Yttrium-90 Glass-Based Microsphere Radioembolization in the Treatment of Hepatocellular Carcinoma Secondary to the Hepatitis B Virus: Safety, Efficacy, and Survival

• Published in: Journal of vascular and interventional radiology Vol. 26; no. 11; pp. 1630 - 1638
• Main Authors: Biederman, Derek M., MD, Titano, Joseph J., MD, Lee, Karen M., MD, Pierobon, Elisa S., MD, Schwartz, Myron, MD, Facciuto, Marcelo E., MD, Gunasekaran, Ganesh, MD, Florman, Sander, MD, Fischman, Aaron M., MD, Patel, Rahul S., MD, Tabori, Nora E., MD, Nowakowski, Francis S., MD, Kim, Edward, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2015
• Subjects: Brachytherapy - mortality; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - radiotherapy; Causality; Comorbidity; Female; Glass; Hepatitis B - mortality; Hepatitis B - radiotherapy; Humans; Liver Neoplasms - mortality; Liver Neoplasms - radiotherapy; Male; Microspheres; New York - epidemiology; Prevalence; Radiology; Radiopharmaceuticals - therapeutic use; Retrospective Studies; Risk Factors; Survival Rate; Treatment Outcome; Yttrium Radioisotopes - therapeutic use; New York; PS; time to progression; hepatitis B virus; HBV-HCC; Eastern Cooperative Oncology Group; mRECIST; hepatocellular carcinoma resulting from hepatitis C virus etiology; HR; modified Response Evaluation Criteria In Solid Tumors; AFP; TTP; ECOG; hepatitis C virus; α-fetoprotein; performance status; Barcelona Clinic Liver Cancer; HBV; hepatocellular carcinoma resulting from hepatitis B virus etiology; hepatocellular carcinoma; WHO; World Health Organization; CI; BCLC; HCC; HCV-HCC; hazard ratio; confidence interval; HCV
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2015.07.019

Abstract Purpose To evaluate outcomes of yttrium-90 radioembolization performed with glass-based microspheres in the treatment of hepatocellular carcinoma (HCC) secondary to the hepatitis B virus (HBV). Materials and Methods A total of 675 patients treated between January 2006 and July 2014 were reviewed, of which 45 (age 62 y ± 10; 91% male) received glass-based radioembolization for HCC secondary to HBV. All patients were stratified according to previous therapy (naive, n = 14; 31.1%), Child–Pugh class (class A, n = 41; 91%), Eastern Cooperative Oncology Group (ECOG) performance status (PS; < 1, n = 21; 47%), solitary (n = 26; 58%) and unilobar (n = 37; 82%) tumor distribution, tumor size < 5 cm (n = 29; 64%), portal vein thrombosis (n = 14; 31%), α-fetoprotein level > 400 ng/mL (n = 17; 38%), and Barcelona Clinic Liver Cancer stage (A, n = 8; B, n = 9; C, n = 28). Results A total of 50 radioembolization treatments were performed, with a 100% technical success rate (median target dose, 120 Gy). Clinical toxicities included pain (16%), fatigue (12%), and nausea (4%). Grade 3/4 laboratory toxicities included bilirubin (8%) and aspartate aminotransferase (4%) toxicities. Observed toxicities were independent of treatment dose. The objective response rates were 55% per modified Response Evaluation Criteria In Solid Tumors and 21% per World Health Organization criteria, and the disease control rate was 63%. Disease progression was secondary to new, nontarget HCC in 45% of cases. Median time to progression and overall survival were 6.0 mo (95% confidence interval [CI], 4.4–8.0 mo) and 19.3 mo (95% CI, 11.2–22.7 mo), respectively. Multivariate analysis demonstrated ECOG PS ≥ 1 and AFP level > 400 ng/mL to be independent predictors of inferior overall survival. Conclusions Glass-based radioembolization for HCC secondary to HBV can be safely performed, with favorable target lesion response and overall survival.