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

69 Citations (Scopus)

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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Portal Vein
Disease Progression
Hepatocellular Carcinoma
Thrombosis
Liver
Venous Thrombosis
Therapeutics
Clinical Trials
Yttrium
Survival
Liver Diseases

Keywords

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

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{86bd7aac490d45c991df1ebed500f928,
title = "Radioembolization for hepatocellular carcinoma with portal vein thrombosis: Impact of liver function on systemic treatment options at disease progression",
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.",
keywords = "Hepatocellular carcinoma, Liver function, Portal venous thrombosis, Progressive disease, Yttrium-90",
author = "Khairuddin Memon and Laura Kulik and Lewandowski, {Robert J.} and Mulcahy, {Mary F.} and Benson, {Al B.} and Daniel Ganger and Ahsun Riaz and Ramona Gupta and Michael Vouche and Gates, {Vanessa L.} and Miller, {Frank H.} and Omary, {Reed A.} and Riad Salem",
year = "2013",
month = "1",
day = "1",
doi = "10.1016/j.jhep.2012.09.003",
language = "English (US)",
volume = "58",
pages = "73--80",
journal = "Journal of Hepatology",
issn = "0168-8278",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - Radioembolization for hepatocellular carcinoma with portal vein thrombosis

T2 - Impact of liver function on systemic treatment options at disease progression

AU - Memon, Khairuddin

AU - Kulik, Laura

AU - Lewandowski, Robert J.

AU - Mulcahy, Mary F.

AU - Benson, Al B.

AU - Ganger, Daniel

AU - Riaz, Ahsun

AU - Gupta, Ramona

AU - Vouche, Michael

AU - Gates, Vanessa L.

AU - Miller, Frank H.

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2013/1/1

Y1 - 2013/1/1

N2 - 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.

AB - 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.

KW - Hepatocellular carcinoma

KW - Liver function

KW - Portal venous thrombosis

KW - Progressive disease

KW - Yttrium-90

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U2 - 10.1016/j.jhep.2012.09.003

DO - 10.1016/j.jhep.2012.09.003

M3 - Article

VL - 58

SP - 73

EP - 80

JO - Journal of Hepatology

JF - Journal of Hepatology

SN - 0168-8278

IS - 1

ER -