Impact of prior procedures on overall survival following radioembolization in patients with unresectable hepatocellular carcinoma (HCC).

Abstract

4099 Background: Radioembolization (RE), which enables the delivery of high dose radiation preferentially to liver tumors, is used in some specialist centers as part of the multimodal treatment of HCC. In this analysis, the impact of prior hepatic-directed procedures on the outcome with RE was evaluated. Methods: A retrospective analysis was conducted of consecutive patients who received RE between 09/2003 and 12/2009 at 8 European centers. Patients who were not suitable for surgery (resection, liver transplantation), local ablation (PEI, RFA, cryoablation) or transarterial therapies (TACE, TAE), or had progressed on prior treatment (surgery, ablation or TACE/TAE) were considered for RE with 90Y resin microspheres (SIR-Spheres). Results: Patients (n=325) were mostly Child-Pugh class A (82.5%), had underlying cirrhosis (78.5%) and a good performance status (ps; ECOG 0-1: 87.7%) but many had multinodular (75.7%) advanced disease (BCLC ‘C’: 56.3%) invading both lobes (52.9%) and/or portal vein occlusion (13.5% branch; 9.8% main). Of these, 182 patients (56.0%) had received RE as first line treatment while 143 patients (44.0%) had had prior hepatic surgery (n=61; 18.8%), ablation (n=29; 8.9%) and/or vascular procedures (n=98; 30.2%), mostly as a single procedure (n=101; 31.1%). The analysis found few differences in baseline characteristics between prior treatment groups, except for baseline bilirubin which was higher in treatment naïve patients (1.2 vs. 1.0 mg/dL; p=0.004). A slightly higher median activity was administered to those who were treatment naïve (1.7 vs. 1.5 GBq; p=0.001) reflecting the higher target tumor volume (253.5 vs. 180 mL). No statistically significant differences were observed in overall survival between the prior procedure and treatment naïve groups (median 13.1 [95% CI 10.9-19.6] vs. 12.5 [10.3-15.9] months; p=0.289); BCLC ‘A’ patients who had received a prior procedure survived longer post-RE than those who received RE first line (33.7 [19.6-46.8] vs. 22.1[15.1-38.1] months; p=0.047). Conclusions: Patients with HCC who had failed prior procedures can be treated effectively with RE and had outcomes similar to those who were treatment naive.