Abstract No. 34: Yttrium-90 radioembolization for hepatocellular carcinoma: Comprehensive analysis of long-term outcomes in 291 patients

Abstract

PurposeHepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following radioembolization are unknown. We assessed clinical outcomes including a) imaging response, b) toxicity, c) time-to-progression and d) survival, of patients treated with intra-arterial yttrium-90 microspheres (90Y).Materials and MethodsPatients with HCC (n=291) were treated with 90Y as part of a single-center prospective longitudinal cohort study. Toxicities were recorded using Common Terminology Criteria version 3.0. Response rate and time-to-progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Uni/multivariate analyses were performed.ResultsFive hundred twenty-six treatments were administered (mean:1.8, range:1-5). Toxicities included fatigue (57%), pain (23%), and nausea/vomiting (20%); 19% exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3%. 1250 scans were reviewed to assess response and TTP. Response rates were 42% and 57% by WHO and EASL, respectively. Overall TTP was 7.9 mo (95% confidence interval [CI]:6-10.3). Survival times differed by Child-Pugh (A:17.2 mo, B:7.7 mo, P=0.002) and Barcelona Clinic Liver Cancer (A:26.9 mo, B:17.2 mo, C:7.3 mo, P<0.0001) stage. Child-Pugh B patients with portal vein thrombosis (PVT) survived 5.6 mo (95% CI:4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and alpha-fetoprotein; and WHO/EASL response rate predicted survival.ConclusionChild-Pugh A patients, with or without PVT, benefited most from treatment. Child-Pugh B patients with PVT had poor outcomes. TTP and overall survival varied by baseline stage. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option to patients with HCC. PurposeHepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following radioembolization are unknown. We assessed clinical outcomes including a) imaging response, b) toxicity, c) time-to-progression and d) survival, of patients treated with intra-arterial yttrium-90 microspheres (90Y). Hepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following radioembolization are unknown. We assessed clinical outcomes including a) imaging response, b) toxicity, c) time-to-progression and d) survival, of patients treated with intra-arterial yttrium-90 microspheres (90Y). Materials and MethodsPatients with HCC (n=291) were treated with 90Y as part of a single-center prospective longitudinal cohort study. Toxicities were recorded using Common Terminology Criteria version 3.0. Response rate and time-to-progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Uni/multivariate analyses were performed. Patients with HCC (n=291) were treated with 90Y as part of a single-center prospective longitudinal cohort study. Toxicities were recorded using Common Terminology Criteria version 3.0. Response rate and time-to-progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Uni/multivariate analyses were performed. ResultsFive hundred twenty-six treatments were administered (mean:1.8, range:1-5). Toxicities included fatigue (57%), pain (23%), and nausea/vomiting (20%); 19% exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3%. 1250 scans were reviewed to assess response and TTP. Response rates were 42% and 57% by WHO and EASL, respectively. Overall TTP was 7.9 mo (95% confidence interval [CI]:6-10.3). Survival times differed by Child-Pugh (A:17.2 mo, B:7.7 mo, P=0.002) and Barcelona Clinic Liver Cancer (A:26.9 mo, B:17.2 mo, C:7.3 mo, P<0.0001) stage. Child-Pugh B patients with portal vein thrombosis (PVT) survived 5.6 mo (95% CI:4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and alpha-fetoprotein; and WHO/EASL response rate predicted survival. Five hundred twenty-six treatments were administered (mean:1.8, range:1-5). Toxicities included fatigue (57%), pain (23%), and nausea/vomiting (20%); 19% exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3%. 1250 scans were reviewed to assess response and TTP. Response rates were 42% and 57% by WHO and EASL, respectively. Overall TTP was 7.9 mo (95% confidence interval [CI]:6-10.3). Survival times differed by Child-Pugh (A:17.2 mo, B:7.7 mo, P=0.002) and Barcelona Clinic Liver Cancer (A:26.9 mo, B:17.2 mo, C:7.3 mo, P<0.0001) stage. Child-Pugh B patients with portal vein thrombosis (PVT) survived 5.6 mo (95% CI:4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and alpha-fetoprotein; and WHO/EASL response rate predicted survival. ConclusionChild-Pugh A patients, with or without PVT, benefited most from treatment. Child-Pugh B patients with PVT had poor outcomes. TTP and overall survival varied by baseline stage. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option to patients with HCC. Child-Pugh A patients, with or without PVT, benefited most from treatment. Child-Pugh B patients with PVT had poor outcomes. TTP and overall survival varied by baseline stage. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option to patients with HCC.