title: Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy.
abstract: Resection and radiofrequency ablation (RFA) are treatment options for hepatocellular carcinoma (HCC) <3 cm; there is interest in expanding the role of ablation to 3-5 cm. RFA is considered high-risk when the lesion is in close proximity to critical structures. Combining microcatheter technology and the localized emission properties of Y90, highly selective radioembolization is a possible alternative to RFA in such cases. We assessed the efficacy (response, radiology-pathology correlation, survival) of radiation segmentectomy in solitary HCC not amenable to RFA or resection. Patients with treatment-naïve, unresectable, solitary HCC ≤ 5 cm not amenable to RFA were included in this multicenter study. Administered dose, response rate, time-to-progression (modified Response Evaluation Criteria in Solid Tumors [mRECIST]), radiology-pathology correlation and long-term survival were assessed. In all, 102 patients were included in this study. mRECIST complete response (CR), partial response (PR), and stable disease (SD) were 47/99 (47%), 39/99 (39%), and 12/99 (12%), respectively. Median time-to-disease-progression was 33.1 months. In all, 33/102 (32%) patients were transplanted with a median (interquartile range [IQR]) time-to-transplantation of 6.3 months (3.6-9.7). Pathology revealed 100% and 50-99% necrosis in 17/33 (52%) and 16/33 (48%), respectively. Median overall survival was 53.4 months. Univariate analysis demonstrated a survival benefit for Eastern Cooperative Oncology Group (ECOG) 0 patients. In the multivariate model, age <65, ECOG 0, and Child-Pugh A were characteristics associated with longer survival.
  
  
  CONCLUSIONS
  Radiation segmentectomy is an effective technique with a favorable risk profile and radiology-pathology outcomes for solitary HCC ≤ 5 cm. This approach may allow for treatment of HCC in difficult locations. Since RFA and resection are not options given tumor location, there appears to be a strong rationale for this technique as second choice.
authors.affiliation: Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Vouche
authors.forename: Ali
authors.initials: A
authors.lastname: Habib
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ward
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
authors.forename: Daniel
authors.initials: D
authors.lastname: Ganger
authors.forename: Mary
authors.initials: M
authors.lastname: Mulcahy
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Caicedo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fryer
authors.forename: Ryan
authors.initials: R
authors.lastname: Hickey
authors.forename: Elias
authors.initials: E
authors.lastname: Hohlastos
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000379:methods* / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes