Same-day 90Y radioembolization: implementing a new treatment paradigm

Gabr, Ahmed; Kallini, Joseph R.; Gates, Vanessa L.; Hickey, Ryan; Kulik, Laura; Desai, Kush; Thornburg, Bartley; Marshall, Karen; Salzig, Krystina; Williams, Melissa; Castillo, Carlene del; Ganger, Daniel; Hohlastos, Elias; Baker, Talia; Lewandowski, Robert J.; Salem, Riad

doi:10.1007/s00259-016-3438-x

Cited by 55 publications

(48 citation statements)

References 19 publications

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“…The major difference relates to TACE traditionally requiring an inpatient admission, whereas Y90 has been an outpatient treatment since its inception, thereby decreasing lifetime resource utilization and, potentially, overall costs. More recently, Y90 has been delivered in one session versus two (same‐day treatment), further reducing time to treatment and cost . Although there has been a recent effort to provide TACE on an outpatient basis, this concept is still investigational.…”

Section: Discussionmentioning

confidence: 99%

“…For early stage A, Y90 has been used to successfully downstage tumors to liver transplantation (LT), hypertrophy the future liver remnant for potential resection, treat recurrences following resection, significantly prolong time to progression (TTP) compared with TACE, and represent an alternative to ablation for unablatable lesions . For stage B, Y90, which is performed in the outpatient setting, has demonstrated comparable survival yet superior quality of life (QoL) compared to TACE . For stage C, Y90 is applicable in patients with portal vein thrombosis (PVT), minimizing the risk of ischemic hepatitis given lack of arterial occlusion .…”

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confidence: 99%

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Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000‐patient 15‐year experience

et al. 2018

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Section: Discussionmentioning

confidence: 99%

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Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000‐patient 15‐year experience

et al. 2018

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“…5–7 Compared with cTACE, Y90 has shown increased time-to-progression 8 , good of quality-of-life 9 , a neoadjuvant role prior to resection. 10–12 and high antitumoral activity in patients with portal vein invasion 13 . Consequently, experts have strongly advocated that Y90 be studied in randomized trials using cTACE as the control arm.…”

Section: Introductionmentioning

confidence: 99%

Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma

et al. 2016

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Background and Aims Conventional transarterial chemoembolization (cTACE) is used to treat patients with hepatocellular carcinoma (HCC). Radioembolization is a minimally invasive procedure that involves implantation of radioactive micron-sized particles loaded with yttrium-90 (Y90) inside the blood vessels that supply a tumor. We performed a randomized, phase 2 study to compare the effects of cTACE and Y90 radioembolization in patients with HCC. Methods From October 2009 through October 2015, we reviewed patients with HCC of all Barcelona Clinic Liver Cancer (BCLC) stages for eligibility. Of these, 179 patients with BCLC stages A or B met our enrollment criteria and were candidates for cTACE or Y90 therapy. Patients were randomly assigned to groups that received Y90 therapy (n=24, 50% Child-Pugh A) or cTACE (n=21, 71% Child-Pugh A). The primary outcome was time to progression (TTP), evaluated by intention to treat analysis. Secondary outcomes included safety, rate of response (based on tumor size and necrosis criteria), and KM survival time. We performed inverse probability of censoring weighting and competing risk analyses. Results Patients in the Y90 radioembolization group had significant longer median TTP (>26 months) than patients in the cTACE group (6.8 months) (P=.0012) (hazard ratio=0.122; 95% CI, 0.027–0.557; P=.007). This was confirmed by competing risk and inverse probability of censoring weighting analyses accounting for transplantation or death. A significantly greater proportion of patients in the cTACE group developed diarrhea (21%) than in the Y90 group (0%; P=.031) or hypoalbuminemia (58% in the cTACE group vs 4% in the Y90 group) (P<.001). Similar proportions of patients in each group had a response to therapy, marked by necrosis (74% in the cTACE group vs 87% in the Y90 group) (P=.433). Median survival time, censored to liver transplantation, was 17.7 months for the cTACE group (95% CI, 8.3–NC) vs 18.6 months for the Y90 group (95% CI, 7.4–32.5) (P=.99). Conclusions In a phase 2 study of patients with HCC of BCLC stages A or B, we found Y90 radioembolization to provide significantly longer TTP than cTACE. Y90 radioembolization provides better tumor control and could reduce dropout from transplant waitlists. ClinicalTrials.gov no. NCT00956930

