mucosal mast cell reactivity. The aim of this study was to determine the effects of long-term antigen expos...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/s0016-5085(96)70013-6

    authors: Rioux KP,Wallace JL

    更新日期:1996-12-01 00:00:00

  • Small intestinal epithelial renewal in the Syrian hamster exposed to cholera enterotoxin.

    abstract::Epithelial renewal of the small intestine was measured in the Syrian hamster utilizing tritiated thymidine by standard autoradiographic and a scintillation counting technique. Scintillation counting of intestinal replicates proved to be as accurate as standard autoradiography. Average mucosal cell turnover was 71 +/- ...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:

    authors: Banwell JG,Lepot A,Hanke DW,Sigdestad C

    更新日期:1978-10-01 00:00:00

  • Delivery of matrix metalloproteinase-1 attenuates established liver fibrosis in the rat.

    abstract:BACKGROUND & AIMS:During hepatic fibrogenesis, the hepatic extracellular matrix changes to fibrillar collagens types I and III, and cirrhosis is believed to produce an irreversible scar. In this study, we investigated whether gene delivery of human matrix metalloproteinase-1, which degrades collagens types I and type I...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/gast.2003.50063

    authors: Iimuro Y,Nishio T,Morimoto T,Nitta T,Stefanovic B,Choi SK,Brenner DA,Yamaoka Y

    更新日期:2003-02-01 00:00:00

  • Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction.

    abstract::To understand the disorders of bowel motility, it is important to know the range of bowel patterns in the general population. We have devised a brief self-administered questionnaire which, when used among a group of 789 students and hospital employees, disclosed that 94.2% had stool frequencies between three per day a...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:

    authors: Drossman DA,Sandler RS,McKee DC,Lovitz AJ

    更新日期:1982-09-01 00:00:00

  • Autoradiographic localization of sigma opioid receptors in the gastrointestinal tract of the guinea pig.

    abstract::The distribution of sigma and phencyclindine binding sites in the gastrointestinal tract of the guinea pig was studied by autoradiography after in vitro incubation of tissue slices with (+)3H-SKF 10,047 and 3H-1-1-[(2-thienyl)cyclohexyl] piperidine to locate sigma and phencyclidine receptors, respectively. A dense dis...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(89)91418-2

    authors: Roman F,Pascaud X,Chomette G,Bueno L,Junien JL

    更新日期:1989-07-01 00:00:00

  • Irbit mediates synergy between ca(2+) and cAMP signaling pathways during epithelial transport in mice.

    abstract:BACKGROUND & AIMS:The cyclic adenosine monophosphate (cAMP) and Ca(2+) signaling pathways synergize to regulate many physiological functions. However, little is known about the mechanisms by which these pathways interact. We investigated the synergy between these signaling pathways in mouse pancreatic and salivary glan...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/j.gastro.2013.03.047

    authors: Park S,Shcheynikov N,Hong JH,Zheng C,Suh SH,Kawaai K,Ando H,Mizutani A,Abe T,Kiyonari H,Seki G,Yule D,Mikoshiba K,Muallem S

    更新日期:2013-07-01 00:00:00

  • Aerobilia and hypomotility of the sphincter of Oddi in a patient with chronic intestinal pseudo-obstruction.

    abstract::A 50-year-old woman with a typical history of chronic idiopathic intestinal pseudo-obstruction was admitted to hospital because of an acute episode of abdominal cramps, nausea, and vomiting. The diagnosis of chronic idiopathic intestinal pseudo-obstruction had been established in this patient who had malnutrition and ...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(92)91744-o

    authors: Allescher HD,Safrany L,Neuhaus H,Feussner H,Classen M

    更新日期:1992-05-01 00:00:00

  • Lipoxygenase metabolites in the rat gastric microvascular response to intragastric ethanol.

    abstract::The role of lipoxygenase metabolites in ethanol-induced gastric mucosal injury and submucosal microvascular change in the rat was studied by in vivo microscopy. Intragastric ethanol-instillation caused marked submucosal venular constriction, dilatation of small arterioles, and corpus mucosal gross lesion formation. Th...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(89)90065-6

    authors: Yonei Y,Guth PH

    更新日期:1989-08-01 00:00:00

  • Intestinal absorption of the octapeptide SMS 201-995 visualized by fluorescence derivatization.

