Clinical outcomes with yttrium-90 resin microsphere radioembolization for hepatocellular carcinoma in a multiethnic southeast Asian population.

Abstract

e15137 Background: Treatment options for unresectable hepatocellular carcinoma (HCC) are limited. Intra-arterial yttrium-90 (90Y) microsphere radioembolization is an emerging treatment option with good outcomes among Caucasian patients. We report clinical outcomes in a multi-ethnic south-east Asian population treated with 90Y microspheres. Methods: A single-centre, retrospective, observational cohort study was conducted on patients who received 90Y microsphere radioembolization at Singapore General Hospital between January 2008 and June 2012. Patients were followed from the date of treatment until January 30, 2013, or until the date of death. Disease was staged by Barcelona Clinic Liver Cancer (BCLC) and Child-Pugh class. Patient survival was estimated using the Kaplan-Meier method. Response rate was determined by RECIST criteria. Prognostic factors for survival were identified using Cox proportional hazards regression. Results: 103 patients comprising 40.8% Chinese, 30.1% Myanmar, 14.6% Indonesian, 6.8% Indochinese and 7.7% others were treated with 90Y microspheres. Hepatitis B or C was recorded as the etiology in 47.6% and 23.3% of patients, respectively. The median overall survival (OS) was 14.4 months [95% CI 11.3-22.2 months] (BCLC B, 23.8 months ; BCLC C, 13.6 months; P = 0.048); (Child-Pugh A, 21.7 months; Child-Pugh B, 10.1 months; P < 0.0001). Median OS in patients with portal vein thrombosis (PVT) was poorer than those without PVT (PVT, 11.0 months; No PVT, 18.1 months; P = 0.024). Overall disease control rate by RECIST was 64.7%, while target lesions response rate was 98.3%. Progression of disease was mainly due to new lesions (69.2%). Significant prognostic factors for survival were serum albumin levels, presence of ascites and PVT. Conclusions: Survival outcomes in south-east Asian patients treated with 90Y microsphere radioembolization for HCC are comparable to Western populations in spite of the different etiologies. While target lesions response was good, new lesions are common and suggest that concomitant systemic therapy may have a role in disease control.