title: Radioembolization for hepatocellular carcinoma with portal vein thrombosis: impact of liver function on systemic treatment options at disease progression.
abstract: OBJECTIVE
  Yttrium-90 ((90)Y) radioembolization is a microembolic procedure. Hence, it is commonly used in hepatocellular carcinoma (HCC) patients with portal venous thrombosis (PVT). We analyzed liver function, imaging findings, and treatment options (local/systemic) at disease progression following (90)Y treatment in HCC patients with PVT.
  
  
  METHODS
  We treated 291 HCC patients with (90)Y radioembolization. From this cohort, we included patients with liver-only disease, PVT and Child-Pugh (CP) score ≤ 7; this identified 63 patients with HCC and PVT (CP-A:35, CP-B7:27). Liver function, CP status, and imaging findings at progression were determined in order to assess potential candidacy for systemic treatment/clinical trials. Survival, time-to-progression (TTP), and time-to-hepatic decompensation analyses were performed using Kaplan-Meier methodology.
  
  
  RESULTS
  Of 35 CP-A and 28 CP-B7 patients, 29 and 15 progressed, respectively. Median survival and TTP were 13.8 and 5.6 months in CP-A and 6.5 and 4.9 months in CP-B7 patients, respectively. Of the 29 CP-A patients who progressed, 45% maintained their CP status at progression (55% decompensated to CP-B). Of the 15 CP-B7 patients who progressed, 20% improved to CP-A, 20% maintained their CP score and 60% decompensated.
  
  
  CONCLUSIONS
  Knowledge of liver function and CP score of HCC with PVT progressing after (90)Y is critically relevant information, as these patients may be considered for systemic therapy/clinical trials. If a strict CP-A status is mandated, our study demonstrated that 64% of cases exhibited inadequate liver function and were ineligible for systemic therapy/clinical trials. An adjuvant approach using local therapy and systemic agents prior to progression should be investigated.
authors.affiliation: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Daniel
authors.initials: D
authors.lastname: Ganger
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.forename: Michael
authors.initials: M
authors.lastname: Vouche
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000532:radiotherapy*; D015331:Cohort Studies; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000401:mortality / Q000532:radiotherapy*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011169:Portal Vein; D020246:Venous Thrombosis / Q000401:mortality / Q000532:radiotherapy*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D015021:Yttrium Radioisotopes