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CardioVascular and Interventional Radiology

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01.03.2020 | Clinical Investigation

Ablative Transarterial Radioembolization Improves Survival in Patients with HCC and Portal Vein Tumor Thrombus

verfasst von: Leandro Cardarelli-Leite, John Chung, Darren Klass, Vladimir Marquez, Frank Chou, Stephen Ho, Henry Walton, Howard Lim, Peter Tae Wan Kim, Anastasia Hadjivassiliou, David M. Liu

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 3/2020

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Abstract

Purpose

Patients with hepatocellular carcinoma and portal vein tumor thrombus have a poor prognosis and limited therapeutic options. We sought to compare survival, tolerability, and safety in such patients treated with conventional yttrium-90 transarterial radioembolization dosimetric techniques or ablative transarterial radioembolization.

Materials and Methods

This retrospective, single-center cohort study included patients with hepatocellular carcinoma and right, left, and/or main portal vein tumor thrombus, preserved liver function (Child–Pugh class ≤ B7), and good performance status (Eastern Cooperative Oncology Group score ≤ 1) treated with yttrium-90 microspheres from 2011 to 2018 with ablative intent transarterial radioembolization (A-TARE), or conventional technique (cTARE). Statistical models were used to compare overall survival, post-treatment survival, toxicities, and prognosticators of response.

Results

Fifty-seven patients were included (21 [36.8%] ablative and 36 [63.2%] conventional intent). Median overall survival was 15.7 months. Compared to conventional treatment, ablative radioembolization was associated with longer median overall survival (45.3 vs 18.2 months; P = 0.003), longer post-treatment survival (19.1 vs 4.9 months; P = 0.005), a 70% lower risk of death (hazard ratio 0.30; 95% confidence interval, 0.13–0.70; P = 0.005), and improved 4-year survival (53.9% vs 11.2%). Overall survival did not differ significantly between treatment with resin and glass microspheres (27.5 vs 22.2 months; P = 0.62). Acceptable hepatic toxicities were observed after yttrium-90 administration, without statistical differences between the groups.

Conclusion

In patients with advanced hepatocellular carcinoma and portal vein tumor thrombus, A-TARE is associated with longer survival than cTARE. Neither modality is associated with deleterious effects on liver function.

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Titel: Ablative Transarterial Radioembolization Improves Survival in Patients with HCC and Portal Vein Tumor Thrombus
verfasst von: Leandro Cardarelli-Leite
John Chung
Darren Klass
Vladimir Marquez
Frank Chou
Stephen Ho
Henry Walton
Howard Lim
Peter Tae Wan Kim
Anastasia Hadjivassiliou
David M. Liu
Publikationsdatum: 01.03.2020
Verlag: Springer US
Erschienen in: CardioVascular and Interventional Radiology / Ausgabe 3/2020
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-019-02404-5

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Ablative Transarterial Radioembolization Improves Survival in Patients with HCC and Portal Vein Tumor Thrombus