title: Survival and pattern of tumor progression with yttrium-90 microsphere radioembolization in predominantly hepatitis B Asian patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Intra-arterial yttrium-90 ((90)Y) microsphere radioembolization (RE) is an emerging treatment option with good outcomes reported predominantly in hepatitis C Western populations with hepatocellular carcinoma (HCC). We report outcomes in predominantly hepatitis B Asian patients treated with (90)Y-RE focusing on overall survival (OS), time to progression (TTP), tumor response, pattern of tumor recurrence and adverse events. Prognostic factors for survival were also identified.
  
  
  METHODS
  A retrospective cohort study was conducted in a single tertiary institution. All non-trial patients treated with (90)Y-RE at our institution from 1 January 2008 to 30 June 2012 were included.
  
  
  RESULTS
  Data from 103 consecutive patients were analyzed. The majority of patients were Child-Pugh class A (59.2 %) and Barcelona Clinic Liver Cancer (BCLC) stage C (68.9 %). Median OS was 14.4 months (95 % CI 11.0-22.2), which varied by disease stage: Child-Pugh A, 21.7 months; Child-Pugh B, 7.1 months; BCLC B, 23.8 months; BCLC C, 11.8 months. Response and disease control rates by RECIST 1.1 were 21.2 and 59.6 %, respectively, while disease control for index lesions treated with (90)Y-RE was 100 %. Development of new intrahepatic lesions was the main reason for eventual disease progression. Median overall TTP was 5.3 months (95 % CI 4.1-10.0). Pretreatment vascular invasion, low serum albumin and elevated total bilirubin levels predicted poorer survival.
  
  
  CONCLUSIONS
  Survival outcomes in hepatitis B Asian patients treated with (90)Y-RE for HCC are comparable to hepatitis C Western populations. While disease control for lesions treated with (90)Y-RE is excellent, the development of new lesions suggests a role for concomitant systemic therapy.
authors.affiliation: Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore 8 College Road, Singapore, 169857, Singapore.
authors.forename: Andrew Yu-Keat
authors.initials: AY
authors.lastname: Khor
authors.affiliation: Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore.
authors.forename: Ying
authors.initials: Y
authors.lastname: Toh
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore.
authors.forename: John Carson
authors.initials: JC
authors.lastname: Allen
authors.affiliation: Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore.
authors.forename: David Chee-Eng
authors.initials: DC
authors.lastname: Ng
authors.affiliation: Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore.
authors.forename: Yung-Hsiang
authors.initials: YH
authors.lastname: Kao
authors.affiliation: Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore 8 College Road, Singapore, 169857, Singapore.
authors.forename: Guili
authors.initials: G
authors.lastname: Zhu
authors.affiliation: Department of Medical Oncology, National Cancer Centre, Singapore, Singapore.
authors.forename: Su-Pin
authors.initials: SP
authors.lastname: Choo
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Richard Hoau-Gong
authors.initials: RH
authors.lastname: Lo
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Kiang-Hiong
authors.initials: KH
authors.lastname: Tay
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Teo
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Brian Kim-Poh
authors.initials: BK
authors.lastname: Goh
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Mark Christiaan
authors.initials: MC
authors.lastname: Burgmans
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Farah Gillian
authors.initials: FG
authors.lastname: Irani
authors.affiliation: Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore.
authors.forename: Anthony Soon-Whatt
authors.initials: AS
authors.lastname: Goh
authors.affiliation: Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore 8 College Road, Singapore, 169857, Singapore. pierce.chow@duke-nus.edu.sg.|Department of General Surgery, Singapore General Hospital, Singapore, Singapore. pierce.chow@duke-nus.edu.sg.|Department of Surgical Oncology, National Cancer Centre, Singapore, Singapore. pierce.chow@duke-nus.edu.sg.
authors.forename: Pierce Kah-Hoe
authors.initials: PK
authors.lastname: Chow
keywords: Hepatocellular carcinoma; Radioembolization; Yttrium-90