Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis

Laura M. Kulik, Brian I. Carr, Mary F. Mulcahy, Robert J. Lewandowski, Bassel Atassi, Robert K. Ryu, Kent T. Sato, Al Benson, Albert A. Nemcek, Vanessa L. Gates, Michael Abecassis, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

415 Citations (Scopus)

Abstract

This study was undertaken to present data from a phase 2 study in which patients with unresectable hepatocellular carcinoma (HCC) with and without portal vein thrombosis underwent radioembolization widi Yttrium (90Y) microspheres. Patients treated were stratified by Okuda, Child-Pugh, baseline bilirubin, tumor burden, Eastern Cooperative Oncology Group (ECOG), presence of cirrhosis and portal vein thrombosis (PVT) (none, branch, and main). Clinical and biochemical data were obtained at baseline and at 4-week intervals following treatment for up to 6 months. Tumor response was obtained using computed tomography (CT). Patients were followed for survival. One hundred eight patients were treated during the study period. Thirty-seven (34%) patients had PVT, 12 (32%) of which involved the main PV. The cumulative dose for those with and without PVT was 139.7 Gy and 131.9 Gy, respectively. The partial response rate using world Health Organization (WHO) criteria was 42.2%. Using European Association for the Study of the Liver (EASL), the response rate was 70%. Kaplan-Meier survival varied depending on location of PVT and presence of cirrhosis. The adverse event (AE) rates were highest in patients with main PVT and cirrhosis. There were no cases of radiation pneumonitis. Conclusion: The use of minimally embolic 90Y glass microspheres to treat patients with HCC complicated by branch/lobar PVT may be clinically indicated and appears to have a favorable toxicity profile. Further investigation is warranted in patients with main PVT.

Original languageEnglish (US)
Pages (from-to)71-81
Number of pages11
JournalHepatology
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2008

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Portal Vein
Hepatocellular Carcinoma
Thrombosis
Radiotherapy
Safety
Fibrosis
Microspheres
Radiation Pneumonitis
Yttrium
Survival
Tumor Burden
Bilirubin
Glass
Tomography
Neoplasms

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{1fe7ead4070f4595a4aabff476c9606d,
title = "Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis",
abstract = "This study was undertaken to present data from a phase 2 study in which patients with unresectable hepatocellular carcinoma (HCC) with and without portal vein thrombosis underwent radioembolization widi Yttrium (90Y) microspheres. Patients treated were stratified by Okuda, Child-Pugh, baseline bilirubin, tumor burden, Eastern Cooperative Oncology Group (ECOG), presence of cirrhosis and portal vein thrombosis (PVT) (none, branch, and main). Clinical and biochemical data were obtained at baseline and at 4-week intervals following treatment for up to 6 months. Tumor response was obtained using computed tomography (CT). Patients were followed for survival. One hundred eight patients were treated during the study period. Thirty-seven (34{\%}) patients had PVT, 12 (32{\%}) of which involved the main PV. The cumulative dose for those with and without PVT was 139.7 Gy and 131.9 Gy, respectively. The partial response rate using world Health Organization (WHO) criteria was 42.2{\%}. Using European Association for the Study of the Liver (EASL), the response rate was 70{\%}. Kaplan-Meier survival varied depending on location of PVT and presence of cirrhosis. The adverse event (AE) rates were highest in patients with main PVT and cirrhosis. There were no cases of radiation pneumonitis. Conclusion: The use of minimally embolic 90Y glass microspheres to treat patients with HCC complicated by branch/lobar PVT may be clinically indicated and appears to have a favorable toxicity profile. Further investigation is warranted in patients with main PVT.",
author = "Kulik, {Laura M.} and Carr, {Brian I.} and Mulcahy, {Mary F.} and Lewandowski, {Robert J.} and Bassel Atassi and Ryu, {Robert K.} and Sato, {Kent T.} and Al Benson and Nemcek, {Albert A.} and Gates, {Vanessa L.} and Michael Abecassis and Omary, {Reed A.} and Riad Salem",
year = "2008",
month = "1",
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doi = "10.1002/hep.21980",
language = "English (US)",
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Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. / Kulik, Laura M.; Carr, Brian I.; Mulcahy, Mary F.; Lewandowski, Robert J.; Atassi, Bassel; Ryu, Robert K.; Sato, Kent T.; Benson, Al; Nemcek, Albert A.; Gates, Vanessa L.; Abecassis, Michael; Omary, Reed A.; Salem, Riad.

