title: Yttrium-90 Glass-Based Microsphere Radioembolization in the Treatment of Hepatocellular Carcinoma Secondary to the Hepatitis B Virus: Safety, Efficacy, and Survival.
abstract: OBJECTIVE
  To evaluate outcomes of yttrium-90 radioembolization performed with glass-based microspheres in the treatment of hepatocellular carcinoma (HCC) secondary to the hepatitis B virus (HBV).
  
  
  METHODS
  A total of 675 patients treated between January 2006 and July 2014 were reviewed, of which 45 (age 62 y ± 10; 91% male) received glass-based radioembolization for HCC secondary to HBV. All patients were stratified according to previous therapy (naive, n = 14; 31.1%), Child-Pugh class (class A, n = 41; 91%), Eastern Cooperative Oncology Group (ECOG) performance status (PS; < 1, n = 21; 47%), solitary (n = 26; 58%) and unilobar (n = 37; 82%) tumor distribution, tumor size < 5 cm (n = 29; 64%), portal vein thrombosis (n = 14; 31%), α-fetoprotein level > 400 ng/mL (n = 17; 38%), and Barcelona Clinic Liver Cancer stage (A, n = 8; B, n = 9; C, n = 28).
  
  
  RESULTS
  A total of 50 radioembolization treatments were performed, with a 100% technical success rate (median target dose, 120 Gy). Clinical toxicities included pain (16%), fatigue (12%), and nausea (4%). Grade 3/4 laboratory toxicities included bilirubin (8%) and aspartate aminotransferase (4%) toxicities. Observed toxicities were independent of treatment dose. The objective response rates were 55% per modified Response Evaluation Criteria In Solid Tumors and 21% per World Health Organization criteria, and the disease control rate was 63%. Disease progression was secondary to new, nontarget HCC in 45% of cases. Median time to progression and overall survival were 6.0 mo (95% confidence interval [CI], 4.4-8.0 mo) and 19.3 mo (95% CI, 11.2-22.7 mo), respectively. Multivariate analysis demonstrated ECOG PS ≥ 1 and AFP level > 400 ng/mL to be independent predictors of inferior overall survival.
  
  
  CONCLUSIONS
  Glass-based radioembolization for HCC secondary to HBV can be safely performed, with favorable target lesion response and overall survival.
authors: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Derek M
authors: DM
authors: Biederman
authors: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Joseph J
authors: JJ
authors: Titano
authors: Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Karen M
authors: KM
authors: Lee
authors: Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Elisa S
authors: ES
authors: Pierobon
authors: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Myron
authors: M
authors: Schwartz
authors: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Marcelo E
authors: ME
authors: Facciuto
authors: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Ganesh
authors: G
authors: Gunasekaran
authors: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Sander
authors: S
authors: Florman
authors: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Aaron M
authors: AM
authors: Fischman
authors: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Rahul S
authors: RS
authors: Patel
authors: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Nora E
authors: NE
authors: Tabori
authors: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.
authors: Francis S
authors: FS
authors: Nowakowski
authors: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl., Box 1234, New York, NY 10029.. Electronic address: kimejoong@yahoo.com.
authors: Edward
authors: E
authors: Kim
mesh_terms: D001918:Brachytherapy / Q000401:mortality; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000532:radiotherapy*; D015984:Causality; D015897:Comorbidity; D005260:Female; D005898:Glass; D006509:Hepatitis B / Q000401:mortality* / Q000532:radiotherapy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes