Selective internal radiation therapy for hepatocellular carcinoma: Experience from a hospital in Hong Kong

Abstract

© 2017 Hong Kong College of Radiologists. Purpose: To report the outcomes and prognostic factors of overall survival after selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC). Methods: Consecutive patients who underwent SIRT for HCC at Queen Elizabeth Hospital between December 2006 and February 2016 were retrospectively reviewed. Results: 51 male and 11 female patients aged 42 to 90 (median, 66) years were deemed suitable to receive SIRT. Most were hepatitis B carriers and had an Eastern Cooperative Oncology Group performance score of ≤1 and Child-Pugh class A cirrhosis. About half of the patients had portal vein thrombosis and an alpha-fetoprotein level of > 200 ng/ml. 30.7% of patients were at Barcelona Clinic Liver Cancer stage B and 64.5% at stage C. 50% of tumours were ≥8 cm at the longest diameter. The median dose received by the tumour was 130 Gy. Three months after SIRT, 1.7% had a complete response, 43.3% had a partial response, 26.7% had stable disease, and 28.3% had progressive disease. The 1-year local control rate was 12.3%. The 1-year overall survival was 30.6%. The median time to tumour progression was 3 months and the median overall survival was 6 months. In multivariate analysis, Child-Pugh class, portal vein thrombosis, and post-SIRT intervention were significant prognostic factors for overall survival. Conclusion: SIRT is an effective and safe treatment for intermediate- to advanced-stage HCC. It achieves good local control with minimal toxicity although the outcome is unsatisfactory in terms of new intrahepatic or distant recurrence. HCC patients with Child-Pugh class A cirrhosis, no portal vein thrombosis, and an ability to undergo subsequent treatments have longer survival.