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Medical Oncology
Erschienen in: Medical Oncology 10/2017

01.10.2017 | Original Paper

Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis

verfasst von: C. Floridi, F. Pesapane, S. A. Angileri, D. De Palma, F. Fontana, F. Caspani, A. Barile, A. Del Sole, C. Masciocchi, G. Lucignani, G. Carrafiello

Erschienen in: Medical Oncology | Ausgabe 10/2017

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Abstract

The aim of this study was to evaluate the efficacy and the safety of Y90 radioembolization (Y90-RE) in patients with unresectable hepatocellular carcinoma (HCC) analysing our results and correlating them with independent prognostic factors for overall survival (OS) and for complications. Forty-three patients with advanced inoperable HCC including those with multiple bilobar lesions or portal vein thrombosis (PVT) treated with Y90-RE were reviewed. Treatment efficacy and safety were evaluated. Survival was calculated by the Kaplan–Meier method. Univariate analyses were performed for identifying potential prognostic factors. Radiologic response was evaluated with the modified Response Evaluation Criteria in Solid Tumours (mRECIST) criteria. Clinical toxicities were prospectively recorded. Median overall progression-free survival and OS were 27.7 and 16.8 months, respectively. Longer median OS was revealed in those without PVT (p = 0.0241) and those whose pre-treatment haemoglobin values was higher (p = 0.0471). According with mRECIST criteria, we observed a disease control rate of 69.2 and 61.9% at 3- and 6-month follow-up, respectively. Complications developed in 28 patients (65.1%), among which grade 2–3 events were reported in 17 patients. We noted that activity administered dose presented a correlation with intra-procedural toxicity (p = 0.039259) while common hepatic artery use as release site was associated with a most frequent presentation of remote adverse events. Y90-RE is an alternative treatment with a promising outcome for poor-risk advanced inoperable HCC. PVT and pre-treatment haemoglobin values can be predictors of efficacy. Activity administered dose and arterial release site can be predictors of safety.
Literatur
1.
2.
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.CrossRefPubMed
3.
Schmidt S, Follmann M, Malek N, Manns MP, Greten TF. Critical appraisal of clinical practice guidelines for diagnosis and treatment of hepatocellular carcinoma. J Gastroenterol Hepatol. 2011;26(12):1779–86.CrossRefPubMed
4.
Bruix J, Sherman M. American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.CrossRefPubMedPubMedCentral
5.
Lan T, Chang L, Rahmathullah MN, Wu L, Yuan YF. Comparative efficacy of interventional therapies for early-stage hepatocellular carcinoma: a PRISMA-compliant systematic review and network meta-analysis. Medicine (Baltim). 2016;95(15):e3185.CrossRef
6.
Duran R, Chapiro J, Schernthaner RE, Geschwind JF. Systematic review of catheter-based intra-arterial therapies in hepatocellular carcinoma: state of the art and future directions. Br J Radiol. 1052;2015(88):20140564.
7.
Goin JE, Salem R, Carr BI, et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: a risk-stratification analysis. J Vasc Interv Radiol. 2005;16(2 Pt 1):195–203.CrossRefPubMed
8.
Braat MN, Samim M, van den Bosch MA, Lam MG. The role of 90Y-radioembolization in downstaging primary and secondary hepatic malignancies: a systematic review. Clin Transl Imaging. 2016;4:283–95.CrossRefPubMedPubMedCentral
9.
10.
Schenk WG Jr, Mc DJ, Mc DK, Drapanas T. Direct measurement of hepatic blood flow in surgical patients: with related observations on hepatic flow dynamics in experimental animals. Ann Surg. 1962;156:463–71.CrossRefPubMedPubMedCentral
11.
Lin G, Lunderquist A, Hagerstrand I, Boijsen E. Postmortem examination of the blood supply and vascular pattern of small liver metastases in man. Surgery. 1984;96(3):517–26.PubMed
12.
