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

• Main Authors: Meyer C, Pieper CC, Ahmadzadehfar H, Lampe NA, Matuschek EME, Maschke TA, Enkirch SJ, Essler M, Spengler U, Schild HH
• Format: Article
• Language: English
• Published: Dove Medical Press 2017-09-01
• Series: OncoTargets and Therapy
• Subjects: Radioembolization; hepatocellular carcinoma; HCC; locoregional therapy; liver
• Online Access: https://www.dovepress.com/yttrium-90-radioembolization-of-unresectable-hepatocellular-carcinoma--peer-reviewed-article-OTT

Carsten Meyer,1,* Claus Christian Pieper,1,* Hojjat Ahmadzadehfar,2 Nina Alexandra Lampe,1 Eva Maria E Matuschek,1 Thomas Adrian Maschke,1 Simon Jonas Enkirch,1 Markus Essler,2 Ulrich Spengler,3 Hans Heinz Schild1 1Department of Radiology, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany, 2Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany, 3Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany *These authors contributed equally to this work Purpose: To determine the value of radioembolization (RE) for treatment of unresectable hepatocellular carcinoma (HCC). Patients and methods: Records 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. Results: One 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-glutamyl-transferase and Child–Pugh score were predictive of OS. Conclusions: RE 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. Keywords: radioembolization, hepatocellular carcinoma, HCC, locoregional therapy, liver