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Radioembolización en hepatocarcinoma: a propósito de 53 casos
Radioembolization in patients with hepatocellular carcinoma: a series of 53 cases
P. Oliván-Sasota,
Autor para correspondencia
olivan_pat@gva.es

Autor para correspondencia.
, D. Pérez-Enguixb, P. Bello-Arquesc, I. Torres-Espallardod, M. Falgás-Lacuevac, A.M. Yepes-Agudeloc, C. Olivas-Arroyoe
a Medicina Nuclear, Hospital de La Ribera, Alzira, Valencia, España
b Radiología intervencionista, Hospital Universitario y Politécnico La Fe, Valencia, España
c Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, España
d Radiofísica, Hospital Universitario y Politécnico La Fe, Valencia, España
e Radiofarmacia, Hospital Universitario y Politécnico La Fe, Valencia, España
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recoge las diferentes opciones de tratamiento en pacientes con hepatocarcinoma&#46; Incluye tratamientos curativos para estadificaciones precoces y terapias paliativas para estadio intermedio y avanzado&#46; El tratamiento est&#225;ndar en estadios intermedios es la QETA &#40;quimioembolizaci&#243;n arterial&#41;&#44; y para estadios avanzados es la terapia sist&#233;mica &#40;sorafenib&#41;&#46; La radioembolizaci&#243;n &#40;RETA&#44; radioembolizaci&#243;n transarterial&#41; no se engloba en el momento actual como terapia en los esquemas del sistema de estadificaci&#243;n BCLC<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; si bien durante las &#250;ltimas d&#233;cadas se ha demostrado la eficacia y perfil de seguridad de la RETA en pacientes afectados de hepatocarcinoma<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">De forma resumida&#44; la RETA consiste en la infusi&#243;n transarterial de microesferas cargadas con un radiois&#243;topo&#46; El producto m&#225;s frecuentemente empleado es el itrio-90 &#40;<span class="elsevierStyleSup">90</span>Y&#41;&#44; que consigue el dep&#243;sito de altas dosis de energ&#237;a en el&#47;los tumor&#47;es hep&#225;ticos con una relativa preservaci&#243;n del par&#233;nquima hep&#225;tico no tumoral<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a>&#46; Las microesferas que act&#250;an como vectores del radiois&#243;topo son de reducido calibre &#40;20-35 micras&#44; vidrio o resina&#41; y permiten alcanzar niveles precapilares peritumorales&#46; A diferencia de la TACE&#44; donde el efecto sin&#233;rgico de la isquemia y la quimioterapia son la base del tratamiento&#44; en la TARE el efecto terap&#233;utico deriva directamente de la radiaci&#243;n&#44; no de la isquemia&#46; Esta ausencia de isquemia permite tratar a pacientes con el flujo portal comprometido&#44; incluidos casos de invasi&#243;n vascular&#44; con resultados muy prometedores<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5&#44;7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La RETA se ha empleado de forma m&#225;s generalizada en pacientes no candidatos a terapias curativas&#44; enmarcados dentro de los estadios intermedio y avanzado del BCLC&#46; Tambi&#233;n ha demostrado su eficacia como m&#233;todo de reducci&#243;n del estadio tumoral &#40;&#8220;downstaging&#8221;&#41; y como t&#233;cnica puente para cirug&#237;a &#40;trasplante hep&#225;tico y&#47;o resecci&#243;n&#41;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">5&#44;8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es presentar nuestra experiencia con la radioembolizaci&#243;n en pacientes afectados de hepatocarcinoma en estadios &#40;BCLC&#41; intermedio y avanzado&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio retrospectivo en pacientes diagnosticados de hepatocarcinoma&#44; tratados con RETA entre marzo de 2009 y diciembre de 2016&#46; El estudio fue aprobado por el Comit&#233; de &#201;tica y de Investigaci&#243;n Biom&#233;dica de nuestro hospital &#40;n&#46;&#176; de registro PDP-ITR-2017-01&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La selecci&#243;n de candidatos a RETA se estableci&#243; en el marco de un comit&#233; multidisciplinar &#40;formado por hepat&#243;logos&#44; cirujanos hep&#225;ticos&#44; radi&#243;logos intervencionistas y radi&#243;logos generalistas con especial dedicaci&#243;n a la patolog&#237;a abdominal&#41;&#46; La carga tumoral&#44; la funci&#243;n hep&#225;tica y el estado general del paciente fueron criterios definitorios&#46; Fueron excluidos los pacientes con una expectativa de vida inferior a 3 meses&#44; extensi&#243;n extrahep&#225;tica significativa&#44; deterioro funcional &#91;Child Pugh &#40;CP&#41; C&#93;&#44; colangitis activa y embarazo&#46; Otros factores fueron considerados como contraindicaciones relativas &#40;tumor infiltrativo&#44; alta carga tumoral&#44; bilirrubina 2-3 mg&#47;dL&#44; extensi&#243;n del 50&#37; del volumen hep&#225;tico total con alb&#250;mina inferior a 3 g&#47;dL&#44; &#237;ndice aspartato aminotransferasa&#47;alanina aminotransferasa &#91;GOT&#47;GPT&#93; mayor de 5 o ascitis&#41;&#44; realizando en el seno del comit&#233; multidisciplinar una valoraci&#243;n riesgo&#47;beneficio exhaustiva de cada caso de forma individualizada&#46; Tras la selecci&#243;n de candidatos&#44; la existencia de elevado <span class="elsevierStyleItalic">shunt</span> hepatopulmonar y&#47;o la existencia de fugas a trav&#233;s de arterias hepat&#243;fugas tambi&#233;n fueron criterios de exclusi&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Cada uno de los pacientes fue valorado con posterioridad por un subcomit&#233; integrado por radiolog&#237;a intervencionista y especialistas en medicina nuclear y radiof&#237;sica&#44; estableciendo la planificaci&#243;n y c&#225;lculo adecuado de actividad&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La totalidad de los pacientes fueron tratados con microesferas de vidrio &#40;TheraSphere&#44; BTG&#44; London&#44; UK&#41; y se engloban dentro de los estadios intermedio y avanzado del BCLC&#46; Los historiales electr&#243;nicos disponibles de cada paciente fueron la base para la obtenci&#243;n de los datos cl&#237;nicos&#44; anal&#237;ticos y de imagen motivo de an&#225;lisis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">T&#233;cnica</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">1&#46;&#170;&#46; fase&#58; acondicionamiento y planificaci&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas del producto terap&#233;utico &#40;radiois&#243;topo emisor de radiaci&#243;n beta de alta energ&#237;a incorporado a la estructura de la microesfera de reducido calibre&#41; puede ser el origen de las posibles complicaciones que aparezcan tras el tratamiento&#46; Este hecho conlleva que el tratamiento se divida en dos etapas o fases&#46; El objetivo de la primera etapa estriba en seleccionar el punto adecuado de infusi&#243;n intrahep&#225;tica y descartar la existencia de <span class="elsevierStyleItalic">shunts</span> hepatopulmonares y&#47;o fugas a trav&#233;s de arterias hepat&#243;fugas&#46; Se realiza una inyecci&#243;n de macroagregados de alb&#250;mina marcados con tecnecio &#40;<span class="elsevierStyleSup">99m</span>Tc-MAA&#41; desde el punto arterial seleccionado&#44; tras lo cual se realiza una gammagraf&#237;a y una tomograf&#237;a por emisi&#243;n de fot&#243;n &#250;nico &#40;SPECT&#41; &#40;Philips Brightview XCT&#41; siempre dentro de la primera hora tras la infusi&#243;n&#46; En el estudio angiogr&#225;fico inicial se embolizan aquellas arterias hepat&#243;fugas cuya proximidad al punto de infusi&#243;n seleccionado haga posible la fuga a territorios extrahep&#225;ticos&#46; Los <span class="elsevierStyleSup">99m</span>Tc-MAA reproducen de forma fiable la distribuci&#243;n posterior de las microesferas cargadas con <span class="elsevierStyleSup">90</span>Y&#44; por lo que se puede estimar&#44; con el estudio de gammagraf&#237;a&#44; la relaci&#243;n tumor&#47;no tumor dentro del l&#243;bulo diana&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Para la realizaci&#243;n de los estudios de tomograf&#237;a por emisi&#243;n de fot&#243;n &#250;nico&#47;tomograf&#237;a computarizada &#40;SPECT&#47;TC&#41; se emple&#243; una matriz de 128&#63;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#63;128&#44; 120 &#225;ngulos&#44; 30 s&#47;&#225;ngulo&#44; TC de localizaci&#243;n r&#225;pida &#40;20 mAs y 120 kV&#41; y filtro de tejidos blandos &#40;en consonancia con el protocolo descrito por Hammami et al&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El hecho de realizar embolizaci&#243;n de arterias hepat&#243;fugas &#40;principalmente las arterias gastroduodenal y g&#225;strica derecha&#41; se recomienda en aquellos casos donde no se pueda garantizar un reflujo que conlleve riesgo de embolizaci&#243;n no deseada&#46; El empleo sistematizado del Cone-bean CT durante la angiograf&#237;a inicial permite excluir dep&#243;sitos extrahep&#225;ticos y aporta mayor seguridad en adoptar la medida de no embolizar arterias hepat&#243;fugas de forma sistematizada&#46; En nuestra pr&#225;ctica actual&#44; la embolizaci&#243;n de arterias hepat&#243;fugas no es habitual<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">C&#225;lculo de actividad y dosimetr&#237;a</span><p id="par0065" class="elsevierStylePara elsevierViewall">El siguiente paso del procedimiento consiste en determinar la actividad requerida para optimizar el tratamiento&#44; para lo cual se contempla el porcentaje de <span class="elsevierStyleItalic">shunt</span> hepatopulmonar estimado&#44; la actividad gastrointestinal&#44; la raz&#243;n tumor&#47;no tumor dentro del volumen blanco &#40;volumen diana que incluye al tejido hep&#225;tico distal al punto de infusi&#243;n intraarterial&#41; y c&#225;lculos de volumetr&#237;a hep&#225;tica&#46; Para ello&#44; se trazaron ROI &#40;<span class="elsevierStyleItalic">region of interest</span>&#41; sobre los estudios de gammagraf&#237;a a nivel pulmonar&#44; volumen blanco&#44; zona tumoral&#44; tracto gastrointestinal y fondo&#44; y se obtuvieron los p&#237;xeles y n&#250;mero de cuentas&#46; Estos valores se trasladaron a una hoja de c&#225;lculo en la que se estim&#243; el porcentaje de <span class="elsevierStyleItalic">shunt</span> pulmonar&#44; la actividad gastrointestinal y la raz&#243;n tumor&#47;no tumor dentro del volumen blanco&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para el c&#225;lculo de la actividad a administrar&#44; nos basamos en el modelo MIRD conjugado con el modelo de partici&#243;n&#44; estableciendo unas restricciones al modelo que conlleva una limitaci&#243;n de dosis al volumen blanco &#40;entre 80 y 150 Gy&#41;&#44; limitaci&#243;n de dosis m&#225;xima a par&#233;nquima no tumoral dentro del volumen blanco &#40;80 Gy&#41; y limitaci&#243;n de dosis m&#225;xima a pulm&#243;n &#40;30 Gy o menos de 50 Gy en sucesivos tratamientos&#41;&#44; as&#237; como una dosis m&#237;nima en tumor de 120 Gy&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Teniendo en cuenta la f&#243;rmula&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0080" class="elsevierStylePara elsevierViewall">Despejando la dosis deseada&#44; obtenemos&#58;<elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0085" class="elsevierStylePara elsevierViewall">Donde SHP es el <span class="elsevierStyleItalic">shunt</span> hepatopumonar y R&#44; la actividad residual en el vial postinfusi&#243;n&#46; Con esta f&#243;rmula y considerando la masa obtenida por TC&#44; el <span class="elsevierStyleItalic">shunt</span> hepatopulmonar y las restricciones anteriormente descritas&#44; calculamos la dosis absorbida estimada por los distintos &#243;rganos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Hay que tener en cuenta que&#44; en este trabajo&#44; cuando nos referimos a la dosis absorbida&#44; se trata de dosis absorbida estimada&#44; dado que se obtiene a partir de c&#225;lculos realizados a partir de las im&#225;genes de <span class="elsevierStyleSup">99m</span>Tc-MAA y no de la tomograf&#237;a por emisi&#243;n de positrones&#47;tomograf&#237;a computarizada &#40;PET&#47;TC&#41;&#44; seg&#250;n estudio preterap&#233;utico y el modelo de partici&#243;n<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">2&#46;&#170; fase&#58; tratamiento</span><p id="par0095" class="elsevierStylePara elsevierViewall">Con una segunda arteriograf&#237;a se comprob&#243;&#44; en aquellos casos de embolizaciones arteriales previas&#44; la ausencia de repermeabilizaciones y se valor&#243; la necesidad de nuevas oclusiones arteriales&#46; Se reprodujo fielmente el posicionamiento del microcat&#233;ter donde se realiz&#243; la infusi&#243;n previa de <span class="elsevierStyleSup">99m</span>Tc-MAA y se procedi&#243; a la infusi&#243;n de las microesferas de vidrio&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Tras la infusi&#243;n del radiois&#243;topo se realiz&#243; un control de calidad de protecci&#243;n radiol&#243;gica que determin&#243; la presencia o no de contaminaci&#243;n radiol&#243;gica tanto del personal como de la propia sala de angiograf&#237;a&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Tras el tratamiento se adquirieron im&#225;genes gammagr&#225;ficas que aprovechan la radiaci&#243;n de frenado del radiois&#243;topo &#40;Bremsstrahlung&#41; y se realiz&#243; un estudio comparativo morfol&#243;gico respecto a las im&#225;genes previas de SPECT&#47;TC&#44; que determinaron la concordancia del tratamiento&#46; A partir de 2013 incorporamos los estudios de PET&#47;TC &#40;Philips Gemini TF&#41; en el control postratamiento debido a su mejor resoluci&#243;n espacial y a su mayor sensibilidad para la detecci&#243;n de fugas gastrointestinales<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a>&#46; Los protocolos de adquisici&#243;n utilizados fueron&#44; para la PET&#58; matriz de 144&#63;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#63;144&#44; 4 mm v&#243;xel&#44; 2 campos<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>15 minutos cada campo y reconstrucci&#243;n iterativa OSEM con tiempo de vuelo&#44; y una TC de baja dosis para localizaci&#243;n y correcci&#243;n de atenuaci&#243;n de 120 kV y 150 mAs&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Seguimiento</span><p id="par0110" class="elsevierStylePara elsevierViewall">El protocolo de seguimiento consisti&#243; en control cl&#237;nico-anal&#237;tico y la realizaci&#243;n de pruebas de imagen &#40;TC&#47;RM&#41; al mes y cada 3 meses durante el primer a&#241;o de seguimiento&#46; Los estudios de imagen se espaciaron a los 6 meses durante el segundo a&#241;o&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis estad&#237;stico</span><p id="par0115" class="elsevierStylePara elsevierViewall">El an&#225;lisis de la supervivencia se bas&#243; en la metodolog&#237;a de Kaplan-Meier&#44; estim&#225;ndose la funci&#243;n de supervivencia para los diferentes tiempos de inter&#233;s de los eventos&#46; Para estudiar si los distintos factores independientes generaron curvas de supervivencia distintas&#44; se emple&#243; el test del logaritmo del rango&#46; Los aspectos que se detectaron como significativos o pr&#243;ximos a serlo &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#41; fueron considerados de inter&#233;s para el subsiguiente modelo de regresi&#243;n de Cox&#46; Con este se identificaron aquellos factores pron&#243;stico que permitieron explicar la tasa instant&#225;nea de fallecimiento &#40;o de progresi&#243;n&#41; desde un punto de vista multivariable&#44; es decir&#44; evaluando la importancia de cada factor en presencia del resto&#46; El nivel de significaci&#243;n que se emple&#243; en los an&#225;lisis fue el 5&#37; &#40;&#945;&#63;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#63;0&#44;05&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Caracter&#237;sticas basales de los pacientes</span><p id="par0120" class="elsevierStylePara elsevierViewall">Entre marzo de 2009 y diciembre de 2016 se trat&#243; con RETA a 53 pacientes con una mediana de edad de 60 a&#241;os &#40;rango 28-86&#41;&#46; Cuarenta y siete pacientes eran cirr&#243;ticos de origen viral en su gran mayor&#237;a &#40;VHC 70&#37;&#41;&#44; ya fuera solo o asociado a otras causas como el alcohol o el VHB&#46; Tras el diagn&#243;stico de hepatocarcinoma&#44; 45 pacientes mostraron una funci&#243;n conservada &#40;CP A&#41;&#46; Tras la valoraci&#243;n de la extensi&#243;n tumoral&#44; incluyendo la invasi&#243;n vascular&#44; 30 pacientes fueron catalogados dentro del estadio BCLC B y 23 pacientes dentro del BCLC C&#44; de los cuales 21 &#40;91&#44;3&#37;&#41; fueron por trombosis portal&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En referencia a la carga tumoral se valor&#243; la extensi&#243;n tumoral &#40;&#62; o &#60;<span class="elsevierStyleHsp" style=""></span>50&#37; con respecto al volumen hep&#225;tico total&#41;&#44; la afectaci&#243;n uni- o multifocal&#44; la afectaci&#243;n lobar o bilobar y el tama&#241;o de la lesi&#243;n principal&#46; Se determin&#243; la existencia o no de trombosis portal y la asociaci&#243;n de f&#237;stulas arteriovenosas&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> quedan recogidas las variables estudiadas&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Caracter&#237;sticas del tratamiento &#40;tabla 2&#41;</span><p id="par0135" class="elsevierStylePara elsevierViewall">&#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; Se realizaron un total de 61 procedimientos &#40;consideramos procedimientos cada una de las infusiones de microesferas cargadas con <span class="elsevierStyleSup">90</span>Y&#41;&#46; Dado que a 7 pacientes con afectaci&#243;n bilobar se les realiz&#243; el tratamiento secuencial en dos tiempos y en un paciente con afectaci&#243;n extensa unilobar&#44; se decidi&#243; realizar terapia