Radioembolization for Hepatocellular Carcinoma Using Yttrium-90 Microspheres: A Comprehensive Report of Long-term Outcomes

Riad Salem*, Robert J. Lewandowski, Mary F. Mulcahy, Ahsun Riaz, Robert K. Ryu, Saad Ibrahim, Bassel Atassi, Talia Baker, Vanessa Gates, Frank H. Miller, Kent T. Sato, Ed Wang, Ramona Gupta, Al B. Benson, Steven B. Newman, Reed A. Omary, Michael Abecassis, Laura Kulik

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Background & Aims: Hepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following intra-arterial radiation are unknown. We assessed clinical outcomes of patients treated with intra-arterial yttrium-90 microspheres (Y90). Methods: Patients with HCC (n = 291) were treated with Y90 as part of a single-center, prospective, longitudinal cohort study. Toxicities were recorded using the Common Terminology Criteria version 3.0. Response rate and time to progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Univariate/multivariate analyses were performed. Results: A total of 526 treatments were administered (mean, 1.8; range, 1-5). Toxicities included fatigue (57%), pain (23%), and nausea/vomiting (20%); 19% exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3%. Response rates were 42% and 57% based on WHO and EASL criteria, respectively. The overall TTP was 7.9 months (95% confidence interval, 6-10.3). Survival times differed between patients with Child-Pugh A and B disease (A, 17.2 months; B, 7.7 months; P = .002). Patients with Child-Pugh B disease who had portal vein thrombosis (PVT) survived 5.6 months (95% confidence interval, 4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and α-fetoprotein; and WHO/EASL response rate predicted survival. Conclusions: Patients with Child-Pugh A disease, with or without PVT, benefited most from treatment. Patients with Child-Pugh B disease who had PVT had poor outcomes. TTP and overall survival varied by patient stage at baseline. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option for patients with HCC.

Original languageEnglish (US)
Pages (from-to)52-64
Number of pages13
JournalGastroenterology
Volume138
Issue number1
DOIs
StatePublished - Jan 1 2010

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Yttrium
Microspheres
Hepatocellular Carcinoma
Portal Vein
Thrombosis
Bilirubin
Survival
Confidence Intervals
Fetal Proteins
Liver
Portal Hypertension
Therapeutics
Terminology
Nausea
Vomiting
Fatigue
Longitudinal Studies
Albumins
Cohort Studies
Multivariate Analysis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{40ff6920e381411e9a264130176d6588,
title = "Radioembolization for Hepatocellular Carcinoma Using Yttrium-90 Microspheres: A Comprehensive Report of Long-term Outcomes",
abstract = "Background & Aims: Hepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following intra-arterial radiation are unknown. We assessed clinical outcomes of patients treated with intra-arterial yttrium-90 microspheres (Y90). Methods: Patients with HCC (n = 291) were treated with Y90 as part of a single-center, prospective, longitudinal cohort study. Toxicities were recorded using the Common Terminology Criteria version 3.0. Response rate and time to progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Univariate/multivariate analyses were performed. Results: A total of 526 treatments were administered (mean, 1.8; range, 1-5). Toxicities included fatigue (57{\%}), pain (23{\%}), and nausea/vomiting (20{\%}); 19{\%} exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3{\%}. Response rates were 42{\%} and 57{\%} based on WHO and EASL criteria, respectively. The overall TTP was 7.9 months (95{\%} confidence interval, 6-10.3). Survival times differed between patients with Child-Pugh A and B disease (A, 17.2 months; B, 7.7 months; P = .002). Patients with Child-Pugh B disease who had portal vein thrombosis (PVT) survived 5.6 months (95{\%} confidence interval, 4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and α-fetoprotein; and WHO/EASL response rate predicted survival. Conclusions: Patients with Child-Pugh A disease, with or without PVT, benefited most from treatment. Patients with Child-Pugh B disease who had PVT had poor outcomes. TTP and overall survival varied by patient stage at baseline. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option for patients with HCC.",
author = "Riad Salem and Lewandowski, {Robert J.} and Mulcahy, {Mary F.} and Ahsun Riaz and Ryu, {Robert K.} and Saad Ibrahim and Bassel Atassi and Talia Baker and Vanessa Gates and Miller, {Frank H.} and Sato, {Kent T.} and Ed Wang and Ramona Gupta and Benson, {Al B.} and Newman, {Steven B.} and Omary, {Reed A.} and Michael Abecassis and Laura Kulik",
year = "2010",
month = "1",
day = "1",
doi = "10.1053/j.gastro.2009.09.006",
language = "English (US)",
volume = "138",
pages = "52--64",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "1",

}

Radioembolization for Hepatocellular Carcinoma Using Yttrium-90 Microspheres : A Comprehensive Report of Long-term Outcomes. / Salem, Riad; Lewandowski, Robert J.; Mulcahy, Mary F.; Riaz, Ahsun; Ryu, Robert K.; Ibrahim, Saad; Atassi, Bassel; Baker, Talia; Gates, Vanessa; Miller, Frank H.; Sato, Kent T.; Wang, Ed; Gupta, Ramona; Benson, Al B.; Newman, Steven B.; Omary, Reed A.; Abecassis, Michael; Kulik, Laura.

