Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000-patient 15-year experience

Riad Salem, Ahmed Gabr, Ahsun Riaz, Ronald Mora, Rehan Ali, Michael Abecassis, Ryan Hickey, Laura Kulik, Daniel Ganger, Steven Flamm, Rohi Atassi, Bassel Atassi, Kent Sato, Al B. Benson, Mary F. Mulcahy, Nadine Abouchaleh, Ali Al Asadi, Kush Desai, Bartley Thornburg, Michael Vouche & 7 others Ali Habib, Juan Caicedo, Frank H. Miller, Vahid Yaghmai, Joseph R. Kallini, Samdeep Mouli, Robert J. Lewandowski

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Abstract

Yttrium-90 transarterial radioembolization (TARE) is a locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival (OS) outcomes in a 1,000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1,000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS), and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline. OS outcomes were reported using censoring and intention-to-treat methodologies. All treatments were outpatient, with a median one treatment per patient. Five hundred six (51%) were CP A, 450 (45%) CP B, and 44 (4%) CP C. Two hundred sixty-three (26%) patients were BCLC A, 152 (15%) B, 541 (54%) C, and 44 (4%) D. Three hundred sixty-eight (37%) were UNOS T1/T2, 169 (17%) T3, 147 (15%) T4a, 223 (22%) T4b, and 93 (9%) N/M. In CP A patients, censored OS for BCLC A was 47.3 (confidence interval [CI], 39.5-80.3) months, BCLC B 25.0 (CI, 17.3-30.5) months, and BCLC C 15.0 (CI, 13.8-17.7) months. In CP B patients, censored OS for BCLC A was 27 (CI, 21-30.2) months, BCLC B 15.0 (CI, 12.3-19.0) months, and BCLC C 8.0 (CI, 6.8-9.5) months. Forty-nine (5%) and 110 (11%) patients developed grade 3/4 albumin and bilirubin toxicities, respectively. Conclusion: Based on our experience with 1,000 patients over 15 years, we have made a decision to adopt TARE as the first-line transarterial LRT for patients with HCC. Our decision was informed by prospective data and incrementally reported demonstrating outcomes stratified by BCLC, applied as either neoadjuvant or definitive treatment. (Hepatology 2017).

Original languageEnglish (US)
Pages (from-to)1429-1440
Number of pages12
JournalHepatology
Volume68
Issue number4
DOIs
StatePublished - Oct 1 2018

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Liver Neoplasms
Hepatocellular Carcinoma
Confidence Intervals
Survival
Therapeutics
Bilirubin
Albumins
Yttrium
Neoplasm Staging
Gastroenterology
Cohort Studies
Outpatients
Prospective Studies

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{aa9fcd9ea06f4902ab97126c00ddad22,
title = "Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000-patient 15-year experience",
abstract = "Yttrium-90 transarterial radioembolization (TARE) is a locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival (OS) outcomes in a 1,000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1,000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS), and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline. OS outcomes were reported using censoring and intention-to-treat methodologies. All treatments were outpatient, with a median one treatment per patient. Five hundred six (51{\%}) were CP A, 450 (45{\%}) CP B, and 44 (4{\%}) CP C. Two hundred sixty-three (26{\%}) patients were BCLC A, 152 (15{\%}) B, 541 (54{\%}) C, and 44 (4{\%}) D. Three hundred sixty-eight (37{\%}) were UNOS T1/T2, 169 (17{\%}) T3, 147 (15{\%}) T4a, 223 (22{\%}) T4b, and 93 (9{\%}) N/M. In CP A patients, censored OS for BCLC A was 47.3 (confidence interval [CI], 39.5-80.3) months, BCLC B 25.0 (CI, 17.3-30.5) months, and BCLC C 15.0 (CI, 13.8-17.7) months. In CP B patients, censored OS for BCLC A was 27 (CI, 21-30.2) months, BCLC B 15.0 (CI, 12.3-19.0) months, and BCLC C 8.0 (CI, 6.8-9.5) months. Forty-nine (5{\%}) and 110 (11{\%}) patients developed grade 3/4 albumin and bilirubin toxicities, respectively. Conclusion: Based on our experience with 1,000 patients over 15 years, we have made a decision to adopt TARE as the first-line transarterial LRT for patients with HCC. Our decision was informed by prospective data and incrementally reported demonstrating outcomes stratified by BCLC, applied as either neoadjuvant or definitive treatment. (Hepatology 2017).",
author = "Riad Salem and Ahmed Gabr and Ahsun Riaz and Ronald Mora and Rehan Ali and Michael Abecassis and Ryan Hickey and Laura Kulik and Daniel Ganger and Steven Flamm and Rohi Atassi and Bassel Atassi and Kent Sato and Benson, {Al B.} and Mulcahy, {Mary F.} and Nadine Abouchaleh and Asadi, {Ali Al} and Kush Desai and Bartley Thornburg and Michael Vouche and Ali Habib and Juan Caicedo and Miller, {Frank H.} and Vahid Yaghmai and Kallini, {Joseph R.} and Samdeep Mouli and Lewandowski, {Robert J.}",
year = "2018",
month = "10",
day = "1",
doi = "10.1002/hep.29691",
language = "English (US)",
volume = "68",
pages = "1429--1440",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Ltd",
number = "4",

