Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma

Riad Salem*, Robert J. Lewandowski, Laura Kulik, Edward Wang, Ahsun Riaz, Robert K. Ryu, Kent T. Sato, Ramona Gupta, Paul Nikolaidis, Frank H. Miller, Vahid Yaghmai, Saad M. Ibrahim, Seanthan Senthilnathan, Talia Baker, Vanessa L. Gates, Bassel Atassi, Steven Newman, Khairuddin Memon, Richard Chen, Robert L. VogelzangAlbert A. Nemcek, Scott A. Resnick, Howard B. Chrisman, James Carr, Reed A. Omary, Michael Abecassis, Al B. Benson, Mary F. Mulcahy

*Corresponding author for this work

Research output: Contribution to journalArticle

378 Citations (Scopus)

Abstract

Background & Aims Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. Methods We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed. Results Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42). Conclusions Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.

Original languageEnglish (US)
Pages (from-to)497-507.e2
JournalGastroenterology
Volume140
Issue number2
DOIs
StatePublished - Jan 1 2011

Fingerprint

Hepatocellular Carcinoma
Yttrium
Survival
Therapeutics
Standard of Care
Transaminases
Microspheres
Abdominal Pain
Radiotherapy
Multivariate Analysis
Outcome Assessment (Health Care)
Safety

Keywords

  • Clinical Trial
  • Comparative Effectiveness
  • Liver Cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{cbb7fbb5a0d847218e6d8a345b5cbf68,
title = "Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma",
abstract = "Background & Aims Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. Methods We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed. Results Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49{\%} vs 36{\%}, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42). Conclusions Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.",
keywords = "Clinical Trial, Comparative Effectiveness, Liver Cancer, Radiotherapy",
author = "Riad Salem and Lewandowski, {Robert J.} and Laura Kulik and Edward Wang and Ahsun Riaz and Ryu, {Robert K.} and Sato, {Kent T.} and Ramona Gupta and Paul Nikolaidis and Miller, {Frank H.} and Vahid Yaghmai and Ibrahim, {Saad M.} and Seanthan Senthilnathan and Talia Baker and Gates, {Vanessa L.} and Bassel Atassi and Steven Newman and Khairuddin Memon and Richard Chen and Vogelzang, {Robert L.} and Nemcek, {Albert A.} and Resnick, {Scott A.} and Chrisman, {Howard B.} and James Carr and Omary, {Reed A.} and Michael Abecassis and Benson, {Al B.} and Mulcahy, {Mary F.}",
year = "2011",
month = "1",
day = "1",
doi = "10.1053/j.gastro.2010.10.049",
language = "English (US)",
volume = "140",
pages = "497--507.e2",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma

AU - Salem, Riad

AU - Lewandowski, Robert J.

AU - Kulik, Laura

AU - Wang, Edward

AU - Riaz, Ahsun

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Gupta, Ramona

AU - Nikolaidis, Paul

AU - Miller, Frank H.

AU - Yaghmai, Vahid

AU - Ibrahim, Saad M.

AU - Senthilnathan, Seanthan

AU - Baker, Talia

AU - Gates, Vanessa L.

AU - Atassi, Bassel

AU - Newman, Steven

AU - Memon, Khairuddin

AU - Chen, Richard

AU - Vogelzang, Robert L.

AU - Nemcek, Albert A.

AU - Resnick, Scott A.

AU - Chrisman, Howard B.

AU - Carr, James

AU - Omary, Reed A.

AU - Abecassis, Michael

AU - Benson, Al B.

AU - Mulcahy, Mary F.

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Background & Aims Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. Methods We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed. Results Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42). Conclusions Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.

AB - Background & Aims Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. Methods We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed. Results Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42). Conclusions Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.

KW - Clinical Trial

KW - Comparative Effectiveness

KW - Liver Cancer

KW - Radiotherapy

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UR - http://www.scopus.com/inward/citedby.url?scp=79251575901&partnerID=8YFLogxK

U2 - 10.1053/j.gastro.2010.10.049

DO - 10.1053/j.gastro.2010.10.049

M3 - Article

C2 - 21044630

AN - SCOPUS:79251575901

VL - 140

SP - 497-507.e2

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 2

ER -