title: Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following intra-arterial radiation are unknown. We assessed clinical outcomes of patients treated with intra-arterial yttrium-90 microspheres (Y90).
  
  
  METHODS
  Patients with HCC (n = 291) were treated with Y90 as part of a single-center, prospective, longitudinal cohort study. Toxicities were recorded using the Common Terminology Criteria version 3.0. Response rate and time to progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Univariate/multivariate analyses were performed.
  
  
  RESULTS
  A total of 526 treatments were administered (mean, 1.8; range, 1-5). Toxicities included fatigue (57%), pain (23%), and nausea/vomiting (20%); 19% exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3%. Response rates were 42% and 57% based on WHO and EASL criteria, respectively. The overall TTP was 7.9 months (95% confidence interval, 6-10.3). Survival times differed between patients with Child-Pugh A and B disease (A, 17.2 months; B, 7.7 months; P = .002). Patients with Child-Pugh B disease who had portal vein thrombosis (PVT) survived 5.6 months (95% confidence interval, 4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and alpha-fetoprotein; and WHO/EASL response rate predicted survival.
  
  
  CONCLUSIONS
  Patients with Child-Pugh A disease, with or without PVT, benefited most from treatment. Patients with Child-Pugh B disease who had PVT had poor outcomes. TTP and overall survival varied by patient stage at baseline. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option for patients with HCC.
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois 60611, 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: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Saad
authors.initials: S
authors.lastname: Ibrahim
authors.forename: Bassel
authors.initials: B
authors.lastname: Atassi
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Vanessa
authors.initials: V
authors.lastname: Gates
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Ed
authors.initials: E
authors.lastname: Wang
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Steven B
authors.initials: SB
authors.lastname: Newman
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000532:radiotherapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes