Radioembolization with yttrium-90 microspheres for inoperable advanced hepatocellular carcinoma (HCC)

Abstract

Objective: Inoperable hepatocellular carcinoma (HCC) confers a grave prognosis. Radioembolization with yttrium-90 microspheres as selective internal radiation therapy (SIRT) was shown to a have favorable outcomes for HCC. We reported our series of patients with inoperable advanced HCC treated in a single institution. Materials and methods: Patients with inoperable HCC and evaluable target lesions were evaluated by hepatic angiography and macroalbumin aggregate (MAA) scan for feasibility for SIRT. Dose of yttrium-90 was decided by Body Surface Area (BSA) method with an aim to achieve dose to tumour ³200Gy and dose to normal liver <80Gy. Treatment outcomes including best local response rate, best local disease control rate, best overall objective response, disease control rate, progression-free survival (PFS), overall survival (OS) and toxicity were assessed. Univariate and multivariate analysis were also performed for any prognostic factors for PFS and OS. Results: 48 inoperable advanced HCC patients, majority of whom with tumour size ³8cm or portal vein invasion, were evaluated for SIRT. After pre-treatment hepatic angiography and macroalbumin aggregate (MAA) scan, 26 patients (54.2%) with a mean age of 61.6 years (range 36-84) were considered feasible and treated with SIRT and 24 patients had evaluable lesions for response assessment. Previous treatment for their HCC was performed in 15 patients (62.5%), including 11 patients (45.8%) who had received transarterial chemoembolization (TACE) before. Mean alpha-feto protein (AFP) was 1187.5ng/ml (range 2.0 to 10389.0 ng/ml). Mean radioactivity of yttrium-90 prescribed was 1.43 GBq (range 0.85 to 2.30 GBq). After a median follow up of 13.9 months, the best local response rate was 33.3% and the best local disease control rate was 54.2%. Median local PFS, overall PFS and OS survival was 3.3 months, 3.2 months and 11.6 months respectively. Patients belonging to Pugh-Child Class A enjoyed longer median OS survival (15.0 months) than those belonging to Pugh-Child B (4.3 months, p=0.014). Similarly, patients whose duration of AFP response ³9 months survived longer (median OS 19.9 months) than whose duration of AFP response <9 months (median OS 8.2 months, p=0.001). Four patients (16.7%) developed grade ³3 toxicity including 1 patient who had persistent radiation peptic ulcer requiring gastrectomy. Univariate analysis showed that radioactivity of yttrium-90 prescribed was prognostic of local progression-free survival (p=0.004), whereas portal vein invasion (p=0.018) and radioactivity of yttrium-90 prescribed (p=0.000) were prognostic of overall progression-free survival and radioactivity of yttrium-90 prescribed (p=0.005), portal vein invasion (p=0.021), dose to tumour (p=0.028) was prognostic factors of OS. Multivariate analysis revealed that duration of AFP response (p=0.011) was prognostic of overall progression-free survival and duration of AFP response (p=0.033) and Pugh-Child Class A (p=0.015) were prognostic of OS. Conclusion: SIRT with yttrium-90 microspheres for inoperable HCC patients produced promising treatment response.