Hepatocellular carcinoma with portal vein thrombosis treated with yttrium-90 microsphere radioembolization results on 22 consecutive patients.

Abstract

e14573 Background: Portal vein tumoral thrombosis is a pejorative and a frequent complication of hepatoculluar carcinoma (HCC). PVT shows as the primary tumour, an arterial hypervascularization; his main characteristic is the rationale of this study which aim to assess the safety and the efficacy of a Yttrium-90 microsphere (90Y- microS) treatment with TheraSphere in this advanced situation. Methods: Since 2008 we have treated 22 patients with unresectable HCC and PVT; 24 treatments were done as described by Salem and col (J Vasc Interv Radiol 2006;17:1251-78.). Patients were evaluated at 3, 6 and then every 3 months for response (EASL criterias), survival and toxicity (CTCAEv3.0 criterias). Patients characteristics were as follow : Sex (M/F; n) 17/5; Mean age+/-SD (y) 65.3 +/-7.1. Previous treatment: 19 Etiology of cirrhosis VHC 5–Alcohol 12–Iron overload 3– Dysmetabolic syndrom 2; Child–Pugh grade: A/B/C : 15/7/0, Mean largest diameter +/- SD (cm) 8.3-3.5; Patent portal vein thrombosis: right/left/both: 8/3/11; a-fetoprotein (ng/mL) 849+/-19400- normal in 5 cases. CLIP score (2/3/4): 11/6/3; BCLC score C (n=22). Toxicity, response, and survival analyses were censored at time of last visit or death. Results: Median follow up was 11 months (1-34). Responses were: complete 2 (9%), partial 14 (63%), stable disease 3 (13%), progression 4 (18%), 3 patients were refered to surgery and one to transplantation. Median time to progression and overall survival were respectively 7.2 (95%CI, 3.9-10.5) and 9.0 (95%CI, 5.5-12.5) months. 4 cases of liver disfunction (Child B patients with right and left PVT) were observed, all were grade 2. Conclusions: The safety and efficacy results of in this monocentric cohort of 22 patients challenged those obtained with sorafenib in this indication and are in accordance with previous published data (Gastroenterology, 2010;138: 52-64; J Vasc Interv Radio. 2010; 8:1205-12.). Further clinical trials are waranted to confirm these results and to compare 90Y-microS with or without sorafenib to sorafenib alone, taking into account not only the overall survival but also the possibility of secondary surgery after downstaging.