}

Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000-patient 15-year experience. / Salem, Riad; Gabr, Ahmed; Riaz, Ahsun; Mora, Ronald; Ali, Rehan; Abecassis, Michael; Hickey, Ryan; Kulik, Laura; Ganger, Daniel; Flamm, Steven; Atassi, Rohi; Atassi, Bassel; Sato, Kent; Benson, Al B.; Mulcahy, Mary F.; Abouchaleh, Nadine; Asadi, Ali Al; Desai, Kush; Thornburg, Bartley; Vouche, Michael; Habib, Ali; Caicedo, Juan; Miller, Frank H.; Yaghmai, Vahid; Kallini, Joseph R.; Mouli, Samdeep; Lewandowski, Robert J.

In: Hepatology, Vol. 68, No. 4, 01.10.2018, p. 1429-1440.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000-patient 15-year experience

AU - Salem, Riad

AU - Gabr, Ahmed

AU - Riaz, Ahsun

AU - Mora, Ronald

AU - Ali, Rehan

AU - Abecassis, Michael

AU - Hickey, Ryan

AU - Kulik, Laura

AU - Ganger, Daniel

AU - Flamm, Steven

AU - Atassi, Rohi

AU - Atassi, Bassel

AU - Sato, Kent

AU - Benson, Al B.

AU - Mulcahy, Mary F.

AU - Abouchaleh, Nadine

AU - Asadi, Ali Al

AU - Desai, Kush

AU - Thornburg, Bartley

AU - Vouche, Michael

AU - Habib, Ali

AU - Caicedo, Juan

AU - Miller, Frank H.

AU - Yaghmai, Vahid

AU - Kallini, Joseph R.

AU - Mouli, Samdeep

AU - Lewandowski, Robert J.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Yttrium-90 transarterial radioembolization (TARE) is a locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival (OS) outcomes in a 1,000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1,000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS), and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline. OS outcomes were reported using censoring and intention-to-treat methodologies. All treatments were outpatient, with a median one treatment per patient. Five hundred six (51%) were CP A, 450 (45%) CP B, and 44 (4%) CP C. Two hundred sixty-three (26%) patients were BCLC A, 152 (15%) B, 541 (54%) C, and 44 (4%) D. Three hundred sixty-eight (37%) were UNOS T1/T2, 169 (17%) T3, 147 (15%) T4a, 223 (22%) T4b, and 93 (9%) N/M. In CP A patients, censored OS for BCLC A was 47.3 (confidence interval [CI], 39.5-80.3) months, BCLC B 25.0 (CI, 17.3-30.5) months, and BCLC C 15.0 (CI, 13.8-17.7) months. In CP B patients, censored OS for BCLC A was 27 (CI, 21-30.2) months, BCLC B 15.0 (CI, 12.3-19.0) months, and BCLC C 8.0 (CI, 6.8-9.5) months. Forty-nine (5%) and 110 (11%) patients developed grade 3/4 albumin and bilirubin toxicities, respectively. Conclusion: Based on our experience with 1,000 patients over 15 years, we have made a decision to adopt TARE as the first-line transarterial LRT for patients with HCC. Our decision was informed by prospective data and incrementally reported demonstrating outcomes stratified by BCLC, applied as either neoadjuvant or definitive treatment. (Hepatology 2017).

AB - Yttrium-90 transarterial radioembolization (TARE) is a locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival (OS) outcomes in a 1,000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1,000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS), and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline. OS outcomes were reported using censoring and intention-to-treat methodologies. All treatments were outpatient, with a median one treatment per patient. Five hundred six (51%) were CP A, 450 (45%) CP B, and 44 (4%) CP C. Two hundred sixty-three (26%) patients were BCLC A, 152 (15%) B, 541 (54%) C, and 44 (4%) D. Three hundred sixty-eight (37%) were UNOS T1/T2, 169 (17%) T3, 147 (15%) T4a, 223 (22%) T4b, and 93 (9%) N/M. In CP A patients, censored OS for BCLC A was 47.3 (confidence interval [CI], 39.5-80.3) months, BCLC B 25.0 (CI, 17.3-30.5) months, and BCLC C 15.0 (CI, 13.8-17.7) months. In CP B patients, censored OS for BCLC A was 27 (CI, 21-30.2) months, BCLC B 15.0 (CI, 12.3-19.0) months, and BCLC C 8.0 (CI, 6.8-9.5) months. Forty-nine (5%) and 110 (11%) patients developed grade 3/4 albumin and bilirubin toxicities, respectively. Conclusion: Based on our experience with 1,000 patients over 15 years, we have made a decision to adopt TARE as the first-line transarterial LRT for patients with HCC. Our decision was informed by prospective data and incrementally reported demonstrating outcomes stratified by BCLC, applied as either neoadjuvant or definitive treatment. (Hepatology 2017).

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DO - 10.1002/hep.29691

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