title: In intermediate stage hepatocellular carcinoma: radioembolization with yttrium 90 or chemoembolization?
abstract: OBJECTIVE
  Transarterial chemoembolization (TACE) is one of the standard treatments recommended for intermediate stage hepatocellular carcinoma (HCC). At the same time, only little is known about the use of radioembolization with Yttrium-90 microspheres (TARE Y-90) for this subset of patients. To perform comparative analysis between both locoregional therapies in intermediate HCCs. Primary endpoint was overall survival (OS), while safety, response rate and time-to-progression (TTP) were considered as secondary endpoints.
  
  
  METHODS
  We collected data of 86 HCC patients in two university hospitals at which conventional TACE with doxorubicin or TARE Y-90 using glass microspheres were performed. The median observation period was 10 months. Patients were followed up for signs of toxicity and response. They underwent imaging analysis at baseline and follow-up at regular time intervals.
  
  
  RESULTS
  Eighty-six HCC patients with intermediate stage B (BCLC) were treated with either TACE (n = 42) or TARE Y-90 (n = 44). Despite a higher tumour burden in the TARE Y-90 group, the median OS (TACE: 18 months vs. TARE Y-90: 16.4 months) and the median TTP (TACE: 6.8 months vs. TARE Y-90: 13.3 months) were not statistically different. The number of treatment sessions, the average rate of treatment sessions per patient, total hospitalization time and rate of adverse events were significantly higher in the TACE cohort.
  
  
  CONCLUSIONS
  In intermediate HCC stage patients, both treatments resulted in similar survival probabilities despite more advanced disease in the TARE Y-90 group. Still, TARE Y-90 was better tolerated and associated with less hospitalization and treatment sessions.
authors.affiliation: Department of Hepatology and Gastroenterology, University Hospital of Essen, Essen, Germany; Tropical Medicine Dep., Ain Shams University Hospital, Cairo, Egypt; Egyptian Atomic Energy Authority, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: El Fouly
authors.forename: Judith
authors.initials: J
authors.lastname: Ertle
authors.forename: Ahmed
authors.initials: A
authors.lastname: El Dorry
authors.forename: Mohamed K
authors.initials: MK
authors.lastname: Shaker
authors.forename: Alexander
authors.initials: A
authors.lastname: Dechêne
authors.forename: Heba
authors.initials: H
authors.lastname: Abdella
authors.forename: Stefan
authors.initials: S
authors.lastname: Mueller
authors.forename: Eman
authors.initials: E
authors.lastname: Barakat
authors.forename: Thomas
authors.initials: T
authors.lastname: Lauenstein
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Joerg F
authors.initials: JF
authors.lastname: Schlaak
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000532:radiotherapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004317:Doxorubicin / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D008863:Microspheres; D011446:Prospective Studies; D015996:Survival Rate; D015019:Yttrium / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D015019:Yttrium; D004317:Doxorubicin
keywords: BCLC Stage B; Chemoembolization; Hepatocellular Carcinoma; Intermediate Stage HCC; Radioembolization; TACE; TARE; Yttrium 90