Abstract
This study aims to assess long-term survival outcomes of ablative segmental radioembolization with yttrium-90 [radiation segmentectomy (RS)] for early stage hepatocellular carcinoma (HCC). With IRB approval, we included patients from our prospectively acquired database that were treated with RS for HCC between 2004-2017. Intention to treat (ITT) overall survival (OS) was estimated using Kaplan Meier method from date of treatment. Censored OS was estimated by censoring patients who underwent curative liver transplantation or resection. Further OS sub-analysis was done on patients with HCC ≤ 3 cm. 269 patients met the inclusion criteria. 66% (n = 177) were males and mean age was 66 years (range, 22-96). At baseline, 51% (n = 136) were Child-Pugh (CP) A, 43% (n = 115) CP B, and 7% (n = 18) CP C. According to UNOS tumor staging, 14% (n = 37) patients had T1 tumors, 79% (n = 212) had T2, and 7% (n = 20) had T3 tumors. 38% (n = 103) of patients were bridged to liver transplant. 4% (n = 10) had surgical resection after RS. 8.5% (n = 23) developed new grade 3/4 bilirubin toxicity, and 1.5% (n = 4) developed new grade 3 albumin toxicity. Censored OS was 80.3 (CI: 44-80.3) months for CP A and 27 (CI:17–31) months for CP B. ITT OS was 102 (CI: 80.3-120) months for CP A and 39 (CI:29-82.5) months for CP B patients. Further stratification for CP A by size demonstrated survival difference by tumor size ≤3 cm vs >3 cm, with median censored OS of 80 (CI: 44:80.3) and 47 (CI: 29.3:61) months, respectively (p = 0.05). For this (≤3 cm) select cohort (n = 87), 1-,3- and 5-year survival rates was 99%, 79%, 69% respectively. On multivariate analysis baseline albumin, and AFP > 100 ng/dl were significant prognosticators of survival. Radiation segmentectomy is a safe and effective treatment for patients with early stage HCC. Patients with CP A liver function and HCC ≤3 cm exhibit survival outcomes similar to other curative surgical and ablative treatments.
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