secuencial segmentaria &#40;segmento anterior y posterior&#41;&#46; De los 14 pacientes restantes con afectaci&#243;n bilobar&#44; tres de ellos fueron sometidos a QETA al menos en uno de los l&#243;bulos tratados con RETA&#46; Cinco pacientes se sometieron a QETA&#44; radiofrecuencia o cirug&#237;a del l&#243;bulo no tratado con RETA&#46; En 6 pacientes con afectaci&#243;n bilobar no se complet&#243; el tratamiento en cuatro casos por progresi&#243;n de la enfermedad&#44; en uno de ellos por deterioro cl&#237;nico y en otro por limitaciones anat&#243;micas vasculares&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">La actividad media administrada por procedimiento fue 2&#44;8 GBq &#40;0&#44;7-6&#44;4 GBq&#41;&#44; con una dosis media en tumor de 229&#44;9 Gy &#40;74-425&#44;9 Gy&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">An&#225;lisis de progresi&#243;n y supervivencia</span><p id="par0145" class="elsevierStylePara elsevierViewall">El seguimiento se realiz&#243; durante al menos 1 a&#241;o posterior al tratamiento y hasta el fallecimiento o p&#233;rdida de contacto&#46; La mediana de seguimiento fue de 12 meses&#46; Hubo progresi&#243;n de enfermedad a lo largo del tiempo de seguimiento en 41 pacientes &#40;77&#44;4&#37;&#41;&#44; de los cuales 35 fallecieron&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La mediana de tiempo libre de progresi&#243;n &#40;TLP&#41; global fue de 6&#44;7 meses&#46; Los pacientes con BCLC B y aquellos con BCLC C presentaron un TLP de 6&#44;7 meses&#46; Los pacientes con funci&#243;n hep&#225;tica CP A presentaron un TLP de 6&#44;7 meses&#44; mientras que los que mostraban un CP B presentaron un TLP de 3&#44;2 meses&#46; No se encontraron diferencias estad&#237;sticamente significativas en el estudio por grupos &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;848 y <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;252&#44; respectivamente&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La mediana de supervivencia global fue de 12&#44;8 meses&#46; Los pacientes con BCLC B presentaron una mediana de supervivencia de 18&#44;6 meses&#46; Los pacientes con un BCLC C presentaron una mediana de supervivencia de 8&#44;8 meses&#46; No se encontraron diferencias estad&#237;sticamente significativas &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;493&#41;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Los pacientes con funci&#243;n hep&#225;tica CP A tuvieron una supervivencia mediana de 17&#44;2 meses frente a 5&#44;1 meses del grupo B&#46; Existieron diferencias estad&#237;sticamente significativas de la mediana de supervivencia respecto a la funci&#243;n hep&#225;tica &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La dosis a tumor umbral establecida como significativa en nuestra serie es de 150 Gy&#44; observando una mediana de supervivencia de 16&#44;5 meses frente a 2 meses en aquellos pacientes con dosis tumoral menor &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; con una <span class="elsevierStyleItalic">hazard ratio</span> &#40;HR&#41; de 0&#44;12 para valores superiores a 150 Gy&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En el seguimiento de los pacientes se observ&#243; un caso de REILD &#40;&#8220;Radioembolization-Induced Liver Disease&#8221; o da&#241;o hep&#225;tico inducido por la irradiaci&#243;n&#41; &#40;1&#44;6&#37;&#41; durante el primer mes tras el tratamiento&#44; con resultado de muerte en un paciente en estadio BCLC C &#40;trombosis portal&#41; y elevada carga tumoral&#46; No se objetivaron otros efectos adversos graves&#46; Los efectos adversos observados quedan recogidos en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> &#40;<span class="elsevierStyleItalic">Common Terminology Criteria for Adverse Events</span> &#40;CTCAE&#41; versi&#243;n 5&#46;0&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Para el resto de las variables estudiadas respecto a la supervivencia&#44; se observaron como estad&#237;sticamente significativos los valores de bilirrubina y GOT previos&#46; Para el resto de variables&#44; no se obtuvieron diferencias estad&#237;sticamente significativas en nuestra muestra&#46; Todos los datos est&#225;n resumidos en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Adicionalmente&#44; en nuestra serie se consigui&#243; reducir la estadificaci&#243;n en 3 pacientes con caracter&#237;sticas tumorales catalogadas como extra-Milan tratados con TARE&#44; de forma que pudieron ser trasplantados&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discusi&#243;n</span><p id="par0185" class="elsevierStylePara elsevierViewall">La radioembolizaci&#243;n es una terapia intraarterial segura y eficaz en el tratamiento de pacientes con hepatocarcinoma&#46; Se considera una terapia individualizada&#44; y su objetivo es administrar una dosis elevada de radiaci&#243;n en el tumor&#44; con m&#237;nima exposici&#243;n del par&#233;nquima no tumoral<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Un factor determinante relacionado con la supervivencia postratamiento es la dosis de radiaci&#243;n recibida&#59; as&#237;&#44; se ha considerado la respuesta radioinducida como un todo o nada<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a>&#44; estableciendo estos autores una dosis en tumor superior a 205 Gy como umbral significativo en cuanto a datos de supervivencia global y tiempo libre de progresi&#243;n&#44; comparativamente con aquellos pacientes con dosis administradas menores&#46; Haciendo referencia a nuestros resultados&#44; se estima que administrar una dosis superior a 150 Gy en tumor reduce el riesgo de mortalidad un 88&#37; &#40;HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;12&#41; durante el tiempo de seguimiento frente a aquellos con dosis menores&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En aquellos pacientes considerados como &#8220;super