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

• Published in: Journal of vascular and interventional radiology Vol. 27; no. 6; pp. 812 - 821.e2
• Main Authors: Biederman, Derek M., MD, Titano, Joseph J., MD, Tabori, Nora E., MD, Pierobon, Elisa S., MD, Alshebeeb, Kutaiba, MD, Schwartz, Myron, MD, Facciuto, Marcelo E., MD, Gunasekaran, Ganesh, MD, Florman, Sander, MD, Fischman, Aaron M., MD, Patel, Rahul S., MD, Nowakowski, Francis S., MD, Kim, Edward, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2016
• Subjects: Aged; alpha-Fetoproteins - metabolism; Aspartate Aminotransferases - blood; Bilirubin - blood; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - radiotherapy; Disease Progression; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Glass; Humans; Kaplan-Meier Estimate; Liver Neoplasms - blood; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - radiotherapy; Male; Microspheres; Middle Aged; Neoplasm Invasiveness; New York City; Portal Vein - pathology; Proportional Hazards Models; Radiology; Radiopharmaceuticals - administration & dosage; Radiopharmaceuticals - adverse effects; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Venous Thrombosis - blood; Venous Thrombosis - mortality; Venous Thrombosis - pathology; Yttrium Radioisotopes - administration & dosage; Yttrium Radioisotopes - adverse effects; AST; 90Y; time to toxicity; OS; time to progression; CI; HCC; HR; yttrium-90; CP; aspartate aminotransferase; PVT; BSA; Child-Pugh; TTP; portal vein thrombosis; TTT; hazard ratio; overall survival; confidence interval; hepatocellular carcinoma; body surface area
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2016.01.147

Abstract Purpose To compare outcomes of yttrium-90 radioembolization performed with resin-based (90 Y-resin) and glass-based (90 Y-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 (90 Y-resin, 21;90 Y-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 the90 Y-resin group. The disease control rate was 37.5% in the90 Y-resin group and 54.5% in the90 Y-glass group ( P = .39). The median (95% CI) TTP was 2.8 (1.9–4.3) months in the90 Y-resin group and 5.9 (4.2–9.1) months in the90 Y-glass group (P = .48). Median (95% CI) survival was 3.7 (2.3–6.0) months in the90 Y-resin group and 9.4 (7.6–15.0) months in the90 Y-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 of90 Y treatment in patients with HCC and PVT was not significantly different between90 Y-glass and90 Y-resin groups. Lower toxicity and improved OS were observed in the90 Y-glass group.