Survival and pattern of tumor progression with yttrium-90 microsphere radioembolization in predominantly hepatitis B Asian patients with hepatocellular carcinoma

• Published in: Hepatology international Vol. 8; no. 3; pp. 395 - 404
• Main Authors: Khor, Andrew Yu-Keat, Toh, Ying, Allen, John Carson, Ng, David Chee-Eng, Kao, Yung-Hsiang, Zhu, Guili, Choo, Su-Pin, Lo, Richard Hoau-Gong, Tay, Kiang-Hiong, Teo, Jin-Yao, Goh, Brian Kim-Poh, Burgmans, Mark Christiaan, Irani, Farah Gillian, Goh, Anthony Soon-Whatt, Chow, Pierce Kah-Hoe
• Format: Journal Article
• Language: English
• Published: India Springer India 01-07-2014; Springer Nature B.V
• Subjects: Colorectal Surgery; Hepatitis B virus; Hepatitis C virus; Hepatology; Medicine; Medicine & Public Health; Original Article; Surgery; Radioembolization; Yttrium-90; Hepatocellular carcinoma
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-014-9533-9

Purpose
Intra-arterial yttrium-90 (
90
Y) microsphere radioembolization (RE) is an emerging treatment option with good outcomes reported predominantly in hepatitis C Western populations with hepatocellular carcinoma (HCC). We report outcomes in predominantly hepatitis B Asian patients treated with
90
Y-RE focusing on overall survival (OS), time to progression (TTP), tumor response, pattern of tumor recurrence and adverse events. Prognostic factors for survival were also identified.
Methods
A retrospective cohort study was conducted in a single tertiary institution. All non-trial patients treated with
90
Y-RE at our institution from 1 January 2008 to 30 June 2012 were included.
Results
Data from 103 consecutive patients were analyzed. The majority of patients were Child-Pugh class A (59.2 %) and Barcelona Clinic Liver Cancer (BCLC) stage C (68.9 %). Median OS was 14.4 months (95 % CI 11.0–22.2), which varied by disease stage: Child-Pugh A, 21.7 months; Child-Pugh B, 7.1 months; BCLC B, 23.8 months; BCLC C, 11.8 months. Response and disease control rates by RECIST 1.1 were 21.2 and 59.6 %, respectively, while disease control for index lesions treated with
90
Y-RE was 100 %. Development of new intrahepatic lesions was the main reason for eventual disease progression. Median overall TTP was 5.3 months (95 % CI 4.1–10.0). Pretreatment vascular invasion, low serum albumin and elevated total bilirubin levels predicted poorer survival.
Conclusions
Survival outcomes in hepatitis B Asian patients treated with
90
Y-RE for HCC are comparable to hepatitis C Western populations. While disease control for lesions treated with
90
Y-RE is excellent, the development of new lesions suggests a role for concomitant systemic therapy.