Analysis of Prognostic Factors After Yttrium-90 Radioembolization of Advanced Hepatocellular Carcinoma

• Published in: International journal of radiation oncology, biology, physics Vol. 77; no. 5; pp. 1441 - 1448
• Main Authors: Iñarrairaegui, Mercedes, M.D., Ph.D, Martinez-Cuesta, Antonio, M.D., M.Sc., F.R.C.R, Rodríguez, Macarena, M.D, Bilbao, J. Ignacio, M.D., Ph.D, Arbizu, Javier, M.D., Ph.D, Benito, Alberto, M.D., Ph.D, Alegre, Félix, M.D, D'Avola, Delia, M.D, Herrero, J. Ignacio, M.D., Ph.D, Quiroga, Jorge, M.D., Ph.D, Prieto, Jesús, M.D., Ph.D, Sangro, Bruno, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2010; Elsevier
• Subjects: 90Y-radioembolization; Aged; alpha-Fetoproteins - metabolism; Analysis of Variance; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; Biological and medical sciences; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - radiotherapy; CARCINOMAS; DAYS LIVING RADIOISOTOPES; Disease Progression; DISEASES; EMBOLI; Embolization, Therapeutic - methods; Female; FORECASTING; Gastroenterology. Liver. Pancreas. Abdomen; Hematology, Oncology and Palliative Medicine; Hepatocellular carcinoma; HEPATOMAS; HOURS LIVING RADIOISOTOPES; Humans; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - radiotherapy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Microspheres; Middle Aged; NEOPLASMS; NUCLEI; ODD-ODD NUCLEI; Patient Selection; Prognosis; Prognostic factors; RADIOISOTOPES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radionuclide Imaging; Radiopharmaceuticals - therapeutic use; Retrospective Studies; Survival; Survival Analysis; SURVIVAL CURVES; Technetium Tc 99m Aggregated Albumin; Tumor Burden; Tumors; YTTRIUM 90; YTTRIUM ISOTOPES; Yttrium Radioisotopes - therapeutic use; Hepatocellular carcinoma; 90Y-radioembolization; Survival; Prognostic factors; Prognosis; Y-radioembolization; Digestive diseases; Hepatic disease; Malignant tumor; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.07.006

Purpose To analyze which patient-, tumor-, and treatment-related factors may influence outcome after90 Y radioembolization (90 Y-RE) for hepatocellular carcinoma (HCC). Patients and Methods Seventy-two consecutive patients with advanced HCC treated with90 Y-RE were studied to detect which factors may have influenced response to treatment and survival. Results Median overall survival was 13 months (95% confidence interval, 9.6–16.3 months). In univariate analysis, survival was significantly better in patients with one to five lesions (19 vs. 8 months, p = 0.001) and in patients with alpha-fetoprotein <52 UI/mL (24 vs. 11 months, p = 0.002). The variation in target tumor size and the appearance of new lesions were analyzed among 50 patients with measurable tumors. A decrease in target tumor size was observed in most patients, and the intensity of such decrease was not associated with any of the factors under study. Patients who developed new lesions in the treated liver (and also in the nontargeted liver) at month 3 more frequently had more than five nodules, bilobar disease, and alpha-fetoprotein >52 UI/mL, and their survival in the multivariate analysis was significantly worse (hazard ratio, 4.7; 95% confidence interval, 13–1.73) ( p = 0.002). Conclusions Yttrium-90 radioembolization results in control of target lesions in the majority of patients with HCC but does not prevent the development of new lesions. Survival of patients treated with90 Y-RE seems to depend largely on factors related to the aggressiveness of the disease (number of nodules, levels of alpha-fetoprotein, and presence of microscopic disease).