title: Use of yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis.
abstract: 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.
authors.affiliation: 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
authors.forename: Andrea Lan
authors.initials: AL
authors.lastname: Tsai
authors.forename: Charles T
authors.initials: CT
authors.lastname: Burke
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Kennedy
authors.forename: Dominic T
authors.initials: DT
authors.lastname: Moore
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Mauro
authors.forename: Robert D
authors.initials: RD
authors.lastname: Dixon
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Stavas
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Bernard
authors.forename: Amir H
authors.initials: AH
authors.lastname: Khandani
authors.forename: Bert H
authors.initials: BH
authors.lastname: O'Neil
mesh_terms: 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
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes