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 language | English (US) |
|---|---|
| Pages (from-to) | 497-507.e2 |
| Journal | Gastroenterology |
| Volume | 140 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2011 |
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Keywords
- Clinical Trial
- Comparative Effectiveness
- Liver Cancer
- Radiotherapy
ASJC Scopus subject areas
- Hepatology
- Gastroenterology
Cite this
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Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. / Salem, Riad; Lewandowski, Robert J.; Kulik, Laura; Wang, Edward; Riaz, Ahsun; Ryu, Robert K.; Sato, Kent T.; Gupta, Ramona; Nikolaidis, Paul; Miller, Frank H.; Yaghmai, Vahid; Ibrahim, Saad M.; Senthilnathan, Seanthan; Baker, Talia; Gates, Vanessa L.; Atassi, Bassel; Newman, Steven; Memon, Khairuddin; Chen, Richard; Vogelzang, Robert L.; Nemcek, Albert A.; Resnick, Scott A.; Chrisman, Howard B.; Carr, James; Omary, Reed A.; Abecassis, Michael; Benson, Al B.; Mulcahy, Mary F.
In: Gastroenterology, Vol. 140, No. 2, 02.2011, p. 497-507.e2.Research output: Contribution to journal › Article
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 - 2011/2
Y1 - 2011/2
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
UR - http://www.scopus.com/inward/record.url?scp=79251575901&partnerID=8YFLogxK
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 -