Radioembolization with Yttrium-90 Glass Microspheres in Hepatocellular Carcinoma: European Experience on Safety and Long-Term Survival

Abstract

Radioembolization has been demonstrated to allow locoregional therapy of patients with hepatocellular carcinoma not eligible for transarterial chemoembolization or other local therapies. The aim of this study was to validate evidence of the safety and efficacy of this treatment in a European sample of patients with advanced hepatocellular carcinoma (HCC). Therefore, 108 consecutive patients with advanced HCC and liver cirrhosis were included. Yttrium-90 (Y-90) microspheres were administered in a lobar fashion over the right or left branch of the hepatic artery. The response to treatment was evaluated by computed tomography (CT) imaging applying Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) criteria with recent European Association for the Study of the Liver / National Cancer Institute (EASL/NCI) amendments. Time to progression (TTP) and overall survival were estimated by the Kaplan-Meier method. In all, 159 treatment sessions were performed ranging between one to three treatments per patient. The mean radiation dose per treatment was 120 (618) Gy. According to EASL criteria, complete responses were determined in 3% of patients, partial responses in 37%, stable disease 53%, and primary progression in 6% of patients. TTP was 10.0 months, whereas the median overall survival was 16.4 months. No lung or visceral toxicity was observed. The most frequently observed adverse events was a transient fatigue-syndrome. Conclusion: Radioembolization with Y-90 glass microspheres for patients with advanced HCC is a safe and effective treatment which can be utilized even in patients with compromised liver function. Because TTP and survival appear to be comparable to systemic therapy in selected patients with advanced HCC, randomized controlled trials in combination with systemic therapy are warranted.

Radioembolisation of hepatocellular carcinoma patients using 90Y-labelled microspheres: towards a diffusion of the technique?

“…The toxicity profile of glass microspheres was shown to be acceptable in the Lambert et al study, in line with previously published reports [2][3][4]. The risk of pulmonary toxicity is effectively detected by MAA scintigraphy, and patients presenting pulmonary risks are systematically excluded from therapy.…”

“…Their report confirms that this technique may be utilised by teams with no prior experience in the use of microspheres, without major complications and with comparable efficacy results. In fact, while taking into account tumour necrosis, Lambert et al reported an objective response rate of 50%, in line with previous results published by Salem et al [2] (57% in a series involving 291 patients) and Hilgard et al [3] (40% in a series involving 108 patients).…”

“…The relatively high rate of patients considered ineligible for treatment in the Lambert et al study (i.e. 19 versus only 7.5% for Hilgard et al [3]) is likely to be accounted for by the learning curve. Therefore, when comparing the results of different studies, it is essential to consider the experience of the respective teams.…”

“…Regarding glass microsphere therapy, recent results obtained with MAA SPECT/CT-based dosimetry clearly demonstrate the necessity of defining a decisional algorithm based on hepatic tumour and nontumour volumes, rather than on the dosimetric evaluation of hepatic injected volume alone. Such an algorithm should lead to improved efficacy results in the case of voluminous hepatic tumours, which are difficult to treat, and perhaps to further reduced hepatic toxicity, currently considered to be low [2][3][4].…”

Yttrium-90 radioembolization for hepatocellular carcinoma in hepatitis B: commentary on a 103-patient Asian cohort

“…Studies from Europe and the United States, comprised of 776 patients in aggregate, have demonstrated comparable results when taking into account cohort differences in terms of baseline Child-Pugh classification and tumor stage defined by the Barcelona Clinic Liver Cancer system (BCLC) [1][2][3][4]. These Western studies included patients predominately with hepatitis C and/or alcohol as the underlying cause of liver disease with limited numbers of patients with hepatitis B virus (HBV) (9-30 %).…”