Superselective yttrium-90 radioembolization for hepatocellular carcinoma yields high response rates with minimal toxicity

Siddharth A. Padia, Sharon W. Kwan, Bahman Sayyar Roudsari, Wayne L. Monsky, Andrew Coveler, William P. Harris

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Purpose To assess the safety and efficacy of yttrium-90 (90Y) radioembolization when performed in a superselective fashion for patients with unresectable hepatocellular carcinoma (HCC). Materials and Methods This retrospective study included 20 patients with unresectable HCC. Median Model for End-Stage Liver Disease score was 10.5 (range, 6-25), with 8 of 20 patients (40%) classified Child-Pugh class B and 1 of 20 patients (5%) classified class C cirrhosis. Segmental tumor-associated portal vein thrombus was present in 12 patients (60%), and a transjugular intrahepatic portosystemic shunt was present in 4 patients (20%). Median tumor diameter was 3.9 cm (range, 2.5-7.1 cm). All patients underwent superselective 90Y radioembolization targeted to a single liver segment using glass microspheres. Results Median dose to the treated segment was 254 Gy, and median dose to the tumor was 536 Gy. No grade 3-4 hepatotoxicity occurred. The most common clinical toxicities were fatigue (30%), abdominal pain (10%), and postembolization syndrome (10%). Follow-up imaging demonstrated complete European Association for the Study of the Liver response of the index tumor in 19 of 20 patients (95%) and stable disease in 1 of 20 patients (5%). In patients with complete response, local tumor recurrence rate was 5.3% (1 of 19 patients). Median time to progression was 319 days. Overall survival was 90% (18 of 20 patients) with a median follow-up period of 275 days (range, 32-677 d). Conclusions When performed in a segmental fashion, 90Y radioembolization demonstrates high response rates and low local tumor recurrence rates. Complete imaging response can be achieved in patients with locally aggressive disease. This study demonstrates no clinically significant hepatotoxicity, despite moderate liver dysfunction in many patients.

Original languageEnglish (US)
Pages (from-to)1067-1073
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume25
Issue number7
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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