title: Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival.
abstract: OBJECTIVE
  To present safety and efficacy results obtained in treatment of a cohort of patients with unresectable hepatocellular carcinoma (HCC) with use of 90Y microspheres (TheraSphere).
  
  
  METHODS
  Forty-three consecutive patients with HCC were treated with 90Y microspheres over a 4-year period. Patients were treated by liver segment or lobe on one or more occasions based on tumor distribution, liver function, and vascular flow dynamics. Patients were followed for adverse events, objective tumor response, and survival. Patients were stratified into three risk groups according to method of treatment and risk stratification (group 0, segmental; group 1, lobar low-risk; group 2, lobar high-risk) and Okuda and Child-Pugh scoring systems.
  
  
  RESULTS
  Based on follow-up data from 43 treated patients, 20 patients (47%) had an objective tumor response based on percent reduction in tumor size and 34 patients (79%) had a tumor response when percent reduction and/or tumor necrosis were used as a composite measure of tumor response. There was no statistical difference among the three risk groups with respect to tumor response. Survival times from date of diagnosis were different among the risk groups (P < .0001). Median survival times were 46.5 months, 16.9 months, and 11.1 months for groups 0, 1, and 2, respectively. Median survival times of 24.4 months and 12.5 months by Okuda scores of I and II, respectively, were achieved (mean, 25.8 months vs 13.1). Patients had median survival times of 20.5 months and 13.8 months according to Child class A and class B/C disease, respectively (mean, 22.7 months vs 13.6 months). Patients classified as having diffuse disease exhibited decreased survival and reduced tumor response. There were no life-threatening adverse events related to treatment.
  
  
  CONCLUSIONS
  Use of 90Y microspheres (TheraSpheres) provides a safe and effective method of treatment for a broad spectrum of patients presenting with unresectable HCC. Further investigation is warranted.
authors.affiliation: Division of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois, USA. r-salem@northwestern.edu
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Bassel
authors.initials: B
authors.lastname: Atassi
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.forename: Omar
authors.initials: O
authors.lastname: Barakat
authors.forename: Ziad
authors.initials: Z
authors.lastname: Sergie
authors.forename: Ching-Yee O
authors.initials: CY
authors.lastname: Wong
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Thurston
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D011446:Prospective Studies; D015641:Radiography, Interventional; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes