Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma

By R. Salem, R. Lewandowski, L. Kulik, E. Wang, A. Riaz, R. Ryu, Kent T. Sato, Ramona Gupta, P. Nikolaidis, F. Miller and 18 more. Gastroenterology, 2010

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Background and Aims Chemoembolization is a standard treatment for hepatocellular carcinoma (HCC). Radioembolization with 90Y microspheres is a new, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. Methods We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up timepoints. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multi-variate analyses were performed. Results Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P<.05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs. 36%, P=0.104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, P=0.046), median survival times were not statistically different (17.4 months vs 20.5 months, P=0.232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P=0.42). Conclusion Patients with HCC treated by chemoembolization or radioembolization with 90Y microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post-hoc analyses of sample size indicated that a randomized study with >1000 patients would be required to establish equivalence of survival times between patients given the different therapies.

Subfields: Genetics, Hepatology, Surgery

View Paper: https://www.semanticscholar.org/paper/dcbb1838b65a040eeefd9ea81d7edfd6eef47708

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Citations in the corpus

Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases (2018, result): “0 months.(157,158) Small randomized trials comparing TACE to TARE have shown results similar to larger retrospective studies with equivalency in OS and progression-free survival {Pitton, 2014 #969}.”
Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma (2012, background): “The half-life of the bead allows for treatment to take place over weeks, with the theoretical advantage of an improvement in the durability of response.(29) Other advantages of yttrium-90 include: 1) better tolerability in patients with vulnerable liver reserve (Child-Pugh class B) when used in a se”
Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data (2016, background): “A comprehensive understanding of updated efficacy and safety data of lipiodol TACE in the treatment of HCC is important, especially considering that alternate options for regional hepatic tumor treatment—including arterial embolization with drug-eluting beads and internal radiation with yttrium-90 m”
Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases (2019, result): “0 months.(157,158) Small randomized trials comparing TACE to TARE have shown results similar to larger retrospective studies with equivalency in OS and progression-free survival {Pitton, 2014 #969}.”
Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma (2016, methodology): “Our hypothesis was that Y90 would prolong TTP when compared to cTACE.(8)”
Survival after yttrium‐90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: A European evaluation (2011, background): “Data contributing to the multivariate model: n¼ 319/325 (98.2%). disease involvement, degree of hepatic functional reserve, and presence or absence of cirrhosis.13,14,19,20,29 Very recently, Salem et al.17 reported a large prospective study in 291 patients treated with glass-based 90Y microspheres (”