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Pt Selection Key to Radioembolization of Liver Ca's

Pt Selection Key to Radioembolization of Liver Ca's

SEATTLE—Therapy via radioembolization improves outcomes in some patients with primary or metastatic liver tumors that are unresectable or refractory to chemotherapy, and research is helping to better identify these patients upfront, according to a set of studies presented at the 32nd Annual Meeting of the Society of Interventional Radiology.

Unresectable HCC

In the first study (abstract 220), Riad Salem, MD, MBA, of Northwestern University Lurie Comprehensive Cancer Center, and colleagues assessed long-term outcomes of radioembolization in 233 patients with unresectable hepatocellular carcinoma (HCC) treated between 2001 and 2007. Tumors were embolized with yttrium-90 (90Y) glass microspheres (TheraSphere, MDS Nordion) at a dose of 100 to 150 Gy, with either a lobar or a segmental protocol (see Figure 1).

Median overall survival, assessed from the first of two radioembolizations, was better in patients with Okuda class 1 disease than in those with class 2-3 disease (530 vs 236 days) and better in low-risk than in high-risk patients (476 vs 139 days), Dr. Salem said. Survival decreased across the Child-Pugh A, B, and C classes (512, 231, and 136 days, respectively).

In subset analyses among patients without portal vein thrombosis (PVT), median survival was 574 days with noninfiltrative Child-Pugh A disease, 672 days with noninfiltrative Okuda class 1 disease, and 920 days with nonmetastatic Child-Pugh A disease. In similar subset analyses of patients with PVT, median survival was 308 days with Child-Pugh A disease, 428 days with Child-Pugh A disease with lobar PVT, 231 days with Child-Pugh A or B disease, and 284 days with Child-Pugh A or B disease with lobar PVT.

Final subset analyses focused on the impact of the location of PVT and of cirrhosis. Among all patients, median survival was 467, 304, and 134 days with no PVT, with branch PVT, and with main PVT, respectively (P = .005), Dr. Salem said. Among patients with cirrhosis, the corresponding values were 352, 234, and 118 days (P = .002), whereas among their counterparts without cirrhosis, they were 813, 323, and 134 days (P = .03).

Further subset analyses are forthcoming and will hopefully lead to controlled or randomized trials, Dr. Salem said. "Patient selection is critical," he concluded.

Cholangiocarcinoma

In a retrospective study (abstract 222), Robert J. Lewandowski, MD, of Northwestern University, and colleagues assessed the safety and efficacy of radioembolization with 90Y glass microspheres (TheraSphere) in patients who had progressive cholangiocarcinoma despite chemotherapy and who were treated in a prospective, open-label phase II trial. The procedure was performed using a lobar protocol with a target dose of 120 Gy.

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