DRAGON 1- Training, Accreditation, Implementation and Safety Evaluation of Combined PVE/HVE

Titre officiel

DRAGON 1- Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization to Accelerate Future Liver Remnant (FLR) Hypertrophy

Sommaire:

Résumé : Certaines métastases hépatiques colorectales ne peuvent être réséquées qu’après régénération du foie induite par embolisation de la veine porte (EVP) visant à accroître le volume et la fonction du futur foie restant (FFR). Bien que l’EVP soit la procédure standard, l’embolisation combinée de la veine porte et des veines hépatiques (EVP/EVH) d’un côté du foie pourrait accélérer la croissance du foie et en améliorer plus rapidement la fonction. L’EVP/EVH est une nouvelle procédure dont l’innocuité et la faisabilité nécessitent d’être évaluées dans un essai préliminaire (DRAGON 1), suivi d’une comparaison avec l’EVP dans un essai contrôlé à répartition aléatoire (ECRA) (DRAGON 2).

Description de l'essai

Primary Outcome:

• Ability of each centre to enroll 3 patients in 12 months without mortality due to the intervention.

Secondary Outcome:

• Efficacy assessment: standardized future liver remnant volume
• Feasibility assessment: resection rate
• Mortality assessment
• Overall survival after PVE/HVE
• Oncological effectiveness of PVE/HVE
• General complication assessment
• Liver specific complication assessment

Detailed Description: Resection of liver metastases from colorectal cancer (CRLM) improves survival compared to chemotherapy alone and may lead to cure in up to 40% of patients. Surgical resectability is limited by location of metastases and by FLR size and function. Commonly, the volume of the future liver remnant (FLR) should be at least 30% of the functional FLR volume. If this volume criterion is not met, the induction of liver regeneration between a two-stage hepatectomy is performed at many centres, with the aim to render patients resectable and reduce the risk of post hepatectomy liver failure. Gold standard to induce regeneration is the embolization of the portal vein branches to the tumour carrying liver (PVE) to induce regeneration of the FLR. Recently, combined embolization of both portal and hepatic veins (PVE/HVE) has been described as an alternative to portal vein embolization because it accelerates and increases growth of the FLR. PVE/HVE combines simultaneous embolization of the portal main branches into the tumour bearing liver and the hepatic vein draining them. The tissue in the part of the liver treated with PVE/HVE stays viable because the hepatic artery continues to supplies the liver deprived of portal and hepatic veins. Preclinical studies in pigs have demonstrated feasibility of this method and human case series show accelerated and increased liver growth. No multi-centre evaluation has been performed so far. DRAGON 1 is an international, prospective, multi-centre trial to test enrolment capacity of participants and safety of portal and hepatic vein embolization (PVE/HVE). DRAGON 1 will form the basis of the RCT DRAGON 2 to compare PVE with PVE/HV. DRAGON 2 is expected to start in 2021.

Voir cet essai sur ClinicalTrials.gov