title: Selective internal radiation therapy compared with sorafenib for hepatocellular carcinoma with portal vein thrombosis.
abstract: OBJECTIVE
  Tumoural portal vein thrombosis (PVT) is a major prognostic factor in hepatocellular carcinoma (HCC). The efficacy of sorafenib, the only treatment approved at an advanced stage, is limited. Based on previous data, selective internal radiation therapy (SIRT), or (90)Y radioembolization, seems an interesting option. We aimed to compare both treatments in this population.
  
  
  METHODS
  We retrospectively compared patients treated in two centres for HCC with tumoural PVT. We compared overall survival (OS) between patients treated with SIRT and patients treated with sorafenib. Analyses were performed before and after 1:1 matching with a propensity score for controlling indication bias, using a Cox proportional hazards model.
  
  
  RESULTS
  A total of 151 patients were analysed, 34 patients treated with SIRT and 117 patients treated with sorafenib only. In the whole population, SIRT was associated with a higher median OS as compared with sorafenib: 18.8 vs 6.5 months (log-rank p < 0.001). There was an imbalance of baseline characteristics between patients treated by SIRT and sorafenib, which justified patient matching with use of a propensity score: 24 patients treated with SIRT could be matched with 24 patients treated with sorafenib. OS was estimated with a median of 26.2 vs 8.7 months in patients treated with SIRT vs sorafenib, respectively (log-rank p = 0.054). Before and after patient matching, the adjusted hazard ratio related to treatment by SIRT was estimated at 0.62 [95 % confidence interval (CI) 0.39-0.97] (p = 0.037) and 0.40 (95 % CI 0.19-0.82) (p = 0.013), respectively.
  
  
  CONCLUSIONS
  SIRT seems more effective than sorafenib in patients presenting with HCC and tumoural PVT. This hypothesis is being tested in prospective randomized trials.
authors.affiliation: Medical Oncology Department, Centre Eugene Marquis, av Bataille Flandres-Dunkerque, 35043, Rennes, France. j.edeline@rennes.unicancer.fr.|Inserm UMR991, Rennes, France. j.edeline@rennes.unicancer.fr.
authors.forename: Julien
authors.identifier: http://orcid.org/0000-0002-8289-7741
authors.initials: J
authors.lastname: Edeline
authors.affiliation: Medical Oncology Department, Centre Eugene Marquis, av Bataille Flandres-Dunkerque, 35043, Rennes, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Crouzet
authors.affiliation: Clinical Research Department, Centre Eugene Marquis, Rennes, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Campillo-Gimenez
authors.affiliation: Imaging Department, Centre Eugene Marquis, Rennes, France.
authors.forename: Yan
authors.initials: Y
authors.lastname: Rolland
authors.affiliation: Medical Oncology Department, Centre Eugene Marquis, av Bataille Flandres-Dunkerque, 35043, Rennes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Pracht
authors.affiliation: Hepatology Department, CHU Pontchaillou, Rennes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Guillygomarc'h
authors.affiliation: Hepatobiliary Surgery, CHU Pontchaillou, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
authors.affiliation: Nuclear Medicine Department, Centre Eugene Marquis, Rennes, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Lenoir
authors.affiliation: Hepato-Gastroenterology Department, Hôpital Saint-Joseph, Marseille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Adhoute
authors.affiliation: Imaging Department, Centre Eugene Marquis, Rennes, France.
authors.forename: Tanguy
authors.initials: T
authors.lastname: Rohou
authors.affiliation: Medical Oncology Department, Centre Eugene Marquis, av Bataille Flandres-Dunkerque, 35043, Rennes, France.
authors.forename: Eveline
authors.initials: E
authors.lastname: Boucher
authors.affiliation: Inserm UMR991, Rennes, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Clément
authors.affiliation: Hepato-Gastroenterology Department, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Blanc
authors.affiliation: Inserm UMR991, Rennes, France.|Nuclear Medicine Department, Centre Eugene Marquis, Rennes, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Garin
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D011169:Portal Vein / Q000473:pathology; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D000077157:Sorafenib; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy*; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D009536:Niacinamide; D000077157:Sorafenib
keywords: Boosted SIRT; Intra-arterial treatment; Liver-directed therapy; Radioembolization; Targeted therapy; Vascular invasion