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Safety and efficacy of 90 Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis
Author(s) -
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
Publication year - 2008
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.21980
Subject(s) - medicine , portal vein thrombosis , hepatocellular carcinoma , cirrhosis , thrombosis , adverse effect , radiology , gastroenterology , venous thrombosis , surgery
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 with Yttrium ( 90 Y) 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 90 Y 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. (H EPATOLOGY 2007.)