Superselective yttrium-90 radioembolization for hepatocellular carcinoma yields high response rates with minimal toxicity.
OBJECTIVE
To assess the safety and efficacy of yttrium-90 ((90)Y) radioembolization when performed in a superselective fashion for patients with unresectable hepatocellular carcinoma (HCC).


METHODS
This retrospective study included 20 patients with unresectable HCC. Median Model for End-Stage Liver Disease score was 10.5 (range, 6-25), with 8 of 20 patients (40%) classified Child-Pugh class B and 1 of 20 patients (5%) classified class C cirrhosis. Segmental tumor-associated portal vein thrombus was present in 12 patients (60%), and a transjugular intrahepatic portosystemic shunt was present in 4 patients (20%). Median tumor diameter was 3.9 cm (range, 2.5-7.1 cm). All patients underwent superselective (90)Y radioembolization targeted to a single liver segment using glass microspheres.


RESULTS
Median dose to the treated segment was 254 Gy, and median dose to the tumor was 536 Gy. No grade 3-4 hepatotoxicity occurred. The most common clinical toxicities were fatigue (30%), abdominal pain (10%), and postembolization syndrome (10%). Follow-up imaging demonstrated complete European Association for the Study of the Liver response of the index tumor in 19 of 20 patients (95%) and stable disease in 1 of 20 patients (5%). In patients with complete response, local tumor recurrence rate was 5.3% (1 of 19 patients). Median time to progression was 319 days. Overall survival was 90% (18 of 20 patients) with a median follow-up period of 275 days (range, 32-677 d).


CONCLUSIONS
When performed in a segmental fashion, (90)Y radioembolization demonstrates high response rates and low local tumor recurrence rates. Complete imaging response can be achieved in patients with locally aggressive disease. This study demonstrates no clinically significant hepatotoxicity, despite moderate liver dysfunction in many patients.
Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119. Electronic address: spadia@uw.edu.
Siddharth A
SA
Padia
Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119.
Sharon W
SW
Kwan
Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119.
Bahman
B
Roudsari
Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119.
Wayne L
WL
Monsky
Department of Radiology, and Department of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195.
Andrew
A
Coveler
Department of Radiology, and Department of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195.
William P
WP
Harris
D000368:Aged; D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes