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

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.