title: Segmental Yttrium-90 Radioembolization versus Segmental Chemoembolization for Localized Hepatocellular Carcinoma: Results of a Single-Center, Retrospective, Propensity Score-Matched Study.
abstract: OBJECTIVE
  To compare segmental radioembolization with segmental chemoembolization for localized, unresectable hepatocellular carcinoma (HCC) not amenable to ablation.
  
  
  METHODS
  In a single-center, retrospective study (2010-2015), 101 patients with 132 tumors underwent segmental radioembolization, and 77 patients with 103 tumors underwent segmental doxorubicin-based drug-eluting embolic or conventional chemoembolization. Patients receiving chemoembolization had worse performance status (Eastern Cooperative Oncology Group 0, 76% vs 56%; P = .003) and Child-Pugh class (class A, 65% vs 52%; P = .053); patients receiving radioembolization had larger tumors (32 mm vs 26 mm; P < .001), more infiltrative tumors (23% vs 9%; P = .01), and more vascular invasion (18% vs 1%; P < .001). Toxicity, tumor response, tumor progression, and survival were compared. Analyses were weighted using a propensity score (PS).
  
  
  RESULTS
  Toxicity rates were low, without significant differences. Index and overall complete response rates were 92% and 84% for radioembolization and 74% and 58% for chemoembolization (P = .001 and P < .001). Index tumor progression at 1 and 2 years was 8% and 15% in the radioembolization group and 30% and 42% in the chemoembolization group (P < .001). Median progression-free and overall survival were 564 days and 1,198 days in the radioembolization group and 271 days and 1,043 days in the chemoembolization group (PS-adjusted P = .002 and P = .35; censored by transplant PS-adjusted P < .001 and P = .064).
  
  
  CONCLUSIONS
  Segmental radioembolization demonstrates higher complete response rates and local tumor control compared with segmental chemoembolization for HCC, with similar toxicity profiles. Superior progression-free survival was achieved.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles, 757 Westwood Plaza, Room 2125, Los Angeles, CA, 90095. Electronic address: spadia@gmail.com.
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Padia
authors.affiliation: Section of Interventional Radiology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Johnson
authors.affiliation: Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Horton
authors.affiliation: Section of Interventional Radiology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Ingraham
authors.affiliation: Section of Interventional Radiology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kogut
authors.affiliation: Section of Interventional Radiology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kwan
authors.affiliation: Section of Interventional Radiology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vaidya
authors.affiliation: Section of Interventional Radiology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Monsky
authors.affiliation: Division of Hepatobiliary Surgery, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: James O
authors.initials: JO
authors.lastname: Park
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Renuka
authors.initials: R
authors.lastname: Bhattacharya
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.affiliation: Division of Oncology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: William P
authors.initials: WP
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D057216:Propensity Score; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D004317:Doxorubicin