title: Outcomes of Radioembolization in the Treatment of Hepatocellular Carcinoma with Portal Vein Invasion: Resin versus Glass Microspheres.
abstract: OBJECTIVE
  To compare outcomes of yttrium-90 radioembolization performed with resin-based ((90)Y-resin) and glass-based ((90)Y-glass) microspheres in the treatment of hepatocellular carcinoma (HCC) with associated portal vein invasion.
  
  
  METHODS
  A single-center retrospective review (January 2005-September 2014) identified 90 patients ((90)Y-resin, 21; (90)Y-glass, 69) with HCC and ipsilateral portal vein thrombosis (PVT). Patients were stratified according to age, sex, ethnicity, Child-Pugh class, Eastern Cooperative Oncology Group status, α-fetoprotein > 400 ng/mL, extent of PVT, tumor burden, and sorafenib therapy. Outcome variables included clinical and laboratory toxicities (Common Terminology Criteria Adverse Events, Version 4.03), imaging response (modified Response Evaluation Criteria in Solid Tumors), time to progression (TTP), and overall survival (OS).
  
  
  RESULTS
  Grade 3/4 bilirubin and aspartate aminotransferase toxicities developed at a 2.8-fold (95% confidence interval [CI], 1.3-6.1) and 2.6-fold (95% CI, 1.1-6.1) greater rate in the (90)Y-resin group. The disease control rate was 37.5% in the (90)Y-resin group and 54.5% in the (90)Y-glass group (P = .39). The median (95% CI) TTP was 2.8 (1.9-4.3) months in the (90)Y-resin group and 5.9 (4.2-9.1) months in the (90)Y-glass group (P = .48). Median (95% CI) survival was 3.7 (2.3-6.0) months in the (90)Y-resin group and 9.4 (7.6-15.0) months in the (90)Y-glass group (hazard ratio, 2.6; 95% CI, 1.5-4.3, P < .001). Additional multivariate predictors of improved OS included age < 65 years, Eastern Cooperative Oncology Group status < 1, α-fetoprotein ≤ 400 ng/mL, and unilobar tumor distribution.
  
  
  CONCLUSIONS
  Imaging response of (90)Y treatment in patients with HCC and PVT was not significantly different between (90)Y-glass and (90)Y-resin groups. Lower toxicity and improved OS were observed in the (90)Y-glass group.
authors.affiliation: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Biederman
authors.affiliation: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Titano
authors.affiliation: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Tabori
authors.affiliation: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Elisa S
authors.initials: ES
authors.lastname: Pierobon
authors.affiliation: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Kutaiba
authors.initials: K
authors.lastname: Alshebeeb
authors.affiliation: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Myron
authors.initials: M
authors.lastname: Schwartz
authors.affiliation: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Facciuto
authors.affiliation: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Gunasekaran
authors.affiliation: Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.affiliation: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Fischman
authors.affiliation: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Patel
authors.affiliation: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
authors.forename: Francis S
authors.initials: FS
authors.lastname: Nowakowski
authors.affiliation: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029. Electronic address: kimejoong@yahoo.com.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
mesh_terms: D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005898:Glass; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009519:New York City; D011169:Portal Vein / Q000473:pathology*; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000097:blood / Q000401:mortality / Q000473:pathology*; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D001663:Bilirubin