supervivientes&#8221;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a> &#40;supervivencia<span class="elsevierStyleHsp" style=""></span>&#62; 3 a&#241;os post-RETA&#41;&#44; la administraci&#243;n de m&#225;s de 200 Gy en el tumor no se relacion&#243; con una respuesta precoz ni con la supervivencia prolongada&#46; En nuestra serie&#44; tenemos 4 pacientes &#8220;super supervivientes&#8221;&#44; tres de ellos con una dosis en tumor superior a 200 Gy y uno de ellos con una dosis menor &#40;151&#44;2 Gy&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">En cuanto a la mediana de TLP&#44; nuestros resultados son ligeramente superiores a los obtenidos por Meyer&#44; si bien son discretamente inferiores a los descritos por otras series como Hilgard y Salem &#40;6&#44;7 meses vs&#46; Meyer&#58; 4 meses vs&#46; Salem y Hilgard&#58; 7&#44;9-10 meses&#41;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#8211;18</span></a>&#46; Los factores que determinan progresi&#243;n precoz de enfermedad y supervivencia parecen estar m&#225;s ligados a las caracter&#237;sticas tumorales que a las procedimentales&#44; lo que podr&#237;a explicar los resultados en nuestro estudio con el 100&#37; de pacientes en estadio intermedio-avanzado&#44; al igual que en la serie de Meyer&#44; mientras que en la serie de Salem se incluye pacientes en estadios precoces&#44; que puede hacer mejorar las cifras<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">16&#44;17&#44;19</span></a>&#46; Tambi&#233;n debemos tener en cuenta la heterogeneidad de pacientes existente en el estadio intermedio &#40;BCLC B&#41;&#44; que ha llevado al equipo de Bolondi et al&#46; a plantear la necesidad de crear una subclasificaci&#243;n dentro de este grupo para facilitar la toma de decisiones en cuanto a tratamiento se refiere&#44; recomendando el uso de RETA en alguno de estos subgrupos<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Comparando la mediana de supervivencia de nuestra muestra seg&#250;n estadios del BCLC obtenemos resultados inferiores respecto a los descritos por Salem<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a> en el estadio B &#40;18&#44;6 meses vs&#46; 25 meses&#41; y en estadio C &#40;8&#44;8 meses vs&#46; 15 meses&#41;&#44; pero similares a los datos aportados por Hilgard<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> y Mazzaferro<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a> en cuanto a supervivencia en el estadio BCLC B &#40;18&#44;6 vs&#46; Hilgard&#58; 16&#44;4 meses vs&#46; Mazzaferro&#58; 18 meses&#41; y en el BCLC C &#40;8&#44;8 meses vs&#46; Mazzaferro&#58; 13 meses&#41;&#46; Adem&#225;s&#44; nuestros resultados se encuentran tambi&#233;n dentro de los esperables recomendados por la Asociaci&#243;n Europea para Estudio del H&#237;gado &#40;EASL&#41; y las gu&#237;as de la Sociedad Europea de Investigaci&#243;n y Tratamiento del C&#225;ncer &#40;EORTC&#41;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;6</span></a>&#46; Globalmente&#44; nuestros resultados son iguales a los descritos por el grupo de I&#241;arrairaegui y Sangro &#40;12&#44;8 meses&#41;&#44; con la diferencia principal en el uso de microesferas de resina por su parte<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">As&#237; tambi&#233;n&#44; comparando la mediana de supervivencia de nuestra muestra seg&#250;n estadios del CP&#44; obtenemos resultados inferiores a los obtenidos por Garin<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a> tanto en el CP A &#40;17&#44;2 vs&#46; 24&#44;5 meses&#41; como en el CP B &#40;5&#44;1 vs&#46; 18 meses&#41;&#44; si bien estos valores son muy similares a los aportados por Hilgard<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> en su serie&#58; CP A &#40;17&#44;2 meses en ambos casos&#41; y CP B &#40;5&#44;1 vs&#46; 6 meses&#41;&#46; En nuestra serie no disponemos de casos de pacientes CP C tratados&#44; si bien existen datos en la literatura de tratamientos sobre pacientes CP C como paso previo al trasplante hep&#225;tico&#44; pese al riesgo de descompensaci&#243;n hep&#225;tica<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">A pesar de observarse m&#225;s del doble de mediana de supervivencia en pacientes sin trombosis portal frente a aquellos que s&#237; presentaban trombosis previa al tratamiento&#44; no hemos encontrado diferencias estad&#237;sticamente significativas&#44; lo que hace presuponer que la referida invasi&#243;n vascular no ha limitado el efecto terap&#233;utico de la RETA&#46; Este dato coincide con las series de pacientes de Garin y Mazzaferro<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">21&#44;23</span></a>&#44; si bien&#44; este &#250;ltimo grupo s&#237; que ha encontrado diferencias estad&#237;sticamente significativas en un art&#237;culo posterior en el que clasificaban a los pacientes seg&#250;n el grado de trombosis portal&#44; y han realizado con esta y otras variables que influ&#237;an en la supervivencia un <span class="elsevierStyleItalic">score</span> pron&#243;stico para predecir la respuesta a la RETA<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Los l&#237;mites de dosis en tejido no tumoral es todav&#237;a un tema controvertido&#44; aunque sigue consider&#225;ndose un factor principal a la hora de minimizar complicaciones&#46; En nuestra serie&#44; en dos pacientes se super&#243; la dosis de 80 Gy &#40;82 y 168 Gy&#41; sin que se hubieran producido efectos delet&#233;reos&#44; si bien es cierto que el volumen tumoral representaba una peque&#241;a parte del volumen hep&#225;tico total &#40;volumen tumoral de 338 cc sobre un volumen hep&#225;tico total de 2042 cc y 824 cc sobre 2540 cc&#44; respectivamente&#41;&#46; Tambi&#233;n Garin muestra en su serie pacientes con exceso de dosis en par&#233;nquima no tumoral sin repercusiones cl&#237;nicas<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">La complicaci&#243;n m&#225;s grave derivada de la RETA es el REILD con una incidencia