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“…Second, when applying strict selection criteria in a manner analogous to other curative treatments, prolonged survival is noted. Third, the favorable adverse event profile in a treatment that can be performed on an outpatient same-day basis should be considered competitive to more invasive traditional curative treatments (30). Fourth, a dose of greater than 190 Gy has been shown to achieve complete pathologic necrosis (9).…”

Section: Vascular and Interventional Radiology: Radiation Segmentectomentioning

confidence: 99%

Radiation Segmentectomy: Potential Curative Therapy for Early Hepatocellular Carcinoma

Lewandowski¹,

Gabr²,

Abouchaleh³

et al. 2018

Radiology

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Purpose:To report long-term outcomes of radiation segmentectomy (RS) for early hepatocellular carcinoma (HCC). The authors hypothesized that outcomes are comparable to curative treatments for patients with solitary HCC less than or equal to 5 cm and preserved liver function. Materials and Methods:This retrospective study included 70 patients (median age, 71 years; range, 22-96 years) with solitary HCC less than or equal to 5 cm not amenable to percutaneous ablation who underwent RS (dose of .190 Gy) between 2003 and. Patients who underwent subsequent curative liver transplantation were excluded to eliminate this confounding variable affecting survival. Radiologic response of time to progression and median overall survival were estimated by using the Kaplan-Meier method per the guidelines of the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO). Results:Seventy patients were treated with RS over 14 years. Sixty-three patients (90%) showed response by using EASL criteria, of which 41 (59%) showed complete response. Fifty patients (71%) achieved response by using WHO criteria, of which 11 (16%) achieved complete response. Response rates at 6 months were 86% and 49% by using EASL and WHO criteria, respectively. Median time to progression was 2.4 years (95% confidence interval: 2.1, 5.7), with 72% of patients having no target lesion progression at 5 years. Median overall survival was 6.7 years (95% confidence interval: 3.1, 6.7); survival probability at 1, 3, and 5 years was 98%, 66%, and 57%, respectively. Overall survival probability at 1, 3, and 5 years was 100%, 82%, and 75%, respectively, in patients with baseline tumor size less than or equal to 3 cm (n = 45) and was significantly longer than in patients with tumors greater than 3 cm (P = .026). In our study, we review our longterm outcomes (.10 years) of patients with HCC less than or equal to 5 cm not amenable to resection, radiofrequency ablation, or transplantation who underwent RS. We hypothesize that this approach could be considered potentially curative based on the same rationale as resection, radiofrequency ablation, and transplantation. Conclusion Materials and MethodsR.J.L. and R.S. are advisors to BTG International. There was no funding for this analysis and all authors had control of the data and information submitted for publication. Our study was approved by the institutional review board and was compliant with the Health Insurance Portability and Accountability Act. All patients provided written informed consent prior to receiving treatment after selecting RS over chemoembolization. We searched our prospectively acquired database of HCC (10) for patients treated with 90 Y radioembolization from December 2003 to 2016 (14 years). Inclusion criteria were as follows: solitary HCC less than or equal to 5 cm, preserved liver function (Child-Pugh class A), and no vascular invasion or extrahepatic metastases (7). Patients who underwent transplantation or resection were excluded to mitigate the potential confo...

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Same-day 90Y radioembolization: implementing a new treatment paradigm

Cited by 55 publications

References 19 publications

Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000‐patient 15‐year experience

Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000‐patient 15‐year experience

Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma

Radiation Segmentectomy: Potential Curative Therapy for Early Hepatocellular Carcinoma

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