Outcomes of Radioembolization in the Treatment of Hepatocellular Carcinoma with Portal Vein Invasion: Resin versus Glass Microspheres

Purpose To compare outcomes of yttrium-90 radioembolization performed with resin-based (⁹⁰Y-resin) and glass-based (⁹⁰Y-glass) microspheres in the treatment of hepatocellular carcinoma (HCC) with associated portal vein invasion. Materials and Methods A single-center retrospective review (January 2005-September 2014) identified 90 patients (⁹⁰Y-resin, 21; ⁹⁰Y-glass, 69) with HCC and ipsilateral portal vein thrombosis (PVT). Patients were stratified according to age, sex, ethnicity, Child-Pugh class, Eastern Cooperative Oncology Group status, α-fetoprotein > 400 ng/mL, extent of PVT, tumor burden, and sorafenib therapy. Outcome variables included clinical and laboratory toxicities (Common Terminology Criteria Adverse Events, Version 4.03), imaging response (modified Response Evaluation Criteria in Solid Tumors), time to progression (TTP), and overall survival (OS). Results Grade 3/4 bilirubin and aspartate aminotransferase toxicities developed at a 2.8-fold (95% confidence interval [CI], 1.3-6.1) and 2.6-fold (95% CI, 1.1-6.1) greater rate in the ⁹⁰Y-resin group. The disease control rate was 37.5% in the ⁹⁰Y-resin group and 54.5% in the ⁹⁰Y-glass group (P =.39). The median (95% CI) TTP was 2.8 (1.9-4.3) months in the ⁹⁰Y-resin group and 5.9 (4.2-9.1) months in the ⁹⁰Y-glass group (P =.48). Median (95% CI) survival was 3.7 (2.3-6.0) months in the ⁹⁰Y-resin group and 9.4 (7.6-15.0) months in the ⁹⁰Y-glass group (hazard ratio, 2.6; 95% CI, 1.5-4.3, P <.001). Additional multivariate predictors of improved OS included age < 65 years, Eastern Cooperative Oncology Group status < 1, α-fetoprotein ≤ 400 ng/mL, and unilobar tumor distribution. Conclusions Imaging response of ⁹⁰Y treatment in patients with HCC and PVT was not significantly different between ⁹⁰Y-glass and ⁹⁰Y-resin groups. Lower toxicity and improved OS were observed in the ⁹⁰Y-glass group.