Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis

Authors

  • Laura M. Kulik,

    1. Department of Hepatology, Northwestern University, Chicago, IL
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  • Brian I. Carr,

    1. Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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  • Mary F. Mulcahy,

    1. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL
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    • Potential conflict of interest: MFM, AB, RS have received grant support from MDS Nordion. RS is an advisor to MDS Nordion. None of the other authors have disclosed a potential conflict of interest.

  • Robert J. Lewandowski,

    1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
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  • Bassel Atassi,

    1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
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  • Robert K. Ryu,

    1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
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  • Kent T. Sato,

    1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
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  • Al Benson III,

    1. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL
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    • Potential conflict of interest: MFM, AB, RS have received grant support from MDS Nordion. RS is an advisor to MDS Nordion. None of the other authors have disclosed a potential conflict of interest.

  • Albert A. Nemcek Jr.,

    1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
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  • Vanessa L. Gates,

    1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
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  • Michael Abecassis,

    1. Division of Transplant Surgery, Northwestern Memorial Hospital, Chicago, IL
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  • Reed A. Omary,

    1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
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  • Riad Salem

    Corresponding author
    1. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL
    2. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
    • Interventional Oncology, Department of Radiology, 676 N. St. Clair, Suite 800, Chicago, IL 60611
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    • Potential conflict of interest: MFM, AB, RS have received grant support from MDS Nordion. RS is an advisor to MDS Nordion. None of the other authors have disclosed a potential conflict of interest.

    • fax: 312-695-0654


Abstract

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 (90Y) 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 90Y 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. (HEPATOLOGY 2007.)

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