Donahue LA, Kulik L, Baker T, et al. Yttrium-90 radioembolization for the treatment of unresectable hepatocellular carcinoma in patients with transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol. 2013;24(1):74–80.CrossRefPubMed
13.
Dieudonne A, Hobbs RF, Sanchez-Garcia M, Lebtahi R. Absorbed-dose calculation for treatment of liver neoplasms with 90Y-microspheres. Clin Transl Imaging. 2016;4:273–82.CrossRef
14.
Salem R, Thurston KG. Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 2: special topics. J Vasc Interv Radiol. 2006;17(9):1425–39.CrossRefPubMed
15.
Lencioni R. New data supporting modified RECIST (mRECIST) for hepatocellular carcinoma. Clin Cancer Res. 2013;19(6):1312–4.CrossRefPubMed
16.
Kluetz PG, Chingos DT, Basch EM, Mitchell SA. Patient-reported outcomes in cancer clinical trials: measuring symptomatic adverse events with the National Cancer Institute’s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Am Soc Clin Oncol Educ Book. 2016;35:67–73.CrossRefPubMed
17.
Tohme S, Sukato D, Chen HW, et al. Yttrium-90 radioembolization as a bridge to liver transplantation: a single-institution experience. J Vasc Interv Radiol. 2013;24(11):1632–8.CrossRefPubMed
18.
Riaz A, Lewandowski RJ, Kulik L, et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with chemoembolization. Cardiovasc Intervent Radiol. 2010;33(6):1143–52.CrossRefPubMed
19.
Kulik L, Vouche M, Koppe S, et al. Prospective randomized pilot study of Y90 ± sorafenib as bridge to transplantation in hepatocellular carcinoma. J Hepatol. 2014;61(2):309–17.CrossRefPubMed
20.
Sangro B, Salem R, Kennedy A, Coldwell D, Wasan H. Radioembolization for hepatocellular carcinoma: a review of the evidence and treatment recommendations. Am J Clin Oncol. 2011;34(4):422–31.CrossRefPubMed
21.
Hilgard P, Hamami M, Fouly AE, et al. Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology. 2010;52(5):1741–9.CrossRefPubMed
22.
Sangro B, Carpanese L, Cianni R, et al. Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: a European evaluation. Hepatology. 2011;54(3):868–78.CrossRefPubMed
23.
Rognoni C, Ciani O, Sommariva S, et al. Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses. Oncotarget. 2016;7(44):72343–55.PubMedPubMedCentral
24.
Fidelman N, Kerlan RK Jr. Transarterial chemoembolization and (90)Y radioembolization for hepatocellular carcinoma: review of current applications beyond intermediate-stage disease. AJR Am J Roentgenol. 2015;205(4):742–52.CrossRefPubMed
25.
Mazzaferro V, Sposito C, Bhoori S, et al. Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: a phase 2 study. Hepatology. 2013;57(5):1826–37.CrossRefPubMed
26.
Inarrairaegui M, Thurston KG, Bilbao JI, et al. Radioembolization with use of yttrium-90 resin microspheres in patients with hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol. 2010;21(8):1205–12.CrossRefPubMed
27.
Woodall CE, Scoggins CR, Ellis SF, et al. Is selective internal radioembolization safe and effective for patients with inoperable hepatocellular carcinoma and venous thrombosis? J Am Coll Surg. 2009;208(3):375–82.CrossRefPubMed
28.
Kulik LM, Carr BI, Mulcahy MF, et al. Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology. 2008;47(1):71–81.CrossRefPubMed
29.
Huang P, Liu C, Li B, et al. Preoperative mean corpuscular hemoglobin affecting long-term outcomes of hepatectomized patients with hepatocellular carcinoma. Mol Clin Oncol. 2016;4(2):229–36.CrossRefPubMed
30.
Caro JJ, Salas M, Ward A, Goss G. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer. 2001;91(12):2214–21.CrossRefPubMed
31.
Aapro M, Osterborg A, Gascon P, Ludwig H, Beguin Y. Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron. Ann Oncol. 2012;23(8):1954–62.CrossRefPubMed
32.
Intragumtornchai T, Rojnukkarin P, Swasdikul D, Vajanamarhutue C, Israsena S. Anemias in Thai patients with cirrhosis. Int J Hematol. 1997;65(4):365–73.CrossRefPubMed
33.
Albain KS, Crowley JJ, LeBlanc M, Livingston RB. Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol. 1991;9(9):1618–26.CrossRefPubMed
34.