descrita entre 4-5&#37; y un 2&#37; de casos graves<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; En nuestra serie se produjo un caso de REILD &#40;1&#44;6&#37;&#41;&#44; igual porcentaje al descrito por Salem y Rodriguez-Fraile<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">6&#44;27</span></a>&#46; En nuestro caso se trataba de un paciente con elevada carga tumoral&#44; multifocal&#44; con trombosis portal asociada y que hab&#237;a recibido dos tratamientos previos con QETA aproximadamente 6 meses antes del tratamiento con RETA&#46; En el estudio previo al tratamiento con <span class="elsevierStyleSup">99m</span>Tc-MAA&#44; se obtuvo una ratio tumor&#47;no tumor de 7&#44; la dosis estimada absorbida por tejido sano fue de 60&#44;8 Gy y se trat&#243; un volumen tumoral aproximado de 285 cc &#40;volumen hep&#225;tico total de 1304&#44;7 cc&#41;&#44; observ&#225;ndose concordancia final entre las im&#225;genes de <span class="elsevierStyleSup">99m</span>Tc-MAA y las im&#225;genes de Brehmsstralung&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Se ha propuesto la RETA como terapia puente para el trasplante hep&#225;tico y como m&#233;todo adecuado en alcanzar una reducci&#243;n del grado de estadificaci&#243;n &#40;<span class="elsevierStyleItalic">downstaging</span>&#41;&#44; reintroduciendo a pacientes dentro de los criterios de Milan<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">8&#44;28</span></a>&#46; Frente a la quimioembolizaci&#243;n &#40;m&#233;todo m&#225;s empleado como terapia puente al trasplante y como m&#233;todo de <span class="elsevierStyleItalic">downstaging</span>&#41;&#44; la RETA ha mostrado cifras superiores en cuanto tiempo libre de enfermedad y mayor porcentaje de consecuci&#243;n de reducci&#243;n de estadificaci&#243;n&#44; acompa&#241;ado de una reducci&#243;n del n&#250;mero de procedimientos necesarios para el control de la enfermedad y menor toxicidad asociada<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; se ha demostrado que es una terapia efectiva en aquellos pacientes que han progresado a tratamientos previos&#44; no observ&#225;ndose diferencias estad&#237;sticamente significativas de supervivencia en aquellos pacientes que han recibido terapia previa vs&#46; aquellos pacientes en los que la radioembolizaci&#243;n es la primera opci&#243;n terap&#233;utica<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a>&#44; por lo que tambi&#233;n es &#250;til como tratamiento en aquellos pacientes candidatos con progresi&#243;n a otros terapias&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusi&#243;n</span><p id="par0240" class="elsevierStylePara elsevierViewall">La radioembolizaci&#243;n se puede considerar como una terapia individualizada para cada paciente&#44; con excelentes resultados de supervivencia y m&#237;nimos efectos secundarios asociados&#44; obteniendo mejores resultados en aquellos pacientes con funci&#243;n hep&#225;tica conservada&#46; La creciente evidencia cient&#237;fica ha de contribuir a la inclusi&#243;n de la RETA dentro de las gu&#237;as de manejo del hepatocarcinoma&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Autor&#237;a</span><p id="par0245" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Responsable de la integridad del estudio&#58; POS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Concepci&#243;n del estudio&#58; POS&#44; DPE&#44; PBA&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Dise&#241;o del estudio&#58; POS&#44; DPE&#44; PBA&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Obtenci&#243;n de los datos&#58; POS&#44; DPE&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0270" class="elsevierStylePara elsevierViewall">An&#225;lisis e interpretaci&#243;n de los datos&#58; POS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Tratamiento estad&#237;tico&#58; POS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0280" class="elsevierStylePara elsevierViewall">B&#250;squeda bibliogr&#225;fica&#58; POS&#44; DPE&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Redacci&#243;n del trabajo&#58; POS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Revisi&#243;n cr&#237;tica del manuscrito con aportaciones intelectualmente relevantes&#58; POS&#44; DPE&#44; PBA&#44; ITE&#44; MFL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0295" class="elsevierStylePara elsevierViewall">Aprobaci&#243;n de la versi&#243;n final&#58; POS&#44; DPE&#44; PBA&#44; ITE&#44; MFL&#44; AMYA&#44; COA&#46;</p></li></ul></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicto de intereses</span><p id="par0300" class="elsevierStylePara elsevierViewall">Patricia Oliv&#225;n-Sasot&#44; Pilar Bello-Arques&#44; Daniel P&#233;rez-Enguix e Irene Torres-Espallardo&#58; Colabora BTG&#46; El resto de los autores no presentan conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Contribuir con la presentaci&#243;n de los resultados de nuestro estudio a ampliar la evidencia cient&#237;fica sobre el empleo de la radioembolizaci&#243;n en el manejo de pacientes con hepatocarcinoma&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se trata de una revisi&#243;n retrospectiva realizada en nuestro centro que incluye a 53 pacientes con hepatocarcinoma tratados con radioembolizaci&#243;n&#46; Los pacientes fueron clasificados seg&#250;n el algoritmo del BCLC &#40;<span class="elsevierStyleItalic">Barcelona Clinic Liver Cancer</span>&#41; y de forma pormenorizada por su estado funcional siguiendo la clasificaci&#243;n de Child-Pugh&#46; Se realiz&#243; un estudio de supervivencia siguiendo la metodolog&#237;a de Kaplan-Meier&#46; Se emple&#243; el m&#233;todo de regresi&#243;n de Cox para la determinaci&#243;n de par&#225;metros cl&#237;nicos significativos&#44; incluyendo dosis administradas en los par&#225;metros estudiados&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La serie evaluada comprende a pacientes con una media de edad de 60 