A comparative analysis of transarterial downstaging for hepatocellular carcinoma: Chemoembolization versus radioembolization

R. J. Lewandowski, L. M. Kulik, A. Riaz, S. Senthilnathan, M. F. Mulcahy, R. K. Ryu, S. M. Ibrahim, K. T. Sato, T. Baker, F. H. Miller, R. Omary, M. Abecassis, R. Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

331 Citations (Scopus)

Abstract

Chemoembolization and other ablative therapies are routinely utilized in downstaging from United Network for Organ Sharing (UNOS) T3 to T2, thus potentially making patients transplant candidates under the UNOS model for end-stage liver disease (MELD) upgrade for hepatocellular carcinoma (HCC). This study was undertaken to compare the downstaging efficacy of transarterial chemoembolization (TACE) versus transarterial radioembolization. Eighty-six patients were treated with either TACE (n = 43) or transarterial radioembolization with Yttrium-90 microspheres (TARE-Y90; n = 43). Median tumor size was similar (TACE: 5.7 cm, TARE-Y90: 5.6 cm). Partial response rates favored TARE-Y90 versus TACE (61% vs. 37%). Downstaging to UNOS T2 was achieved in 31% of TACE and 58% of TARE-Y90 patients. Time to progression according to UNOS criteria was similar for both groups (18.2 months for TACE vs. 33.3 months for TARE-Y90, p = 0.098). Event-free survival was significantly greater for TARE-Y90 than TACE (17.7 vs. 7.1 months, p = 0.0017). Overall survival favored TARE-Y90 compared to TACE (censored 35.7/18.7 months; p = 0.18; uncensored 41.6/19.2 months; p = 0.008). In conclusion, TARE-Y90 appears to outperform TACE for downstaging HCC from UNOS T3 to T2.

Original languageEnglish (US)
Pages (from-to)1920-1928
Number of pages9
JournalAmerican Journal of Transplantation
Volume9
Issue number8
DOIs
StatePublished - Aug 1 2009

Fingerprint

Hepatocellular Carcinoma
Yttrium
End Stage Liver Disease
Microspheres
Disease-Free Survival
Transplants
Survival
Neoplasms
Therapeutics

Keywords

  • Chemoembolization
  • Downstaging
  • Hepatocellular carcinoma
  • Radioembolization
  • Yttrium-90 microspheres

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

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title = "A comparative analysis of transarterial downstaging for hepatocellular carcinoma: Chemoembolization versus radioembolization",
abstract = "Chemoembolization and other ablative therapies are routinely utilized in downstaging from United Network for Organ Sharing (UNOS) T3 to T2, thus potentially making patients transplant candidates under the UNOS model for end-stage liver disease (MELD) upgrade for hepatocellular carcinoma (HCC). This study was undertaken to compare the downstaging efficacy of transarterial chemoembolization (TACE) versus transarterial radioembolization. Eighty-six patients were treated with either TACE (n = 43) or transarterial radioembolization with Yttrium-90 microspheres (TARE-Y90; n = 43). Median tumor size was similar (TACE: 5.7 cm, TARE-Y90: 5.6 cm). Partial response rates favored TARE-Y90 versus TACE (61{\%} vs. 37{\%}). Downstaging to UNOS T2 was achieved in 31{\%} of TACE and 58{\%} of TARE-Y90 patients. Time to progression according to UNOS criteria was similar for both groups (18.2 months for TACE vs. 33.3 months for TARE-Y90, p = 0.098). Event-free survival was significantly greater for TARE-Y90 than TACE (17.7 vs. 7.1 months, p = 0.0017). Overall survival favored TARE-Y90 compared to TACE (censored 35.7/18.7 months; p = 0.18; uncensored 41.6/19.2 months; p = 0.008). In conclusion, TARE-Y90 appears to outperform TACE for downstaging HCC from UNOS T3 to T2.",
keywords = "Chemoembolization, Downstaging, Hepatocellular carcinoma, Radioembolization, Yttrium-90 microspheres",
author = "Lewandowski, {R. J.} and Kulik, {L. M.} and A. Riaz and S. Senthilnathan and Mulcahy, {M. F.} and Ryu, {R. K.} and Ibrahim, {S. M.} and Sato, {K. T.} and T. Baker and Miller, {F. H.} and R. Omary and M. Abecassis and R. Salem",
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T1 - A comparative analysis of transarterial downstaging for hepatocellular carcinoma

T2 - Chemoembolization versus radioembolization

AU - Lewandowski, R. J.

AU - Kulik, L. M.

AU - Riaz, A.

AU - Senthilnathan, S.

AU - Mulcahy, M. F.

AU - Ryu, R. K.

AU - Ibrahim, S. M.

AU - Sato, K. T.

AU - Baker, T.

AU - Miller, F. H.

AU - Omary, R.

AU - Abecassis, M.

AU - Salem, R.

PY - 2009/8/1

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N2 - Chemoembolization and other ablative therapies are routinely utilized in downstaging from United Network for Organ Sharing (UNOS) T3 to T2, thus potentially making patients transplant candidates under the UNOS model for end-stage liver disease (MELD) upgrade for hepatocellular carcinoma (HCC). This study was undertaken to compare the downstaging efficacy of transarterial chemoembolization (TACE) versus transarterial radioembolization. Eighty-six patients were treated with either TACE (n = 43) or transarterial radioembolization with Yttrium-90 microspheres (TARE-Y90; n = 43). Median tumor size was similar (TACE: 5.7 cm, TARE-Y90: 5.6 cm). Partial response rates favored TARE-Y90 versus TACE (61% vs. 37%). Downstaging to UNOS T2 was achieved in 31% of TACE and 58% of TARE-Y90 patients. Time to progression according to UNOS criteria was similar for both groups (18.2 months for TACE vs. 33.3 months for TARE-Y90, p = 0.098). Event-free survival was significantly greater for TARE-Y90 than TACE (17.7 vs. 7.1 months, p = 0.0017). Overall survival favored TARE-Y90 compared to TACE (censored 35.7/18.7 months; p = 0.18; uncensored 41.6/19.2 months; p = 0.008). In conclusion, TARE-Y90 appears to outperform TACE for downstaging HCC from UNOS T3 to T2.

AB - Chemoembolization and other ablative therapies are routinely utilized in downstaging from United Network for Organ Sharing (UNOS) T3 to T2, thus potentially making patients transplant candidates under the UNOS model for end-stage liver disease (MELD) upgrade for hepatocellular carcinoma (HCC). This study was undertaken to compare the downstaging efficacy of transarterial chemoembolization (TACE) versus transarterial radioembolization. Eighty-six patients were treated with either TACE (n = 43) or transarterial radioembolization with Yttrium-90 microspheres (TARE-Y90; n = 43). Median tumor size was similar (TACE: 5.7 cm, TARE-Y90: 5.6 cm). Partial response rates favored TARE-Y90 versus TACE (61% vs. 37%). Downstaging to UNOS T2 was achieved in 31% of TACE and 58% of TARE-Y90 patients. Time to progression according to UNOS criteria was similar for both groups (18.2 months for TACE vs. 33.3 months for TARE-Y90, p = 0.098). Event-free survival was significantly greater for TARE-Y90 than TACE (17.7 vs. 7.1 months, p = 0.0017). Overall survival favored TARE-Y90 compared to TACE (censored 35.7/18.7 months; p = 0.18; uncensored 41.6/19.2 months; p = 0.008). In conclusion, TARE-Y90 appears to outperform TACE for downstaging HCC from UNOS T3 to T2.

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