title: Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma.
abstract: OBJECTIVE
  The European Network on Radioembolization with Yttrium-90 resin microspheres study group (ENRY) conducted a retrospective study to evaluate the outcomes among elderly (≥ 70 years) and younger patients (<70 years) with unresectable hepatocellular carcinoma (HCC) who received radioembolization at 8 European centers.
  
  
  METHODS
  Patients with confirmed diagnosis of unresectable HCC who either progressed following resection or locoregional treatment and/or who were considered poor candidates for chemoembolization were evaluated by a multidisciplinary team for radioembolization with (90)Y-resin microspheres (SIR-Spheres; Sirtex Medical). The survival outcome and all adverse events were compared between the two age groups.
  
  
  RESULTS
  Between 2003 and 2009, 128 elderly and 197 younger patients received radioembolization. Patients in both groups had similar demographic characteristics. Many elderly and younger patients alike had multinodular, BCLC stage C disease, invading both lobes (p = 0.648). Elderly patients had a lower tumor burden, a smaller median target liver volume (p = 0.016) and appeared more likely to receive segmental treatment (p = 0.054). Radioembolization was equally well tolerated in both cohorts and common procedure-related adverse events were predominantly grade 1-2 and of short duration. No significant differences in survival between the groups were found (p = 0.942) with similar median survival in patients with early, intermediate or advanced BCLC stage disease.
  
  
  CONCLUSIONS
  Radioembolization appears to be as well-tolerated and effective for the elderly as it is for younger patients with unresectable HCC. Age alone should not be a discriminating factor for the management of HCC patients.
authors.affiliation: Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy. Electronic address: rita.golfieri@aosp.bo.it.
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Josè Ignacio
authors.initials: JI
authors.lastname: Bilbao
authors.forename: Livio
authors.initials: L
authors.lastname: Carpanese
authors.forename: Roberto
authors.initials: R
authors.lastname: Cianni
authors.forename: Daniele
authors.initials: D
authors.lastname: Gasparini
authors.forename: Samer
authors.initials: S
authors.lastname: Ezziddin
authors.forename: Philipp Marius
authors.initials: PM
authors.lastname: Paprottka
authors.forename: Francesco
authors.initials: F
authors.lastname: Fiore
authors.forename: Alberta
authors.initials: A
authors.lastname: Cappelli
authors.forename: Macarena
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Ettorre
authors.forename: Adelchi
authors.initials: A
authors.lastname: Saltarelli
authors.forename: Onelio
authors.initials: O
authors.lastname: Geatti
authors.forename: Hojjat
authors.initials: H
authors.lastname: Ahmadzadehfar
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Haug
authors.forename: Francesco
authors.initials: F
authors.lastname: Izzo
authors.forename: Emanuela
authors.initials: E
authors.lastname: Giampalma
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pizzi
authors.forename: Ermanno
authors.initials: E
authors.lastname: Notarianni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vit
authors.forename: Kai
authors.initials: K
authors.lastname: Wilhelm
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Jakobs
authors.forename: Secondo
authors.initials: S
authors.lastname: Lastoria
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes
keywords: (90)Y; (99m)Tc-MAA; AEs; AFP; ALT; ANOVA; BCLC; Barcelona Clinic Liver Cancer; CT; CTCAE; EASL; ECOG; ENRY; Elderly patients; European Association for the Study of the Liver; European Cooperative Oncology Group; European Network on Radioembolization with Yttrium-90; GBq; GGTP; GI; HBV; HCC; HCV; Hepatocellular carcinoma; INR; International Normalized Ratio; MELD; Model for End-Stage Liver Disease; NASH; PEI; REILD; RFA; Radioembolization; SD; SIRT; Safety; Survival; TACE; Technetium-99m macroaggregated albumin; Tolerability; Yttrium-90; adverse events; alanine transaminase; alpha fetoprotein; analysis of variance; common toxicity criteria adverse events; computed tomography; gamma-glutamyl transpeptidase; gastrointestinal; gigabecquerel; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; non-alcoholic steatohepatitis; percutaneous ethanol injection; radioembolization-induced liver disease; radiofrequency ablation; selective internal radiation therapy; standard deviation; transarterial chemoembolization