Yttrium-90 radioembolization for advanced inoperable hepatocellular carcinoma

Abstract

Victor Ho-Fun Lee,1,* Dennis KC Leung,1,* Mai-Yee Luk,1 Chi-Chung Tong,1 Martin WM Law,2 Sherry CY Ng,1 Ka-Kin Wong,3 Ronnie TP Poon,4 Dora LW Kwong,1 To-Wai Leung1 1Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2Department of Nuclear Medicine, 3Department of Radiology, Queen Mary Hospital, 4Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong *These authors contributed equally to this work Background: Advanced inoperable hepatocellular carcinoma (HCC) conferring a grave prognosis may benefit from yttrium-90 (90Y) radioembolization.Methods: Thirty patients with advanced inoperable HCC including those with any lesion >8 cm in maximal diameter or multiple bi-lobar lesions (totally more than five lesions), or portal vein thrombosis treated with radioembolization were reviewed. Treatment efficacy and safety were evaluated. Univariate and multivariate analyses were performed for identifying potential prognostic factors.Results: After a median follow-up of 18.3 months, the response rate was 30.0%, and the disease control rate was 50.0%. Median overall progression-free survival (PFS) and overall survival (OS) were 3.3 months and 13.2 months, respectively. Longer median PFS was noted in those who had transarterial chemoembolization before radioembolization (7.3 months vs 3.1 months; P=0.021) and duration of alfa-feto protein (AFP) response ≥6 months (11.8 months vs 3.0 months; P<0.001). Longer median OS was also revealed in those without portal vein thrombosis (17.1 months vs 4.4 months; P=0.015) and those whose duration of AFP response was ≥6 months (21.2 months vs 8.6 months; P=0.001). Seventeen patients (56.7%) developed treatment-related complications including five (16.7%) grade 3 events. Multivariate analysis revealed that treatment responders (P=0.001) and duration of AFP response ≥6 months (P=0.006) were prognostic of PFS, whereas the absence of portal vein invasion (P=0.025), treatment responders (P=0.010), and duration of AFP response ≥6 months (P=0.001) were prognostic of OS.Conclusion: 90Y radioembolization is an alternative treatment with a promising outcome for poor-risk advanced inoperable HCC. Keywords: radioembolization, transarterial chemoembolization, hepatocellular carcinoma, inoperable