Yttrium-90 glass-based microsphere radioembolization in the treatment of hepatocellular carcinoma secondary to the hepatitis B virus: Safety, efficacy, and survival

Purpose: To evaluate outcomes of yttrium-90 radioembolization performed with glass-based microspheres in the treatment of hepatocellular carcinoma (HCC) secondary to the hepatitis B virus (HBV). Materials and Methods: A total of 675 patients treated between January 2006 and July 2014 were reviewed, of which 45 (age 62 y +/- 10; 91% male) received glass-based radioembolization for HCC secondary to HBV. All patients were stratified according to previous therapy (naive, n = 14; 31.1%), Child-Pugh class (class A, n = 41; 91%), Eastern Cooperative Oncology Group (ECOG) performance status (PS; 400 ng/mL (n = 17; 38%), and Barcelona Clinic Liver Cancer stage (A, n = 8; B, n = 9; C, n = 28). Results: A total of 50 radioembolization treatments were performed, with a 100% technical success rate (median target dose, 120 Gy). Clinical toxicities included pain (16%), fatigue (12%), and nausea (4%). Grade 3/4 laboratory toxicities included bilirubin (8%) and aspartate aminotransferase (4%) toxicities. Observed toxicities were independent of treatment dose. The objective response rates were 55% per modified Response Evaluation Criteria In Solid Tumors and 21% per World Health Organization criteria, and the disease control rate was 63%. Disease progression was secondary to new, nontarget HCC in 45% of cases. Median time to progression and overall survival were 6.0 mo (95% confidence interval [CI], 4.4-8.0 mo) and 19.3 mo (95% CI, 11.2-22.7 mo), respectively. Multivariate analysis demonstrated ECOG PS >= 1 and AFP level > 400 ng/mL to be independent predictors of inferior overall survival. Conclusions: Glass-based radioembolization for HCC secondary to HBV can be safely performed, with favorable target lesion response and overall survival

Outcomes of Radioembolization in the Treatment of Hepatocellular Carcinoma with Portal Vein Invasion: Resin versus Glass Microspheres

Purpose: To compare outcomes of yttrium-90 radioembolization performed with resin-based (Y-90-resin) and glass-based (Y-90-glass) microspheres in the treatment of hepatocellular carcinoma (HCC) with associated portal vein invasion. Materials and Methods: A single-center retrospeetive review (January 2005-September 2014) identified 90 patients (Y-90-resin, 21; Y-90-glass, 69) with HCC and ipsilateral portal vein thrombosis (PVT), Patients were stratified according to age, sex, ethnicity, Child-Pugh class, Eastern Cooperative Oncology Group status, alpha-fetoprotein > 400 ng/mL, extent of PVT, tumor burden, and sorafenib therapy. Outcome variables included clinical and laboratory toxicifies (Common Terminology Criteria Adverse Events, Version 4.03), imaging response (modified Response Evaluation Criteria in Solid Tumors), time to progression (TTP), and overall survival (OS). Results: Grade 3/4 bilirubin and aspartate aminotransferase toxicities developed at a 2.8-fold (95% confidence interval [CI], 1.3-6.1) and 2.6-fold (95% CI, 1.1-6.1) greater rate in the Y-90-resin group. The disease control rate was 37.5% in the Y-90-resin group and 54.5% in the Y-90-glass group (P = .39). The median (95% CI) TTP was 2.8 (1.9-4.3) months in the Y-90-resin group and 5.9 (4.2-19.1) months in the Y-90-glass group (P = .48). Median (95% CI) survival was 3,7 (2.3-6.0) months in the Y-90-resin group and 9.4 (7.6-45.0) months in the Y-90-glass group (hazard ratio, 2.6; 95% CI, 1.5-4.3, P < .001). Additional multivariate predictors of improved OS included age < 65 years, Eastern Cooperative Oncology Group status < 1, alpha-fetoproteiu <= 400 ng/mL, and unilobar tumor distribution. Conclusions: Imaging response of Y-90 treatment in patients with HCC and PVT was not significantly different between Y-90-glass and Y-90-resin groups. Lower toxicity and improved OS were observed in the Y-90-glass group