    abstract::The absorption of an intact oligopeptide was investigated in rat and dog small intestine using the metabolically stable somatostatin analogue SMS 201-995. The synthetic octapeptide was coupled to 4-nitrobenzo-2-oxa-1,3-diazol to have a fluorescent label for the direct visualization. The 4-nitrobenzo-2-oxa-1,3-diazol-l...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(91)90651-z

    authors: Fricker G,Bruns C,Munzer J,Briner U,Albert R,Kissel T,Vonderscher J

    更新日期:1991-06-01 00:00:00

  • Cholangiopancreatography, sphincterotomy, and common duct stone removal via Roux-en-Y limb enteroscopy.

    abstract::An enteroscopic method that uses a pediatric colonoscope provides an alternative approach to the diagnostic and management problems arising in the setting of a Roux-en-Y limb hepaticojejunostomy or biliary diversion. Three patients with Roux-en-Y limb reconstructions who experienced recurrent cholangitis, recurrent pa...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(88)90305-8

    authors: Gostout CJ,Bender CE

    更新日期:1988-07-01 00:00:00

  • Rat intestinal M cells contain acidic endosomal-lysosomal compartments and express class II major histocompatibility complex determinants.

    abstract:BACKGROUND:It is generally believed that M cells do not modify the antigens they transport from the intestinal lumen to underlying immunocompetent cells because it has been reported that M cells contain few elements of the lysosomal system. METHODS:We used specific cytochemical and immunocytochemical probes to examine...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(93)91004-2

    authors: Allan CH,Mendrick DL,Trier JS

    更新日期:1993-03-01 00:00:00

  • A new cause of Zollinger-Ellison syndrome: non-small cell lung cancer.

    abstract::Numerous epidemiologic studies suggest a relationship between lung cancer and peptic ulcer disease. Furthermore, various lung cancers synthesize and release a number of peptides such as gastrin and gastrin-releasing peptide that could cause acid hypersecretion; however, Zollinger-Ellison syndrome (ZES), because of a l...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/gast.2001.23242

    authors: Abou-Saif A,Lei J,McDonald TJ,Chakrabarti S,Waxman IF,Shojamanesh H,Schrump DS,Kleiner DE,Gibril F,Jensen RT

    更新日期:2001-04-01 00:00:00

  • A proinflammatory, antiapoptotic phenotype underlies the susceptibility to acute pancreatitis in cystic fibrosis transmembrane regulator (-/-) mice.

    abstract:BACKGROUND & AIMS:Cystic fibrosis transmembrane regulator (CFTR) gene mutations are associated with pancreatic insufficiency and pancreatitis. Chronic pancreatitis, including cystic fibrosis-related disease, may exist as a continuum between acute and chronic disease and may manifest as recurrent pain. We hypothesized t...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/j.gastro.2005.05.059

    authors: Dimagno MJ,Lee SH,Hao Y,Zhou SY,McKenna BJ,Owyang C

    更新日期:2005-08-01 00:00:00

  • Propranolol inhibits adenylate cyclase and secretion stimulated by deoxycholic acid in the rabbit colon.

    abstract::Bile acids cause diarrhea by inducing colonic secretion, probably mediated through the cyclic AMP system. The aim was to determine the effects of an adenylate cyclase inhibitor, propranolol, on deoxycholic acid (DCA) stimulation of net secretion and the cyclic AMP system in the colon. In each of 30 New Zealand white r...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:

    authors: Conley D,Coyne M,Chung A,Bonorris G,Schoenfield L

    更新日期:1976-07-01 00:00:00

  • Isolation and morphologic characterization of bile duct epithelial cells from normal rat liver.

    abstract::To study directly the functions of the cells that line the bile ducts inside the liver, we developed a new technique for isolating intrahepatic bile duct epithelial cells (IBDECs) from normal rat liver. Parenchymal and nonparenchymal cells were separated from whole liver by enzymatic digestion and mechanical disruptio...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(89)91695-8

    authors: Ishii M,Vroman B,LaRusso NF

    更新日期:1989-11-01 00:00:00

  • Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus.

    abstract:BACKGROUND & AIMS:Barrett's esophagus-associated high-grade dysplasia is commonly treated by endoscopy. However, most guidelines offer no recommendations for endoscopic treatment of mucosal adenocarcinoma of the esophagus (mAC). We investigated the efficacy and safety of endoscopic resection in a large series of patien...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/j.gastro.2013.11.006

    authors: Pech O,May A,Manner H,Behrens A,Pohl J,Weferling M,Hartmann U,Manner N,Huijsmans J,Gossner L,Rabenstein T,Vieth M,Stolte M,Ell C

