title: Yttrium-90 microspheres for the treatment of hepatocellular carcinoma.
abstract: Unresectable hepatocellular carcinoma is extremely difficult to treat. TheraSphere consists of yttrium-90 (a pure beta emitter) microspheres, which are injected into the hepatic arteries. This article reviews the safety and survival of patients with hepatocellular carcinoma who were treated with yttrium-90 microspheres. Eighty patients were selected from a database of 108 yttrium-90 microsphere-treated patients and were staged by using Child-Pugh, Okuda, and Cancer of the Liver Italian Program scoring systems. Patients were treated with local, regional, and whole-liver approaches. Survival from first treatment was analyzed with Kaplan-Meier and Cox regression methods. Adverse events and complications of treatment were coded by using the Southwest Oncology Group toxicity scoring system. Patients received liver doses ranging from 47 to 270 Gy. Thirty-two patients (40%) received more than 1 treatment. Survival correlated with pretreatment Cancer of the Liver Italian Program scores ( P = .002), as well as with the individual Cancer of the Liver Italian Program components, Child-Pugh class, alpha-fetoprotein levels, and percentage of tumor replacement. Patients classified as Okuda stage I (n = 54) and II (n = 26) had median survival durations and 1-year survival rates of 628 days and 63%, and 384 days and 51%, respectively ( P = .02). One patient died of liver failure judged as possibly related to treatment. Thus, in selected patients with hepatocellular carcinoma, yttrium-90 microsphere treatment is safe and well tolerated. On the basis of these results, a randomized controlled trial is warranted comparing yttrium-90 microsphere treatment with transarterial chemoembolization by using the Cancer of the Liver Italian Program system for prospective stratified randomization.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 545, Baltimore, Maryland 21287-4010, USA. jfg@jhmi.edu
authors.forename: Jean Francois H
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Thurston
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Goin
authors.forename: Mark
authors.initials: M
authors.lastname: Van Buskirk
authors.forename: Carol A
authors.initials: CA
authors.lastname: Roberts
authors.forename: James E
authors.initials: JE
authors.lastname: Goin
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D015021:Yttrium Radioisotopes