Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma.
OBJECTIVE
Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC.


METHODS
We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed.


RESULTS
Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42).


CONCLUSIONS
Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.
Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois 60611, USA. r-salem@northwestern.edu
Riad
R
Salem
Robert J
RJ
Lewandowski
Laura
L
Kulik
Edward
E
Wang
Ahsun
A
Riaz
Robert K
RK
Ryu
Kent T
KT
Sato
Ramona
R
Gupta
Paul
P
Nikolaidis
Frank H
FH
Miller
Vahid
V
Yaghmai
Saad M
SM
Ibrahim
Seanthan
S
Senthilnathan
Talia
T
Baker
Vanessa L
VL
Gates
Bassel
B
Atassi
Steven
S
Newman
Khairuddin
K
Memon
Richard
R
Chen
Robert L
RL
Vogelzang
Albert A
AA
Nemcek
Scott A
SA
Resnick
Howard B
HB
Chrisman
James
J
Carr
Reed A
RA
Omary
Michael
M
Abecassis
Al B
AB
Benson
Mary F
MF
Mulcahy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D017322:Clinical Trials, Phase II as Topic; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D059039:Standard of Care; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes