Outcomes of radioembolization for unresectable hepatocellular carcinoma in patients with marginal functional hepatic reserve

Derek M. Biederman, Raghuram Posham, Raisa J. Durrani, Joseph J. Titano, Rahul S. Patel, Nora E. Tabori, Francis S. Nowakowski, Aaron M. Fischman, Robert A. Lookstein, Edward Kim

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4 Scopus citations

Abstract

Purpose To evaluate the outcomes of radioembolization (RE) as a therapy for unresectable hepatocellular carcinoma (HCC) in patients with marginal functional hepatic reserve. Methods A retrospective review of 471 patients (1/2010–7/2015) treated with RE (Therasphere, BTG, UK) was performed. A total of 36 patients (mean age: 66.1 ± 9.3, male: 86.1%) underwent therapy for HCC with a MELD ≥ 15 (median: 16, range: 15–22). Baseline demographics of the study cohort were as follows: etiology (HCV: 26, 72.2%), cirrhosis (n = 32, 88.9%), ECOG 0 (n = 16, 44.4%), Child-Pugh class (A = 15, B = 19, C = 2), unilobar distribution (n = 27, 75%), AFP > 200 (n = 11, 30.6%), portal vein thrombosis (PVT, n = 7, 19.4%), metastasis (n = 3, 8.3%). Outcomes analyzed included CTCAEv4.03 laboratory toxicities (120-day), imaging response (mRECIST), progression-free survival (PFS), and overall survival (OS). Results A total of 42 treatments were performed with mean dose of 2.02 ± 1.23 GBq. The cumulative grade 3/4 toxicity was 28% overall and 21% for bilirubin at 120-days. The objective response and disease control rates were 48.3% (14/29) and 69% (20/29) respectively. The median (95% CI) PFS was 5.9 (4.4–7.7) months. Ten (27.8%) patients received additional locoregional therapy at a median (IQR) of 138 (102–243) days post RE. The mean (95% CI) OS was 21.9 (14.8–29.0) months. The absence of PVT was associated with improved OS (p = 0.005) Disease control at 90-days was also associated with an OS benefit (p = 0.037). Conclusions Patients with unresectable HCC and marginal functional hepatic reserve treated with RE had favorable objective response and disease control rates, both predictive of overall survival.

Original languageEnglish
Pages (from-to)34-40
Number of pages7
JournalClinical Imaging
Volume47
DOIs
StatePublished - Jan 2018

Keywords

  • Hepatocellular carcinoma treatment
  • Interventional oncology
  • Radioembolization

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