Yttrium-90 Radioembolization as the Major Treatment of Hepatocellular Carcinoma

Abstract

Background The purpose of this study was to assess the safety and efficacy of Yttrium-90 radioembolization using in unresectable hepatocellular carcinoma. Methods From 2017 to 2021, 32 patients with unresectable hepatocellular carcinoma, with mean tumor diameter about 7cm (21 males, 11 females; median age, 57.5 years of age), treated with Yttrium-90 radioembolization using resin microspheres were reviewed at pre-Yttrium-90 and post-Yttrium-90 follow-up. Tumor response was assessed according to the modified Response Evaluation Criteria in Solid Tumors. Outcomes including overall survival and progression-free survival were reported. Results Median follow-up was 18 months. At follow-up examinations at 3-, 6-, and 12-months follow-up, the overall survival rates were 94%, 87% and 59%, and the progression-free survival rates were 78%, 64% and 60%, respectively. Complete response, partial response, stable disease, and progressive disease were noted in 7 (21.9%), 14 (43.7%), 4 (12.5%), and 7 (21.9%) patients, respectively. The disease control rate was 78.1%, the objective response rate was 65.6%, and the successful downstage rate was 34.4% (11 of 32). Nine of thirty-two patients underwent resection or transplantation after Yttrium-90 radioembolization with 2-year overall survival being 100%. No serious adverse events occurred after Yttrium-90 treatment. Worse overall survival was related to the larger tumor, higher stage, Eastern Cooperative Oncology Group performance status, and Child-Pugh score. And worse progression-free survival was related to the higher tumor burden, and pre-Yttrium-90 serum α-fetoprotein level >100. Conclusion Yttrium-90 Radioembolization can control hepatocellular carcinoma well even in advanced diseases. Patients successfully downstaging/bridging to resection or transplantation have excellent overall survival.

Transarterial Radioembolization (TARE) in Patients with Hepatocellular Carcinoma: A Comparison of Palliative with Bridging-to-Transplant Concepts

“…The estimated survival rate in our whole patient cohort was 82.0% and 60.5% at 6 and 12 months after TARE, respectively, which is similar to other studies evaluating patients with unresectable HCC, also regarding the proportion of patients who underwent LT after bridging TARE [ 11 , 23 , 24 ]. Despite our hospital being a specialized liver transplantation center, only approx.…”

“…In this context, a bridging therapy, such as transarterial radioembolization (TARE) before liver transplantation (LT), is applied. The effectiveness of locoregional, neoadjuvant therapies for this purpose has been demonstrated by several studies [ 5 , 6 , 11 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Studies directly comparing TARE with TACE found a higher disease control rate, significantly better overall and intrahepatic PFS, and better survival outcomes in the patients treated with TARE even with advanced disease [ 19 , 20 ].…”

Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips

“…There are many clinical trials currently looking at this question (NCT05809869, NCT03889093, NCT05701488, NCT04605731), with some preliminary results suggesting that the combination of Y90-RE with systemic therapy can be safe and effective. 25 26 As this field of Y90-RE continues to evolve, the authors recommend strongly considering the utilization of personalized dosimetry and the limiting of the treatment angiosome whenever combination therapy with Y90-RE is sought. Of note, the combination of atezolizumab and bevacizumab has become first-line systemic therapy for advanced HCC.…”

Pushing the limits of treatment for hepatocellular carcinoma

“…In this study, overall survival was 17.7- and 18.6-months survival, respectively. Y-90 has been shown to be effective in large tumors >5 cm, with 59% overall survival at 12 months and 60% PFS at 12 months [34]. Advances in imaging techniques and radiologic oncology have allowed more precise locoregional therapies than were previously available.…”