Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma

Kolligs, Frank T.; Bilbao, J.I.; Jakobs, Tobias; Iñarrairaegui, Mercedes; Nagel, J.; Rodríguez, Macarena; Haug, Alexander; D’Avola, Delia; Winkel, Mark op den; Martínez-Cuesta, Antonio; Trumm, Christoph; Benito, Alberto; Tatsch, Klaus; Zech, Christoph J.; Hoffmann, Ralf‐Thorsten; Sangro, Bruno

doi:10.1111/liv.12750

Cited by 139 publications

(102 citation statements)

References 27 publications

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“…Compared with TACE, radioembolization has a similar or even better objective response rate and similar survival statistics (60). Moreover, as previously discussed, PVT and bilidigestive anastomoses are no absolute contraindication.…”

Section: Clinical Outcome and Tumor Responsementioning

confidence: 72%

“…In the intermediate and early-advanced stages of HCC (respectively, BCLC B and BCLC C), radioembolization has shown favorable outcomes compared with the currently preferred treatments (59,60). Compared with TACE, radioembolization has a similar or even better objective response rate and similar survival statistics (60).…”

Section: Clinical Outcome and Tumor Responsementioning

confidence: 99%

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⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

et al. 2015

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Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the status of the current literature regarding new indications for radioembolization; (2) describe standard hepatic vascularization, identify common routes for extrahepatic depositions, and judge when "skeletization" of hepatic arteries could be unnecessary; and (3) appraise the different methods of activity calculation and recognize the strengths and pitfalls of pretreatment and posttreatment dosimetry.Financial Disclosure: Dr. Lam is a consultant/advisor for BTG International and a meeting participant/lecturer for SirTex Medical. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through July 2018.Radioembolization is an established treatment modality that has been subjected to many improvements over the last decade. Developments are occurring at a high pace, affecting patient selection and treatment. The aim of this review is therefore to provide an overview of current practice, with a focus on recent developments in the field of radioembolization. Several practical issues and recommendations in the application of radioembolization will be discussed, ranging from patient selection to treatment response and future applications.

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Section: Clinical Outcome and Tumor Responsementioning

confidence: 72%

Section: Clinical Outcome and Tumor Responsementioning

confidence: 99%

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

et al. 2015

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“…All of the articles were published between 2009 and 2016 and included with nine observational studies 13,16-23 and two RCTs 14,15 . The locations of the studies included Germany, Spain, China, Egypt, Turkey, and the USA.…”

Section: Resultsmentioning

confidence: 99%

“…The risk of bias was assessed using the Cochrane Collaboration tool for two RCTs ( Figure 2 ). One RCT, with more than two high-risk components, was considered to have a moderate risk of bias 15 , and another RCT was determined to have a low risk of bias 14 . …”

Section: Resultsmentioning

confidence: 99%

Yttrium-90 transarterial radioembolization versus conventional transarterial chemoembolization for patients with hepatocellular carcinoma: a systematic review and meta-analysis

Yang

2018

Cancer Biology & Medicine

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Objective:To compare the effects and safety of conventional transarterial chemoembolization (cTACE) and yttrium-90 transarterial radioembolization [TARE (90Y)] for hepatocellular carcinoma (HCC)Methods:Nine high-quality observational studies, one low bias-risk randomized controlled trial (RCT), and one moderate bias-risk RCT included 1,652 patients [cTACE, 1,124; TARE (90Y), 528], from whom data were extracted for this systematic review and meta-analysis.Results:The extracted study outcomes included 1-year and 2-year overall survival (OS) rates, objective responses (ORs), and serious adverse events (AEs). 1-year OS rates: OR = 0.939, 95 % CI: 0.705-1.251, P = 0.66. 2-year OS rates: overall pooled OR = 0.641, 95% CI: 0.382-1.075, P = 0.092; observational study subgroup OR = 0.575, 95% CI: 0.336-0.984, P = 0.043; RCT subgroup OR* = 0.641, 95% CI: 0.382-1.075, P = 0.346. OR: overall pooled OR = 0.781, 95% CI: 0.454-1.343, P = 0.371; mRECIST subgroup OR = 0.584, 95 % CI: 0.349-0.976, P = 0.040; WHO subgroup OR = 1.065; 95% CI: 0.500-2.268, P = 0.870. Serious AEs: overall pooled RR = 1.477, 95% CI: 0.864-2.526, P = 0.154; RCT subgroup RR = 0.680, 95% CI: 0.325-1.423, P = 0.306; observational study subgroup RR = 1.925; 95 % CI: 0.978-3.788, P = 0.058. Conclusions:TARE (90Y) increased 2-year OS rates in the observational subgroup and resulted in better OR rates, according to mRECIST criteria, in comparison with cTACE. Furthermore, a lower risk of AEs was observed for TARE (90Y) than for cTACE.

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“…A retrospective case series has found similar major and minor complication rates between TACE and TARE, but greater hospitalization for both initial procedure and readmission, and worse postembolization syndrome, with TACE [53]. There is no published cost-effectiveness study on use of Y-90 TARE for HCC; a small www.karger.com/lic © 2018 S. Karger AG, Basel DOI: 10.1159/000485984 randomized trial that evaluated health-related quality of life of patients with unresectable HCC did not find a significant difference between TACE and Y-90 TARE [54]. 34.…”

Section: Tace Should Be Stopped When There Is Absence Of Viable Tumormentioning

confidence: 99%

Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma

et al. 2018

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Background: Hepatocellular carcinoma (HCC) is highly prevalent in Hong Kong due to the high prevalence of chronic hepatitis B infection. Liver cancer is the fourth most common cancer and the third most common cause of cancer death. Due to the high case load, there is a high level of local expertise in treating HCC, and the full spectrum of treatment modalities is available. This document summarizes how these modalities should be used based on the latest evidence. Summary: In 2 meetings held in early 2017, a multidisciplinary group of Hong Kong clinicians, including liver surgeons, interventional radiologists, clinical oncologists, and medical oncologists, met to update local consensus statements for management of HCC. These statements are based on the latest evidence and give detailed guidance on how to deploy these modalities, in particular for cases of HCC which are not suited to surgical resection. Key Messages: These statements give detailed information on how to decide if a patient is a candidate for resection, methods to improve candidacy for resection, and guidance for use of various nonsurgical interventions to manage patients ineligible for resection.

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Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma

Abstract: Single-session SIRT appeared to be as safe and had a similar impact on HRQoL as multiple sessions of TACE, suggesting that SIRT might be an alternative option for patients eligible for TACE.

Cited by 139 publications

References 27 publications

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

Yttrium-90 transarterial radioembolization versus conventional transarterial chemoembolization for patients with hepatocellular carcinoma: a systematic review and meta-analysis

Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma

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Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma

Abstract: Single-session SIRT appeared to be as safe and had a similar impact on HRQoL as multiple sessions of TACE, suggesting that SIRT might be an alternative option for patients eligible for TACE.

Cited by 139 publications

References 27 publications

90Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

90Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

Yttrium-90 transarterial radioembolization versus conventional transarterial chemoembolization for patients with hepatocellular carcinoma: a systematic review and meta-analysis

Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma

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Product

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⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments