title: Radioembolization Versus Chemoembolization (DEBDOX) for the Treatment of Unresectable Hepatocellular Carcinoma: A Propensity Matched Study.
abstract: OBJECTIVE
  Hepatocellular cancer is a rising dilemma. Patients with unresectable disease may benefit from locoregional therapy. The comparative effectiveness of radioembolization and Doxorubicin-Drug-Eluting-Beads (DEBDOX) has not been established to date. We compared the performance of radioembolization and DEBDOX in the treatment of hepatocellular carcinoma.
  
  
  METHODS
  An analysis of our prospectively managed locoregional therapy (LRT) database was performed. Three hundred and fifty-eight patients were treated with LRT for unresectable HCC, out of which 291 were treated with DEBDOX and 67 with Ytrrium-90 ((90)Y). Comparative toxicity, tumor response, progression-free survival (PFS) and overall survival (OS) were assessed. Propensity score matching was used to reduce treatment-selection bias, producing 48 pairs. Comparative analysis was repeated after propensity matching.
  
  
  RESULTS
  Median age was 67 and 65 years for the DEBDOX and (90)Y groups respectively (p=0.2). Overall survival favored the DEBDOX group (DEBDOX: 15-months, (90)Y: 6-months, p<0.0001). PFS also favored the DEBDOX group (DEBDOX: 15-months, (90)Y: 6-months, p<0.0001). All-grade adverse events were similar in both groups, although slightly favoring the DEBDOX group (DEBDOX 10%, (90)Y 15%, p=0.1). After propensity score matching, again longer OS was seen with the DEBDOX group (DEBDOX 13 months, (90)Y 4 months; p=0.0077). There were also similar all-grade adverse events that slightly favored DEBDOX (DEBDOX 14%, (90)Y 20%, p=0.3). Disease control rate was found to be statistically significant, favoring the DEBDOX group (DEBDOX 72%, (90)Y 48%; p=0.02).
  
  
  CONCLUSIONS
  Our observation suggests that DEBDOX outperforms (90)Y with superior efficacy and survival with a trend towards lower all-grade toxicity.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Johns Hopkins University, Baltimore, MD, U.S.A.
authors.forename: Olaguoke
authors.initials: O
authors.lastname: Akinwande
authors.affiliation: Department of Surgical Oncology, University of Louisville, Louisville, KY, U.S.A.
authors.forename: Prejesh
authors.initials: P
authors.lastname: Philips
authors.affiliation: Department of Surgical Oncology, University of Louisville, Louisville, KY, U.S.A.
authors.forename: Charles
authors.initials: C
authors.lastname: Scoggins
authors.affiliation: Department of Surgical Oncology, University of Louisville, Louisville, KY, U.S.A. Robert.Martin@louisville.edu.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: DEBDOX; DEBTACE; Efficacy; RECIST; Ytrrium-90; chemoembolization; hepatocellular carcinoma; radioembolization; toxicity