title: Comparative analysis of the safety and efficacy of transcatheter arterial chemoembolization and yttrium-90 radioembolization in patients with unresectable hepatocellular carcinoma.
abstract: OBJECTIVE
  To compare retrospectively the safety and efficacy of yttrium-90 ((90)Y) radioembolization with the safety and efficacy of chemoembolization in patients with unresectable hepatocellular carcinoma (HCC).
  
  
  METHODS
  Survival and complication rates were evaluated for patients with HCC who underwent chemoembolization or radioembolization at a single institution between August 2007 and April 2010. Complications were graded according to a standardized grading system for embolization procedures. Survival was determined via the Kaplan-Meier method, and multivariable analysis for factors affecting survival was performed.
  
  
  RESULTS
  This study included 73 patients with HCC who underwent index embolization with radioembolization (n = 38; 52.1%) or chemoembolization (n = 35; 47.9%). The two patient populations were similar in terms of demographics, etiology of cirrhosis, functional status, tumor characteristics, Child-Pugh class, previous liver-directed therapy, and number of patients with bilirubin > 2.0 mg/dL. There was no significant difference in survival between the radioembolization (median 8.0 months) and chemoembolization (median 10.3 months) cohorts (P = .33). Postembolization syndrome was significantly more severe in patients who underwent chemoembolization, which led to increased total hospitalization rates in these patients. The rates of other complications and rehospitalization were similar between groups. Increased age, Child-Pugh class B, hepatitis seropositivity, bilobar tumor distribution, tumor vascular invasion, and presence of extrahepatic metastases were associated with reduced patient survival.
  
  
  CONCLUSIONS
  Patients treated with radioembolization did not show a survival advantage over patients treated with chemoembolization. However, patients who underwent chemoembolization had significantly higher rates of hospitalization as a result of postembolization syndrome.
authors: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors: Craig
authors: C
authors: Lance
authors: Gordon
authors: G
authors: McLennan
authors: Nancy
authors: N
authors: Obuchowski
authors: Grace
authors: G
authors: Cheah
authors: Abraham
authors: A
authors: Levitin
authors: Mark
authors: M
authors: Sands
authors: James
authors: J
authors: Spain
authors: Shyam
authors: S
authors: Srinivas
authors: Sankaran
authors: S
authors: Shrikanthan
authors: Federico N
authors: FN
authors: Aucejo
authors: Richard
authors: R
authors: Kim
authors: K V Narayanan
authors: KV
authors: Menon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000401:mortality*; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000401:mortality; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D011878:Radiotherapy / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes