title: Favorable survival time provided with radioembolization in hepatocellular carcinoma patients with and without portal vein thrombosis.
abstract: OBJECTIVE
  Although some algorithms are defined for the treatment of advanced hepatocellular carcinoma (HCC), the expected survival cannot be prolonged as it is intended. Treatment options for this group of patients are limited. Radioembolization with yttrium-90 (Y-90) microspheres is a new treatment modality, which has also been used in advanced HCC patients. In this study, the authors aimed to assess the efficiency of radioembolization with Y-90 microspheres and evaluate prognostic factors that influence the survival in HCC patients.
  
  
  METHODS
  The authors retrospectively evaluated data of 29 HCC patients who had radioembolization with Y-90 resin or glass microspheres between May 2009 and January 2014. Patient survival was evaluated by using the Kaplan-Meier method. Subgroup comparisons in terms of age, sex, prior treatment status before radioembolization, tumor burden, time between HCC diagnosis and radioembolization, alpha fetoprotein (AFP) level before radioembolization, presence of portal vein thrombosis (PVT), hepatopulmonary shunt ratio, extrahepatic disease burden, multifocality, bilaterality, Eastern Cooperative Oncology Group (ECOG), Child-Pugh, and Barcelona Clinic Liver Cancer (BCLC) status were performed to evaluate prognostic factors that affected survival.
  
  
  RESULTS
  There were 29 HCC patients (mean age: 59.9±12 years) in the patient group. Grade ≤1 and 2 ECOG performance status was present in 19 and 10 patients, respectively. Twenty-six patients were classified as Child A and 3 patients as Child B. According to the BCLC staging system, 18 patients were in stage B and 11 patients were in stage C. PVT was diagnosed in 12 patients. The median follow-up was 15 months. The median overall survival was 17±2.5 months. BCLC disease stage was a significant prognostic variable associated with survival, but other parameters, even the presence of PVT, were found to be not significantly affecting survival.
  
  
  CONCLUSIONS
  Radioembolization provides favorable survival time in advanced HCC patients. Even patients who are not eligible for transarterial chemoembolization due to PVT can have radioembolization without a decrease in the median survival time.
authors.affiliation: 1 Nuclear Medicine Department, Istanbul Medical Faculty, Istanbul University , Istanbul, Turkey .
authors.forename: Zeynep Gozde
authors.initials: ZG
authors.lastname: Ozkan
authors.forename: Arzu
authors.initials: A
authors.lastname: Poyanli
authors.forename: Adem
authors.initials: A
authors.lastname: Ucar
authors.forename: Serkan
authors.initials: S
authors.lastname: Kuyumcu
authors.forename: Filiz
authors.initials: F
authors.lastname: Akyuz
authors.forename: Serkan
authors.initials: S
authors.lastname: Keskin
authors.forename: Sezer
authors.initials: S
authors.lastname: Saglam
authors.forename: Ebru
authors.initials: E
authors.lastname: Yilmaz
authors.forename: Cetin
authors.initials: C
authors.lastname: Karaca
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Turkmen
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D004621:Embolization, Therapeutic / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009367:Neoplasm Staging; D011169:Portal Vein / Q000473:pathology*; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden; D020246:Venous Thrombosis / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D015021:Yttrium Radioisotopes / Q000493:pharmacokinetics*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes
keywords: SIRT; Y-90 microspheres; hepatocellular carcinoma; portal vein thrombosis; radioembolization; selective intraarterial radionuclide therapy