Survival after (90) Y resin microsphere radioembolization of hepatocellular carcinoma across BCLC stages: A European evaluation
Sangro B, Carpanese L, Cianni R, Golfieri R, Gasparini D, Ezziddin S, Paprottka PM, Fiore F, Van Buskirk M, Bilbao JI, Ettorre GM, Salvatori R, Giampalma E, Geatti O, Wilhelm K, Hoffmann RT, Izzo F, Iñarrairaegui M, Maini CL, Urigo C, Cappelli A, Vit A, Ahmadzadehfar H, Jakobs TF, Lastoria S; on behalf of European Network on Radioembolization with yttrium-90 resin microspheres (ENRY).
A multicenter analysis was conducted to evaluate the main prognostic factors driving survival following radioembolization using (90) Y-labelled resin microspheres in patients with hepatocellular carcinoma (HCC) at 8 European centers. In total, 325 patients received a median activity of 1.6 GBq between September 2003 and December 2009, predominantly as whole-liver (45.2%) or right-lobe (38.5%) infusions.
Typically patients were Child-Pugh class A (82.5%), had underlying cirrhosis (78.5%) and a good Eastern Cooperative Oncology Group (ECOG) performance status (ECOG 0-1; 87.7%) but many had multinodular disease (75.9%) invading both lobes (53.1%) and/or portal vein occlusion (13.5% branch; 9.8% main). Over half were classified by Barcelona Clinic Liver Cancer (BCLC) staging as advanced (BCLC C: 56.3%) and a quarter were intermediate (BCLC B: 26.8%). Median overall survival was 12.8 months (95% CI 10.9-15.7) which varied significantly by disease stage: BCLC A 24.4 months (18.6-38.1), BCLC B 16.9 months (12.8-22.8) and BCLC C 10.0 months (7.7-10.9). Reflecting this, survival varied significantly by ECOG; hepatic function (Child-Pugh class, ascites and baseline total bilirubin); tumor burden (number of nodules, alpha-fetoprotein); and presence of extrahepatic disease.
When considered in the framework of BCLC staging, variables reflecting tumor burden and liver function provided additional prognostic information. The most significant independent prognostic factors for survival upon multivariate analysis were: ECOG, tumor burden (nodules >5), INR >1.2 and extrahepatic disease. Common adverse events were: fatigue, nausea/vomiting and abdominal pain. Grade 3 or higher increases in bilirubin were reported in 5.8% of patients. All-cause mortality was 0.6% and 6.8% at 30 and 90 days, respectively. Conclusion: This analysis provides robust evidence of the survival achieved with radioembolization, including those with advanced disease and few treatment options.
CITATION Hepatology. 2011 May 26. doi: 10.1002/hep.24451