In: Gastroenterology, Vol. 138, No. 1, 01.01.2010, p. 52-64.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radioembolization for Hepatocellular Carcinoma Using Yttrium-90 Microspheres

T2 - A Comprehensive Report of Long-term Outcomes

AU - Salem, Riad

AU - Lewandowski, Robert J.

AU - Mulcahy, Mary F.

AU - Riaz, Ahsun

AU - Ryu, Robert K.

AU - Ibrahim, Saad

AU - Atassi, Bassel

AU - Baker, Talia

AU - Gates, Vanessa

AU - Miller, Frank H.

AU - Sato, Kent T.

AU - Wang, Ed

AU - Gupta, Ramona

AU - Benson, Al B.

AU - Newman, Steven B.

AU - Omary, Reed A.

AU - Abecassis, Michael

AU - Kulik, Laura

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Background & Aims: Hepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following intra-arterial radiation are unknown. We assessed clinical outcomes of patients treated with intra-arterial yttrium-90 microspheres (Y90). Methods: Patients with HCC (n = 291) were treated with Y90 as part of a single-center, prospective, longitudinal cohort study. Toxicities were recorded using the Common Terminology Criteria version 3.0. Response rate and time to progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Univariate/multivariate analyses were performed. Results: A total of 526 treatments were administered (mean, 1.8; range, 1-5). Toxicities included fatigue (57%), pain (23%), and nausea/vomiting (20%); 19% exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3%. Response rates were 42% and 57% based on WHO and EASL criteria, respectively. The overall TTP was 7.9 months (95% confidence interval, 6-10.3). Survival times differed between patients with Child-Pugh A and B disease (A, 17.2 months; B, 7.7 months; P = .002). Patients with Child-Pugh B disease who had portal vein thrombosis (PVT) survived 5.6 months (95% confidence interval, 4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and α-fetoprotein; and WHO/EASL response rate predicted survival. Conclusions: Patients with Child-Pugh A disease, with or without PVT, benefited most from treatment. Patients with Child-Pugh B disease who had PVT had poor outcomes. TTP and overall survival varied by patient stage at baseline. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option for patients with HCC.

AB - Background & Aims: Hepatocellular carcinoma (HCC) has limited treatment options; long-term outcomes following intra-arterial radiation are unknown. We assessed clinical outcomes of patients treated with intra-arterial yttrium-90 microspheres (Y90). Methods: Patients with HCC (n = 291) were treated with Y90 as part of a single-center, prospective, longitudinal cohort study. Toxicities were recorded using the Common Terminology Criteria version 3.0. Response rate and time to progression (TTP) were determined using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival by stage was assessed. Univariate/multivariate analyses were performed. Results: A total of 526 treatments were administered (mean, 1.8; range, 1-5). Toxicities included fatigue (57%), pain (23%), and nausea/vomiting (20%); 19% exhibited grade 3/4 bilirubin toxicity. The 30-day mortality rate was 3%. Response rates were 42% and 57% based on WHO and EASL criteria, respectively. The overall TTP was 7.9 months (95% confidence interval, 6-10.3). Survival times differed between patients with Child-Pugh A and B disease (A, 17.2 months; B, 7.7 months; P = .002). Patients with Child-Pugh B disease who had portal vein thrombosis (PVT) survived 5.6 months (95% confidence interval, 4.5-6.7). Baseline age; sex; performance status; presence of portal hypertension; tumor distribution; levels of bilirubin, albumin, and α-fetoprotein; and WHO/EASL response rate predicted survival. Conclusions: Patients with Child-Pugh A disease, with or without PVT, benefited most from treatment. Patients with Child-Pugh B disease who had PVT had poor outcomes. TTP and overall survival varied by patient stage at baseline. These data can be used to design future Y90 trials and to describe Y90 as a potential treatment option for patients with HCC.

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DO - 10.1053/j.gastro.2009.09.006

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