Yttrium-90 radioembolization for the treatment of unresectable hepatocellular carcinoma in patients with transjugular intrahepatic portosystemic shunts

Laurence A. Donahue, Laura Kulik, Talia Baker, Daniel R. Ganger, Ramona Gupta, Khairuddin Memon, Michael M. Abecassis, Riad Salem, Robert J. Lewandowski*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Purpose: To evaluate the toxicity and response to radioembolization with yttrium-90 (90Y) glass microspheres in patients with hepatocellular carcinoma (HCC) and existing transjugular intrahepatic portosystemic shunts (TIPS). Materials and Methods: For treatment of unresectable HCC, 12 patients with a patent TIPS underwent a total of 21 infusions of 90Y. Toxicity within 90 days of treatment was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE v4.0). Imaging response within the index lesion was assessed using the World Health Organization (WHO) and European Association for the Study of the Liver (EASL) guidelines. Survival was calculated using the Kaplan-Meier method. Results: All patients had a patent TIPS on imaging before treatment. Clinical toxicities included fatigue (83%), encephalopathy (33%), and abdominal pain (25%). Three patients (25%) experienced new grade 3 or 4 bilirubin toxicity. Imaging response was achieved in 50% and 67% of patients according to WHO and EASL criteria. Six patients (50%) went on to liver transplantation. Median survival censored for liver transplantation was 498 days (95% confidence interval [CI],100-800 d), and uncensored median survival was 827 days (95% CI, 250-2,400 d). Conclusions: 90Y radioembolization may be a safe and effective treatment for patients with unresectable HCC and existing TIPS. This minimally embolic therapy may be particularly useful as a bridge to curative liver transplantation.

Original languageEnglish (US)
Pages (from-to)74-80
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume24
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • CI
  • EASL
  • European Association for the Study of the Liver
  • HCC
  • SD
  • TIPS
  • WHO
  • World Health Organization
  • Y
  • confidence interval
  • hepatocellular carcinoma
  • standard deviation
  • transjugular intrahepatic portosystemic shunt
  • yttrium-90

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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