a&#241;os &#40;rango 28-86&#41;&#46; Se llevaron a cabo un total de 61 procedimientos&#46; La actividad media administrada fue de 2&#44;8 GBq &#40;0&#44;7-6&#44;4 GBq&#41;&#44; administrando una dosis media en tumor de 229&#44;9 Gy &#40;74-425&#44;9 Gy&#41;&#46; El tiempo libre de progresi&#243;n fue de 6&#44;7 meses desde el momento del tratamiento y la supervivencia global fue de 12&#44;8 meses&#46; La clasificaci&#243;n de los pacientes seg&#250;n BCLC &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;848&#41; y Child-Pugh &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;252&#41; no result&#243; significativa respecto al tiempo libre de enfermedad&#46; Los par&#225;metros cl&#237;nicos que resultaron con diferencias significativas en cuanto a supervivencia global fueron los niveles de bilirrubina &#40;<span class="elsevierStyleItalic">p</span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; y las cifras de transaminasas &#40;GOT&#41; pretratamiento &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;022&#41;&#44; la subclasificaci&#243;n Child-Pugh &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; y la dosis recibida por el tumor &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Tan solo uno de los pacientes tratados present&#243; un efecto adverso grave&#44; con fallo hep&#225;tico posterapia y resultado de muerte&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La radioembolizaci&#243;n es un procedimiento seguro y eficaz en el tratamiento de pacientes con hepatocarcinoma&#46; La funci&#243;n hep&#225;tica y las dosis recibidas por el tumor son par&#225;metros claves en la eficacia del tratamiento&#46; El incremento de la evidencia cient&#237;fica apoya su inclusi&#243;n en gu&#237;as terap&#233;uticas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material y m&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To contribute our results to increase the scientific evidence about the use of radioembolization in the management of patients with hepatocellular carcinoma&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This retrospective review included 53 patients with hepatocellular carcinoma treated with radioembolization at our center&#46; Patients were classified according to the BCLC algorithm in detail according to their Child-Pugh functional status&#46; We analyzed survival using the Kaplan-Meier method&#46; We used Cox regression analysis to determine clinically significant parameters&#44; including the doses administered in the parameters studied&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Patients ranged in age from 28 to 86 years &#40;mean&#44; 60 years&#41;&#46; A total of 61 procedures were done&#46; The mean activity administered was 2&#46;8 GBq &#40;0&#46;7-6&#46;4 GBq&#41;&#44; with a mean dose of 229&#46;9<span class="elsevierStyleHsp" style=""></span>Gy &#40;74-425&#46;9<span class="elsevierStyleHsp" style=""></span>Gy&#41; administered in the tumor&#46; Progression-free survival was 6&#46;7 months and overall survival was 12&#46;8 months&#46; Differences in disease-free survival according to BCLC and Child-Pugh classification were not significant &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;848 and p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;252&#44; respectively&#41;&#46; The clinical parameters that were significantly different with respect to overall survival were bilirubin levels &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; pretreatment transaminase levels &#40;AST&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;022&#41;&#44; Child-Pugh subclassification &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#44; and dose administered in the tumor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Only one patient had a severe adverse reaction&#44; developing posttreatment liver failure resulting in death&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Radioembolization is safe and efficacious in the treatment of patients with hepatocellular carcinoma&#46; Liver function and the doses received by the tumor are key parameters for the efficacy of treatment&#46; The increase in the scientific evidence supports the inclusion of this technique in treatment guidelines&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">BCLC&#58; <span class="elsevierStyleItalic">Barcelona Clinic Liver Cancer</span>&#59; CP&#58; Child-Pugh&#59; VHB&#58; virus de la hepatitis B&#59; VHC&#58; virus de la hepatitis C&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Procedimientos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41; &#40;mediana&#59; rango&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;28-86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Causa de hepatocarcinoma</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">VHC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;62&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alcohol&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;11&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Causa desconocida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;11&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VHC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>otro factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;7&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VHB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflamatoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45 &#40;84&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;15&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46 &#40;86&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;13&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo tumoral</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unifocal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;13&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multifocal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;71&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infiltrativo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;15&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n