Radioembolization for Hepatocellular Carcinoma Using Yttrium-90 Microspheres: A Comprehensive Report of Long-term Outcomes

Riad Salem, Robert J. Lewandowski, Mary F. Mulcahy, Ahsun Riaz, Robert K. Ryu, Saad Ibrahim, Bassel Atassi, Talia Baker, Vanessa Gates, Frank H. Miller, Kent T. Sato, Ed Wang, Ramona Gupta, Al B. Benson, Steven B. Newman, Reed A. Omary, Michael Abecassis, Laura Kulik

Research output: Contribution to journalArticlepeer-review

670 Scopus citations

Abstract

Background & Aims: Hepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following intra-arterial radiation are unknown. We assessed clinical outcomes of patients treated with intra-arterial yttrium-90 microspheres (Y90). Methods: Patients with HCC (n = 291) were treated with Y90 as part of a single-center, prospective, longitudinal cohort study. Toxicities were recorded using the Common Terminology Criteria version 3.0. Response rate and time to progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Univariate/multivariate analyses were performed. Results: A total of 526 treatments were administered (mean, 1.8; range, 1-5). Toxicities included fatigue (57%), pain (23%), and nausea/vomiting (20%); 19% exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3%. Response rates were 42% and 57% based on WHO and EASL criteria, respectively. The overall TTP was 7.9 months (95% confidence interval, 6-10.3). Survival times differed between patients with Child-Pugh A and B disease (A, 17.2 months; B, 7.7 months; P = .002). Patients with Child-Pugh B disease who had portal vein thrombosis (PVT) survived 5.6 months (95% confidence interval, 4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and α-fetoprotein; and WHO/EASL response rate predicted survival. Conclusions: Patients with Child-Pugh A disease, with or without PVT, benefited most from treatment. Patients with Child-Pugh B disease who had PVT had poor outcomes. TTP and overall survival varied by patient stage at baseline. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option for patients with HCC.

Original languageEnglish (US)
Pages (from-to)52-64
Number of pages13
JournalGastroenterology
Volume138
Issue number1
DOIs
StatePublished - Jan 2010

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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