Abstract
BackgroundTo determine the effect of Yttrium-90 (Y90) radioembolization on health-related quality of life (HRQOL) and its effect on overall survival advanced, unresectable infiltrative hepatocellular carcinoma (HCC) patients with concurrent portal vein thrombosis (PVT).MethodsConsecutive patients with unresectable infiltrative HCC and PVT were recruited. The Short-Form 36 (SF-36) questionnaire was used to assess HRQOL for consecutive patients treated with glass-based Y90 based on a prospective phase II trial. MR imaging was used to determine tumor progression every 3 months post-treatment. Overall survival (OS) from treatment and time to progression (TTP) was analyzed using Kaplan-Meier estimation and log-rank test.ResultsThirty patients were treated and followed for 17.4 months; physical and mental component summary scores (PCS & MCS) remained unchanged at one, three, and six months. While no difference was observed in baseline SF-36 scores for patients with prolonged TTP (≥4 months) and OS (≥ 6 months), corresponding 1-month PCS were significantly higher than those with TTP < 4 months and OS < 6 months. At 1 month, patients with normalized Physical Function (PF), Role Physical (RP) and PCS within 2 standard deviations (SD) of US normalized baseline scores had a significantly prolonged median OS (15.7 vs. 3.7 months; p < 0.001) and TTP (12.4 vs. 1.8 mo; p < 0.001) compared those with physical component scores greater than 2SD below normalized US population values.ConclusionY90 radioembolization for HCC demonstrated long-term preservation of HRQOL. Lower baseline HRQOL scores were predictive of poorer OS. Early (1 month post-treatment) significant decreases in PCS were independent predictors of poorer OS and TTP.Trial registrationClinicalTrials.gov identifier NCT01556282, registered March 16, 2012.
Highlights
To determine the effect of Yttrium-90 (Y90) radioembolization on health-related quality of life (HRQOL) and its effect on overall survival advanced, unresectable infiltrative hepatocellular carcinoma (HCC) patients with concurrent portal vein thrombosis (PVT)
Study design and patient selection In an Institutional Review Board (IRB) approved correlative study based on a prospective phase II trial, consecutive patients with infiltrative HCC with PVT were enrolled for possible therapy with glass-based 90Y radioembolization
This study examined the efficacy of 90Y radioembolization therapy on HRQOL in patients with advanced, infiltrative HCC with PVT
Summary
To determine the effect of Yttrium-90 (Y90) radioembolization on health-related quality of life (HRQOL) and its effect on overall survival advanced, unresectable infiltrative hepatocellular carcinoma (HCC) patients with concurrent portal vein thrombosis (PVT). Approximately 10 to 40% of HCC patients have portal vein thrombosis concurrently [4, 5]. More recent studies establishing the safety and efficacy of conventional TACE (cTACE) in prolonging survival for HCC patients with PVT have been conducted [12, 13]. In long-term studies, selective intra-arterial yttrium (90Y) radioembolization has demonstrated equal or better overall survival (OS) and time to progression (TTP) vs cTACE [15], with comparable safety and efficacy in patients with infiltrative HCC with PVT [16]. Given the lowered risk of hepatic ischemia and decreased embolic effect with 90Y radioembolization compared to cTACE, some authors have noted that it may be a preferred therapeutic option for patients with concurrent PVT [10, 12, 13]
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