tumoral</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lobar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;60&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bilobar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;39&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o tumoral</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3-5 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;26&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5-8 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;35&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62; 8 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;37&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trombosis portal</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;39&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Segmentaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;23&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lobar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;52&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Troncal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;9&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lobar y troncal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;60&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">F&#237;stulas arteriovenosas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;18&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A vena porta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;90&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A vena suprahep&#225;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;81&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BCLC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;56&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;43&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          ]
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            0 => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Actividad administrada &#40;GBq&#41; &#40;media&#59; rango&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#40;0&#44;7-6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dosis absorbida blanco &#40;Gy&#41; &#40;media&#59; rango&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116&#44;5 &#40;31&#44;2-243&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dosis absorbida por tumor &#40;Gy&#41; &#40;media&#59; rango&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">229&#44;9 &#40;74-425&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dosis no tumor &#40;Gy&#41; &#40;media&#59; rango&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;9 &#40;21&#44;2-168&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dosis pulmones &#40;Gy&#41; &#40;media&#59; rango&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;7 &#40;0-29&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Raz&#243;n tumor&#47;no tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8 &#40;1-10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SHP &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;3 &#40;0&#44;03-34&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ning&#250;n efecto secundario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">22 pacientes &#40;41&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Trastornos gastrointestinales&#58;Dolor abdominalAscitisDiarreaN&#225;useasDispepsia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 pacientes &#40;7&#44;5&#37;&#41;5 pacientes &#40;9&#44;4&#37;&#41;2 pacientes &#40;3&#44;8&#37;&#41;2 pacientes &#40;3&#44;8&#37;&#41;4 pacientes &#40;7&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trastornos generales&#58;FatigaFiebreCuadro seudogripal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 pacientes &#40;28&#44;3&#37;&#41;2 pacientes &#40;3&#44;8&#37;1 paciente &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alteraciones del sistema nervioso&#58;Alteraci&#243;n del gusto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 pacientes &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trastornos de la piel y del tejido subcut&#225;neo&#58;Prurito&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 paciente &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infecciones&#58;Peritonitis bacteriana espont&#225;nea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 paciente &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trastornos hepatobiliares&#58;Otros&#58; REILD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 paciente &#40;1&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col"></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable</th><th class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mediana de superviv&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de <span class="elsevierStyleItalic">p</span>&#40;Log-rank&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-valor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de <span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8804;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;4-24&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;613&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;9-18&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;62-2&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;614&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilirrubina &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">DT estimada &#40;Gy&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;150&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Dosis estimadaNo Tumor &#40;Gy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;8cm&nbsp;\t\t\t\t\t\t\n
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