Yttrium-90 radioembolization of unresectable hepatocellular carcinoma - a single center experience.

Abstract

PurposeTo determine the value of radioembolization (RE) for treatment of unresectable hepatocellular carcinoma (HCC).Patients and methodsRecords of patients undergoing RE for unresectable HCC were retrospectively reviewed. Biochemical and clinical toxicities, imaging response (according to modified Response Evaluation Criteria In Solid Tumors), time-to-progression (TTP) and overall survival (OS) were analyzed. Data were stratified according to clinical and procedural parameters. Univariate and multivariate analyses were performed.ResultsOne hundred and fifteen patients (89 male, mean age 69.3 years) underwent 158 REs (119 resin-, 39 glass-based) (Barcelona Clinic Liver Cancer [BCLC]-A: 6.1%, B: 33.9%, C: 60.0%). Median clinical follow-up was 5.9 (0.9–83.5) months. No grade 4 or 5 clinical toxicities were noted. Objective response rate was 35.6%; disease control rate was 76.7%. Median TTP of the treated part of the liver was 4 (0.9–45.4) months. 108/115 patients died during follow-up (median OS 8.4 [0.3–82.8] months after first RE [BCLC-A: 52.8 months, BCLC-B: 12.4 months, BCLC-C: 6.1 months]). On multivariate analysis, baseline Eastern Co-operative Oncology Group status <1, ascites prior to RE and best imaging response were predictors of longer OS. In BCLC-C patients, tumor burden, ascites prior to RE, baseline gamma-glutamyltransferase and Child–Pugh score were predictive of OS.ConclusionsRE is safe and effective in carefully selected patients suffering from HCC with a low complication rate. Low baseline Eastern Co-operative Oncology Group status and absence of ascites prior to RE are positive prognostic factors.