title: Is radioembolization ((90)Y) better than doxorubicin drug eluting beads (DEBDOX) for hepatocellular carcinoma with portal vein thrombosis? A retrospective analysis.
abstract: BACKGROUND
  This study compares radioembolization ((90)Y) versus doxorubicin drug eluting beads (DEBDOX) in the treatment of unresectable hepatocellular carcinoma with portal vein thrombosis.
  
  
  METHODS
  Using our prospectively maintained, multi-center, non-controlled intra-arterial therapy registry, we identified 28 consecutive patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT) treated with DEBDOX and 20 with (90)Y. Follow-up protocol consisted of a 3-phase CT scan of the liver within 3 months post-treatment. Tumor response rates were measured according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria.
  
  
  RESULTS
  There were 65 and 29 treatments in the DEBDOX and (90)Y groups respectively. Median age of DEBDOX was 59.8 (35-81) and (90)Y was 66.5 (49-82) years. A defined number of lesions were seen in 78% DEBDOX and 50% (90)Y patients. Patients were similar in the remaining 8 baseline characteristics including performance status, Child Pugh and extent of PVT. There were fewer overall side effects in the DEBDOX group compared to the (90)Y group (11% vs 39%; P = 0.03). There was better disease control (mRECIST) in the DEBDOX group compared to the (90)Y group (67% vs 20%; P = 0.0014). Median survival times were 10 months in DEBDOX and 3 months in the (90)Y group respectively from first treatment (log-rank, P = 0.037).
  
  
  CONCLUSIONS
  DEBDOX is safe for patients with HCC and PVT and may have lower toxicity than (90)Y. It may also provide better disease control and survival benefit. Further studies are warranted to validate our observations and to determine if current clinical practice should be altered.
authors.affiliation: Department of Radiology, University of Louisville, United States. Electronic address: okakin01@louisville.edu.
authors.forename: Olaguoke
authors.initials: O
authors.lastname: Akinwande
authors.affiliation: University of Louisville Medical School, United States. Electronic address: d0kim016@louisville.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.affiliation: University of Louisville Medical School, United States. Electronic address: jacob.edwards@louisville.edu.
authors.forename: Jacob
authors.initials: J
authors.lastname: Edwards
authors.affiliation: Department of Surgical Oncology, University of Louisville, United States. Electronic address: Russell.brown@infirmaryhealth.org.
authors.forename: Russell
authors.initials: R
authors.lastname: Brown
authors.affiliation: Department of Surgical Oncology, University of Louisville, United States. Electronic address: prejesh.philips@louisville.edu.
authors.forename: Prejesh
authors.initials: P
authors.lastname: Philips
authors.affiliation: Department of Surgical Oncology, University of Louisville, United States. Electronic address: charles.scoggins@louisville.edu.
authors.forename: Charles
authors.initials: C
authors.lastname: Scoggins
authors.affiliation: Department of Surgical Oncology, University of Louisville, United States. Electronic address: Robert.Martin@louisville.edu.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D004317:Doxorubicin / Q000627:therapeutic use*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D020246:Venous Thrombosis / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D015021:Yttrium Radioisotopes
chemical_list: D000903:Antibiotics, Antineoplastic; D015021:Yttrium Radioisotopes; D004317:Doxorubicin
keywords: Comparative; DEBTACE; Efficacy; RECIST; Toxicity