Radioembolization for hepatocellular carcinoma with portal vein thrombosis: Impact of liver function on systemic treatment options at disease progression

Khairuddin Memon, Laura Kulik, Robert J. Lewandowski, Mary F. Mulcahy, Al B. Benson, Daniel Ganger, Ahsun Riaz, Ramona Gupta, Michael Vouche, Vanessa L. Gates, Frank H. Miller, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

75 Scopus citations

Abstract

Background & Aims: Yttrium-90 (90Y) radioembolization is a microembolic procedure. Hence, it is commonly used in hepatocellular carcinoma (HCC) patients with portal venous thrombosis (PVT). We analyzed liver function, imaging findings, and treatment options (local/systemic) at disease progression following 90Y treatment in HCC patients with PVT. Methods: We treated 291 HCC patients with 90Y radioembolization. From this cohort, we included patients with liver-only disease, PVT and Child-Pugh (CP) score ≤7; this identified 63 patients with HCC and PVT (CP-A:35, CP-B7:27). Liver function, CP status, and imaging findings at progression were determined in order to assess potential candidacy for systemic treatment/clinical trials. Survival, time-to-progression (TTP), and time-to-hepatic decompensation analyses were performed using Kaplan-Meier methodology. Results: Of 35 CP-A and 28 CP-B7 patients, 29 and 15 progressed, respectively. Median survival and TTP were 13.8 and 5.6 months in CP-A and 6.5 and 4.9 months in CP-B7 patients, respectively. Of the 29 CP-A patients who progressed, 45% maintained their CP status at progression (55% decompensated to CP-B). Of the 15 CP-B7 patients who progressed, 20% improved to CP-A, 20% maintained their CP score and 60% decompensated. Conclusions: Knowledge of liver function and CP score of HCC with PVT progressing after 90Y is critically relevant information, as these patients may be considered for systemic therapy/clinical trials. If a strict CP-A status is mandated, our study demonstrated that 64% of cases exhibited inadequate liver function and were ineligible for systemic therapy/clinical trials. An adjuvant approach using local therapy and systemic agents prior to progression should be investigated.

Original languageEnglish (US)
Pages (from-to)73-80
Number of pages8
JournalJournal of Hepatology
Volume58
Issue number1
DOIs
StatePublished - Jan 1 2013

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Keywords

  • Hepatocellular carcinoma
  • Liver function
  • Portal venous thrombosis
  • Progressive disease
  • Yttrium-90

ASJC Scopus subject areas

  • Hepatology

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