Use of yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis.
OBJECTIVE
Patients with portal vein thrombosis (PVT) and hepatocellular carcinoma (HCC) have limited treatment options because of increased disease burden and diminished hepatic perfusion. Yttrium-90 ((90)Y) microspheres may be better tolerated than chemoembolization in these patients. The present study reviews the safety and efficacy of (90)Y microspheres in HCC with major PVT.


METHODS
A retrospective review of HCC with main (n = 10) or first-branch (n = 12) PVT treated with (90)Y microspheres (N = 22) was conducted. Cancer of the Liver Italian Program (CLIP) scores ranged from 2 to 5, with 18% of patients having a score of 4 or greater. Imaging response at 8-12 was based on Response Evaluation Criteria In Solid Tumors. Overall survival (OS) was estimated by the Kaplan-Meier method.


RESULTS
A total of 32 microsphere treatments (26 glass, six resin) were administered to 22 patients. Common grade 1/2 toxicities included abdominal pain (38%), nausea (28%), and fatigue (22%). Four posttreatment hospitalizations occurred, all less than 48 hours in duration. One death occurred 10 days after therapy. The partial response rate was 8% and progressive disease was seen in 42% of patients. Stable disease was achieved in 50% of treatments. Median OS was 7 months from initial treatment. Patients with Child-Pugh class A disease had a median OS of 7.7 months; those with class B/C disease had an OS of 2.7 months (P = .01). Median OS for patients with CLIP scores of 2/3 was 7 months, versus 1.3 months for those with scores of 4/5 (P = .04).


CONCLUSIONS
Yttrium-90 microspheres are tolerated in patients with HCC and major PVT. Compared with chemoembolization, rates of severe adverse events appear low. Radiographic response rates are low. The median OS of 7 months is promising and warrants further study versus systemic therapy.
Tsai
Andrea Lan
AL
Department of Hematology/Oncology, University of North Carolina School of Medicine, 3009 Old Clinic Building, CB 7305, Chapel Hill, NC 27599, USA. andrea.tsai@post.harvard.edu
Burke
Charles T
CT
Kennedy
Andrew S
AS
Moore
Dominic T
DT
Mauro
Matthew A
MA
Dixon
Robert D
RD
Stavas
Joseph M
JM
Bernard
Stephen A
SA
Khandani
Amir H
AH
O'Neil
Bert H
BH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009657:North Carolina; D011169:Portal Vein; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000401:mortality; D055815:Young Adult; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes