title: Yttrium-90 resin microspheres as an adjunct to sorafenib in patients with unresectable hepatocellular carcinoma.
abstract: OBJECTIVE
  The safety and efficacy of the combined use of sorafenib and yttrium-90 resin microspheres (Y90 RMS) to treat advanced hepatocellular carcinoma (HCC) is not well established. We determined the incidence of adverse events with this combination therapy in patients with advanced HCC at our institution and analyzed the treatment and survival outcomes.
  
  
  METHODS
  We reviewed the records of 19 patients with Barcelona Clinic Liver Cancer class B or C HCC who underwent treatment with Y90 RMS (for 21 sessions) while receiving full or reduced doses of sorafenib between January 2008 and May 2010. Therapy response was evaluated using Response Evaluation Criteria in Solid Tumors. We evaluated median overall survival (OS) and progression-free survival (PFS) as well as hepatic and extrahepatic disease PFS and incidence of adverse events.
  
  
  RESULTS
  The median patient age was 67 years, and portal or hepatic venous invasion was present in eight patients (42%). Ten patients received reduced doses of sorafenib. The median Y90 radiation activity delivered was 41.2 mCi. The partial response of Response Evaluation Criteria in Solid Tumors was observed in four patients (19%). The median hepatic disease PFS was 7.82 months, extrahepatic disease PFS was 8.94 months, OS was 19.52 months, and PFS was 6.63 months. Ninety days after treatment with Y90 RMS, five patients (26%) had grade II adverse events and four patients (21%) had grade III adverse events.
  
  
  CONCLUSIONS
  OS and PFS outcomes were superior to those observed in prior studies evaluating sorafenib alone in patients with a similar disease status, warranting further study of this treatment combination.
authors: Department of Interventional Radiology.
authors: Armeen
authors: A
authors: Mahvash
authors: Department of Interventional Radiology.
authors: Ravi
authors: R
authors: Murthy
authors: Department of Interventional Radiology.
authors: Bruno C
authors: BC
authors: Odisio
authors: Department of Gastrointestinal Medical Oncology.
authors: Kanwal Pratap
authors: KP
authors: Raghav
authors: Department of Gastrointestinal Medical Oncology.
authors: Lauren
authors: L
authors: Girard
authors: Department of Interventional Radiology.
authors: Sheree
authors: S
authors: Cheung
authors: Department of Pharmacy.
authors: Van
authors: V
authors: Nguyen
authors: Department of Statistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Joe
authors: J
authors: Ensor
authors: Department of Radiology, Saint Louis University Hospital, St Louis, MO.
authors: Sameer
authors: S
authors: Gadani
authors: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Khaled M
authors: KM
authors: Elsayes
authors: Department of Interventional Radiology; Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.
authors: Reham
authors: R
authors: Abdel-Wahab
authors: Department of Interventional Radiology.
authors: Manal
authors: M
authors: Hassan
authors: Department of Interventional Radiology.
authors: Ahmed S
authors: AS
authors: Shalaby
authors: Department of Interventional Radiology.
authors: James C
authors: JC
authors: Yao
authors: Department of Interventional Radiology.
authors: Michael J
authors: MJ
authors: Wallace
authors: Department of Gastrointestinal Medical Oncology.
authors: Ahmed O
authors: AO
authors: Kaseb
keywords: hepatocellular carcinoma; sorafenib; yttrium-90