    更新日期:2014-03-01 00:00:00

  • Interleukin-28B polymorphism improves viral kinetics and is the strongest pretreatment predictor of sustained virologic response in genotype 1 hepatitis C virus.

    abstract:BACKGROUND & AIMS:We recently identified a polymorphism upstream of interleukin (IL)-28B to be associated with a 2-fold difference in sustained virologic response (SVR) rates to pegylated interferon-alfa and ribavirin therapy in a large cohort of treatment-naive, adherent patients with chronic hepatitis C virus genotyp...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/j.gastro.2010.04.013

    authors: Thompson AJ,Muir AJ,Sulkowski MS,Ge D,Fellay J,Shianna KV,Urban T,Afdhal NH,Jacobson IM,Esteban R,Poordad F,Lawitz EJ,McCone J,Shiffman ML,Galler GW,Lee WM,Reindollar R,King JW,Kwo PY,Ghalib RH,Freilich B,Nyberg

    更新日期:2010-07-01 00:00:00

  • Hepcidin expression does not rescue the iron-poor phenotype of Kupffer cells in Hfe-null mice after liver transplantation.

    abstract:BACKGROUND & AIMS:Hemochromatosis is a common hereditary disease caused by mutations in HFE and characterized by increased absorption of iron in the intestine. However, the intestine does not appear to be the site of mutant HFE activity in the disease; we investigated the role of the liver-the source of the iron regula...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/j.gastro.2010.03.043

    authors: Garuti C,Tian Y,Montosi G,Sabelli M,Corradini E,Graf R,Ventura P,Vegetti A,Clavien PA,Pietrangelo A

    更新日期:2010-07-01 00:00:00

  • The protective effect of gamma-hydroxybutyrate in regional intestinal ischemia in the hamster.

    abstract::The purpose of this study was to determine whether gamma-hydroxybutyrate provides protection against intestinal ischemia/reperfusion injury and to compare its effect with that of allopurinol and vitamin E. Thirty minutes of total regional ischemia, followed by 3 hours of reperfusion, produced intestinal damage that wa...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1016/0016-5085(90)90982-7

    authors: Boyd AJ,Sherman IA,Saibil FG,Mamelak M

    更新日期:1990-09-01 00:00:00

  • Relationship between activation of the sympathetic nervous system and renal blood flow autoregulation in cirrhosis.

    abstract:BACKGROUND & AIMS:It has been proposed that activation of the sympathetic nervous system causes a rightward shift in the renal autoregulatory curve such that renal blood flow is critically dependent on renal perfusion pressure and that this contributes to the development of the hepatorenal syndrome. The aims of the stu...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/j.gastro.2007.10.055

    authors: Stadlbauer V,Wright GA,Banaji M,Mukhopadhya A,Mookerjee RP,Moore K,Jalan R

    更新日期:2008-01-01 00:00:00

  • Development and validation of a symptom-based activity index for adults with eosinophilic esophagitis.

    abstract:BACKGROUND & AIMS:Standardized instruments are needed to assess the activity of eosinophilic esophagitis (EoE) and to provide end points for clinical trials and observational studies. We aimed to develop and validate a patient-reported outcome (PRO) instrument and score, based on items that could account for variations...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:10.1053/j.gastro.2014.08.028

    authors: Schoepfer AM,Straumann A,Panczak R,Coslovsky M,Kuehni CE,Maurer E,Haas NA,Romero Y,Hirano I,Alexander JA,Gonsalves N,Furuta GT,Dellon ES,Leung J,Collins MH,Bussmann C,Netzer P,Gupta SK,Aceves SS,Chehade M,Moawad F

    更新日期:2014-12-01 00:00:00

  • Decrease of a hepatic binding protein specific for asialoglycoproteins with accumulation of serum asialoglycoproteins in galactosamine-treated rats.

    abstract::Acute liver injury was induced experimentally in rats by a single injection of a large amount of D-galactosamine. Hepatocellular damage was apparent from decrease of total serum proteins, marked release of transaminases into the circulation, precipitous decrease of total microsomal proteins, and intracellular enzymes ...

    journal_title:Gastroenterology

    pub_type: 杂志文章

    doi:

    authors: Sawamura T,Kawasato S,Shiozaki Y,Sameshima Y,Nakada H,Tashiro Y

    更新日期:1981-09-01 00:00:00