Glaser CM, Millesi W, Kornek GV, et al. Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx. Int J Radiat Oncol Biol Phys. 2001;50(3):705–15.CrossRefPubMed
35.
Ludwig H, Fritz E, Leitgeb C, et al. Erythropoietin treatment for chronic anemia of selected hematological malignancies and solid tumors. Ann Oncol. 1993;4(2):161–7.CrossRefPubMed
36.
Soignet S. Management of cancer-related anemia: epoetin alfa and quality of life. Semin Hematol. 2000;37(4 Suppl 6):9–13.CrossRefPubMed
37.
Glaspy J, Bukowski R, Steinberg D, et al. Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Procrit Study Group. J Clin Oncol. 1997;15(3):1218–34.CrossRefPubMed
38.
Demetri GD, Kris M, Wade J, Degos L, Cella D. Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a prospective community oncology study. Procrit Study Group. J Clin Oncol. 1998;16(10):3412–25.CrossRefPubMed
39.
Gabrilove JL, Cleeland CS, Livingston RB, et al. Clinical evaluation of once-weekly dosing of epoetin alfa in chemotherapy patients: improvements in hemoglobin and quality of life are similar to three-times-weekly dosing. J Clin Oncol. 2001;19(11):2875–82.CrossRefPubMed
40.
Littlewood TJ, Bajetta E, Nortier JW, et al. Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol. 2001;19(11):2865–74.CrossRefPubMed
41.
Crawford J, Cella D, Cleeland CS, et al. Relationship between changes in hemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin alfa therapy. Cancer. 2002;95(4):888–95.CrossRefPubMed
42.
Hamoui N, Minocha J, Memon K, et al. Prophylactic embolization of the gastroduodenal and right gastric arteries is not routinely necessary before radioembolization with glass microspheres. J Vasc Interv Radiol. 2013;24(11):1743–5.CrossRefPubMed
43.
Mahnken AH, Spreafico C, Maleux G, Helmberger T, Jakobs TF. Standards of practice in transarterial radioembolization. Cardiovasc Intervent Radiol. 2013;36(3):613–22.CrossRefPubMed
44.
Pech M, Kraetsch A, Wieners G, et al. Embolization of the gastroduodenal artery before selective internal radiotherapy: a prospectively randomized trial comparing platinum-fibered microcoils with the Amplatzer Vascular Plug II. Cardiovasc Interv Radiol. 2009;32(3):455–61.CrossRef
45.
Borggreve AS, Landman AJ, Vissers CM, et al. Radioembolization: is prophylactic embolization of hepaticoenteric arteries necessary? A systematic review. Cardiovasc Interv Radiol. 2016;39(5):696–704.CrossRef
46.
Faletti R, Cassinis MC, Fonio P, et al. Diffusion-weighted imaging and apparent diffusion coefficient values versus contrast-enhanced MR imaging in the identification and characterisation of acute pyelonephritis. Eur Radiol. 2013;23(12):3501–8.CrossRefPubMed
47.
Sieghart W, Hucke F, Pinter M, et al. The ART of decision making: retreatment with transarterial chemoembolization in patients with hepatocellular carcinoma. Hepatology. 2013;57(6):2261–73.CrossRefPubMed
48.
Gonzalez-Guindalini FD, Botelho MP, Harmath CB, et al. Assessment of liver tumor response to therapy: role of quantitative imaging. Radiographics. 2013;33(6):1781–800.CrossRefPubMed
49.
Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92(3):205–16.CrossRefPubMed
50.
Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.CrossRefPubMed
51.
Forner A, Ayuso C, Varela M, et al. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: are response evaluation criteria in solid tumors reliable? Cancer. 2009;115(3):616–23.CrossRefPubMed
52.
Shim JH, Lee HC, Won HJ, et al. Maximum number of target lesions required to measure responses to transarterial chemoembolization using the enhancement criteria in patients with intrahepatic hepatocellular carcinoma. J Hepatol. 2012;56(2):406–11.CrossRefPubMed
53.
Gillmore R, Stuart S, Kirkwood A, et al. EASL and mRECIST responses are independent prognostic factors for survival in hepatocellular cancer patients treated with transarterial embolization. J Hepatol. 2011;55(6):1309–16.CrossRefPubMed
54.
Prasad SR, Jhaveri KS, Saini S, et al. CT tumor measurement for therapeutic response assessment: comparison of unidimensional, bidimensional, and volumetric techniques initial observations. Radiology. 2002;225(2):416–9.CrossRefPubMed
