title: Yttrium-90 Radioembolization in Patients with Hepatocellular Carcinoma Who have Previously Received Sorafenib.
abstract: OBJECTIVE
  Yttrium-90 radioembolization (RE) is a locoregional therapy option for hepatocellular carcinoma (HCC). Sorafenib is a multikinase inhibitor used in HCC that can potentially affect the efficacy of RE by altering tumor vascularity or suppressing post-irradiation angiogenesis. The safety and efficacy of sorafenib followed by RE has not been previously reported.
  
  
  METHODS
  Patients with HCC who received RE after sorafenib were included in this retrospective review. Overall survival, toxicity, and maximal radiographic response and necrosis criteria were examined.
  
  
  RESULTS
  Ten patients (15 RE administrations) fit the inclusion criteria. All were Barcelona Clinic Liver Cancer (BCLC) stage C. Median follow-up was 16.5 weeks. Median overall survival and radiographic progression-free survival were 30 and 28 weeks, respectively. Significant differences in overall survival were seen based on Child-Pugh class (p = 0.002) and radiographic response (p = 0.009). Three patients had partial response, six had stable disease, and one had progressive disease. Grade 1 or 2 acute fatigue, anorexia, and abdominal pain were common. Three patients had Grade 3 ascites in the setting of disease progression. Two patients had Grade 3 biochemical toxicity. One patient was sufficiently downstaged following RE and sorafenib to receive a partial hepatectomy.
  
  
  CONCLUSIONS
  Yttrium-90 RE in patients with HCC who have received sorafenib demonstrate acceptable toxicity and rates of radiographic response. However, the overall survival is lower than that reported in the literature on RE alone or sorafenib alone. This may be due in part to more patients in this study having advanced disease compared to these other study populations. Larger prospective studies are needed to determine whether the combination of RE and sorafenib is superior to either therapy alone.
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Nitesh
authors.initials: N
authors.lastname: Rana
authors.affiliation: Department of Radiation Oncology, Brody School of Medicine, East Carolina University , Greenville, NC , USA.
authors.forename: Andrew Wenhua
authors.initials: AW
authors.lastname: Ju
authors.affiliation: Department of Interventional Radiology at Georgetown University Hospital , Washington, DC , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Bazylewicz
authors.affiliation: Department of Pathology, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Kallakury
authors.affiliation: Department of Hematology and Oncology, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Aiwu Ruth
authors.initials: AR
authors.lastname: He
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Unger
authors.affiliation: Department of Interventional Radiology at Georgetown University Hospital , Washington, DC , USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Lee
keywords: HCC; SIRT; Y90; hepatocellular carcinoma; radioembolization; sorafenib; yttrium-90