In: Hepatology, Vol. 47, No. 1, 01.01.2008, p. 71-81.

Research output: Contribution to journalArticle

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T1 - Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis

AU - Kulik, Laura M.

AU - Carr, Brian I.

AU - Mulcahy, Mary F.

AU - Lewandowski, Robert J.

AU - Atassi, Bassel

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Benson, Al

AU - Nemcek, Albert A.

AU - Gates, Vanessa L.

AU - Abecassis, Michael

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2008/1/1

Y1 - 2008/1/1

N2 - This study was undertaken to present data from a phase 2 study in which patients with unresectable hepatocellular carcinoma (HCC) with and without portal vein thrombosis underwent radioembolization widi Yttrium (90Y) microspheres. Patients treated were stratified by Okuda, Child-Pugh, baseline bilirubin, tumor burden, Eastern Cooperative Oncology Group (ECOG), presence of cirrhosis and portal vein thrombosis (PVT) (none, branch, and main). Clinical and biochemical data were obtained at baseline and at 4-week intervals following treatment for up to 6 months. Tumor response was obtained using computed tomography (CT). Patients were followed for survival. One hundred eight patients were treated during the study period. Thirty-seven (34%) patients had PVT, 12 (32%) of which involved the main PV. The cumulative dose for those with and without PVT was 139.7 Gy and 131.9 Gy, respectively. The partial response rate using world Health Organization (WHO) criteria was 42.2%. Using European Association for the Study of the Liver (EASL), the response rate was 70%. Kaplan-Meier survival varied depending on location of PVT and presence of cirrhosis. The adverse event (AE) rates were highest in patients with main PVT and cirrhosis. There were no cases of radiation pneumonitis. Conclusion: The use of minimally embolic 90Y glass microspheres to treat patients with HCC complicated by branch/lobar PVT may be clinically indicated and appears to have a favorable toxicity profile. Further investigation is warranted in patients with main PVT.

AB - This study was undertaken to present data from a phase 2 study in which patients with unresectable hepatocellular carcinoma (HCC) with and without portal vein thrombosis underwent radioembolization widi Yttrium (90Y) microspheres. Patients treated were stratified by Okuda, Child-Pugh, baseline bilirubin, tumor burden, Eastern Cooperative Oncology Group (ECOG), presence of cirrhosis and portal vein thrombosis (PVT) (none, branch, and main). Clinical and biochemical data were obtained at baseline and at 4-week intervals following treatment for up to 6 months. Tumor response was obtained using computed tomography (CT). Patients were followed for survival. One hundred eight patients were treated during the study period. Thirty-seven (34%) patients had PVT, 12 (32%) of which involved the main PV. The cumulative dose for those with and without PVT was 139.7 Gy and 131.9 Gy, respectively. The partial response rate using world Health Organization (WHO) criteria was 42.2%. Using European Association for the Study of the Liver (EASL), the response rate was 70%. Kaplan-Meier survival varied depending on location of PVT and presence of cirrhosis. The adverse event (AE) rates were highest in patients with main PVT and cirrhosis. There were no cases of radiation pneumonitis. Conclusion: The use of minimally embolic 90Y glass microspheres to treat patients with HCC complicated by branch/lobar PVT may be clinically indicated and appears to have a favorable toxicity profile. Further investigation is warranted in patients with main PVT.

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