55.
Suzuki C, Torkzad MR, Jacobsson H, et al. Interobserver and intraobserver variability in the response evaluation of cancer therapy according to RECIST and WHO-criteria. Acta Oncol. 2010;49(4):509–14.CrossRefPubMed
56.
Zhao B, Tan Y, Bell DJ, et al. Exploring intra- and inter-reader variability in uni-dimensional, bi-dimensional, and volumetric measurements of solid tumors on CT scans reconstructed at different slice intervals. Eur J Radiol. 2013;82(6):959–68.CrossRefPubMed
57.
Bonekamp S, Jolepalem P, Lazo M, et al. Hepatocellular carcinoma: response to TACE assessed with semiautomated volumetric and functional analysis of diffusion-weighted and contrast-enhanced MR imaging data. Radiology. 2011;260(3):752–61.CrossRefPubMed
58.
Mantatzis M, Kakolyris S, Amarantidis K, Karayiannakis A, Prassopoulos P. Treatment response classification of liver metastatic disease evaluated on imaging. Are RECIST unidimensional measurements accurate? Eur Radiol. 2009;19(7):1809–16.CrossRefPubMed
59.
Sohaib SA, Turner B, Hanson JA, et al. CT assessment of tumour response to treatment: comparison of linear, cross-sectional and volumetric measures of tumour size. Br J Radiol. 2000;73(875):1178–84.CrossRefPubMed
60.
Salem R, Lewandowski RJ, Kulik L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011;140(2):497–507 e92.CrossRefPubMed
61.
Lee VH, Leung DK, Luk MY, et al. Yttrium-90 radioembolization for advanced inoperable hepatocellular carcinoma. Onco Targets Ther. 2015;8:3457–64.CrossRefPubMedPubMedCentral
62.
El Fouly A, Ertle J, El Dorry A, et al. In intermediate stage hepatocellular carcinoma: radioembolization with yttrium 90 or chemoembolization? Liver Int. 2015;35(2):627–35.CrossRefPubMed
63.
Stubbs RS, Cannan RJ, Mitchell AW. Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases. J Gastrointest Surg. 2001;5(3):294–302.CrossRefPubMed
64.
Lim L, Gibbs P, Yip D, et al. A prospective evaluation of treatment with Selective Internal Radiation Therapy (SIR-spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy. BMC Cancer. 2005;5:132.CrossRefPubMedPubMedCentral
65.
Murthy R, Xiong H, Nunez R, et al. Yttrium 90 resin microspheres for the treatment of unresectable colorectal hepatic metastases after failure of multiple chemotherapy regimens: preliminary results. J Vasc Interv Radiol. 2005;16(7):937–45.CrossRefPubMed
66.
Padia SA, Lewandowski RJ, Johnson GE, et al. Radioembolization of hepatic malignancies: background, quality improvement guidelines, and future directions. J Vasc Interv Radiol. 2017;28(1):1–15.CrossRefPubMed
67.
Wright CL, Werner JD, Tran JM, et al. Radiation pneumonitis following yttrium-90 radioembolization: case report and literature review. J Vasc Interv Radiol. 2012;23(5):669–74.CrossRefPubMed
68.
Maccauro M, Salem R. The impact of clinical factor on dosimetry in radioembolisation. Clin Transl Imaging. 2016;4:225–7.CrossRef
69.
Powerski M, Busse A, Seidensticker M, et al. Prophylactic embolization of the cystic artery prior to radioembolization of liver malignancies—an evaluation of necessity. Cardiovasc Interv Radiol. 2015;38(3):678–84.CrossRef
70.
Atassi B, Bangash AK, Lewandowski RJ, et al. Biliary sequelae following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol. 2008;19(5):691–7.CrossRefPubMed
71.
Ward TJ, Louie JD, Sze DY. Yttrium-90 radioembolization with resin microspheres without routine embolization of the gastroduodenal artery. J Vasc Interv Radiol. 2017;28(2):246–53.CrossRefPubMed
Metadaten
Titel
Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis
verfasst von
C. Floridi
F. Pesapane
S. A. Angileri
D. De Palma
F. Fontana
F. Caspani
A. Barile
A. Del Sole
C. Masciocchi
G. Lucignani
G. Carrafiello
Publikationsdatum
01.10.2017
Verlag
Springer US
Erschienen in
Medical Oncology / Ausgabe 10/2017
Print ISSN: 1357-0560
Elektronische ISSN: 1559-131X
DOI
https://doi.org/10.1007/s12032-017-1021-3

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