Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma

Golfieri, Rita; Bilbao, J.I.; Carpanese, L; Cianni, Roberto; Gasparini, Daniele; Ezziddin, Samer; Paprottka, Philipp M.; Fiore, Francesco; Cappelli, Alberta; Rodríguez, Macarena; Ettorre, Giuseppe Maria; Saltarelli, A.; Geatti, Onelio; Ahmadzadehfar, Hojjat; Haug, Alexander; Izzo, Francesco; Giampalma, Emanuela; Sangro, Bruno; Pizzi, G.; Notarianni, E.; Vit, Alessandro; Wilhelm, Kai; Jakobs, Tobias; Lastoria, Secondo

doi:10.1016/j.jhep.2013.05.025

Cited by 90 publications

(65 citation statements)

References 39 publications

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“…In a large retrospective study from Korea, the authors found that TACE was associated with even better results in elderly than in younger patients, with respect to median OS and disease-specific survival (15.2 mo vs 8.7 mo, P < 0.001) without significant differences in terms of TACE-related mortality [43] . In an "in field" study from Italy, the authors reported similar outcomes in elderly and younger patients treated with TACE [66] . These data suggest that in the elderly population, TACE should be part of therapeutic armamentarium for HCC being effective with a satisfactorily safety profile.…”

Section: Transhepatic Arterial Chemoemboizationmentioning

confidence: 79%

Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under-or no-treatment of aged patients should not be longer justified. Core tip: The number of elderly patients with cancer is expected to rise in the next future, and facing with elderly cirrhotic patients with hepatocellular carcinoma (HCC) will characterize liver oncology scenario in the near future. International guidelines do not specifically address how to approach HCC in aged patients and no recommendations are available on age threshold to which clinical decisions should refer. Available data seem to rule out an intrinsic negative impact of age itself on HCC prognosis, and treatment allocation should be decided mainly according to HCC stage, liver residual function and general conditions. Indeed, a nihilistic AbstractMean age of hepatocellular carcinoma (HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific REVIEWSubmit a

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Section: Transhepatic Arterial Chemoemboizationmentioning

confidence: 79%

Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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“…However, RFA has broader indications and is still the first-line preferred treatment in patients not suitable for LT surgery, patients with no surgical indications, the young and the elderly [22], and patients with multiple tumors and liver cirrhosis [16]. However, there is a need to control and reduce the rate of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic hepatectomy versus radiofrequency ablation for minimally invasive treatment of single, small hepatocellular carcinomas

Song

Wang

et al. 2015

Surg Endosc

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“…There is a lot of data existing about the effectiveness of radioembolization therapy in patients suffering from hepatocellular carcinoma [6,26] and intrahepatic cholangiocarcinoma [8] as well as patients with unresectable liver metastases of colorectal cancer [9,27], breast carcinoma [7,23], pancreatic carcinoma [21], and neuroendocrine tumors [8,13,31].…”

Section: Discussionmentioning

confidence: 99%

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

Paprottka

Walter

et al. 2015

Cardiovasc Intervent Radiol

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Purpose To evaluate the safety of radioembolization (RE) with 90 Yttrium ( 90 Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels. Materials and MethodsEarly and late toxicity after 566 RE procedures were analyzed retrospectively in accordance with the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v3.0). For optimal safety, aberrant vessels were either coil embolized (n = 240/566, coiling group) or a more peripheral position of the catheter tip was chosen to treat right or left liver lobes (n = 326/566, no-coiling group). Results Clinically relevant late toxicities (CGrade 3) were observed in 1 % of our overall cohort. The no-coiling group had significantly less ''any'' (P = 0.0001) or ''clinically relevant'' (P = 0.0003) early toxicity. There was no significant difference (P [ 0.05) in delayed toxicity in the coiling versus the no-coiling group. No RE-induced liver disease was noted after all 566 procedures. Conclusion RE with 90 Y resin microspheres is a safe and effective treatment option. Performing RE without coil embolization of aberrant vessels prior to treatment could be an alternative for experienced centers.

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Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma

Cited by 90 publications

References 39 publications

Management of hepatocellular carcinoma in the elderly

Management of hepatocellular carcinoma in the elderly

Laparoscopic hepatectomy versus radiofrequency ablation for minimally invasive treatment of single, small hepatocellular carcinomas

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

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