Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis.
This study was undertaken to present data from a phase 2 study in which patients with unresectable hepatocellular carcinoma (HCC) with and without portal vein thrombosis underwent radioembolization with Yttrium ((90)Y) microspheres. Patients treated were stratified by Okuda, Child-Pugh, baseline bilirubin, tumor burden, Eastern Cooperative Oncology Group (ECOG), presence of cirrhosis and portal vein thrombosis (PVT) (none, branch, and main). Clinical and biochemical data were obtained at baseline and at 4-week intervals following treatment for up to 6 months. Tumor response was obtained using computed tomography (CT). Patients were followed for survival. One hundred eight patients were treated during the study period. Thirty-seven (34%) patients had PVT, 12 (32%) of which involved the main PV. The cumulative dose for those with and without PVT was 139.7 Gy and 131.9 Gy, respectively. The partial response rate using world Health Organization (WHO) criteria was 42.2%. Using European Association for the Study of the Liver (EASL), the response rate was 70%. Kaplan-Meier survival varied depending on location of PVT and presence of cirrhosis. The adverse event (AE) rates were highest in patients with main PVT and cirrhosis. There were no cases of radiation pneumonitis.


CONCLUSIONS
The use of minimally embolic (90)Y glass microspheres to treat patients with HCC complicated by branch/lobar PVT may be clinically indicated and appears to have a favorable toxicity profile. Further investigation is warranted in patients with main PVT.
Kulik
Laura M
LM
Department of Hepatology, Northwestern University, Chicago, IL, USA.
Carr
Brian I
BI
Mulcahy
Mary F
MF
Lewandowski
Robert J
RJ
Atassi
Bassel
B
Ryu
Robert K
RK
Sato
Kent T
KT
Benson
Al
A
Nemcek
Albert A
AA
Gates
Vanessa L
VL
Abecassis
Michael
M
Omary
Reed A
RA
Salem
Riad
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D015021:Yttrium Radioisotopes