Downstaging unresectable hepatocellular carcinoma by radioembolization using 90-yttrium resin microspheres: a single center experience

Abstract

Background: Only one third of patients with hepatocellular carcinoma can benefit from curative treatments at the time of first diagnosis. Tumor downstaging by radioembolization may enable initially unresectable hepatocellular carcinoma (HCC) to be treated with surgery lengthening survival. Methods: From June 2011 through June 2014, all patients with a first diagnosis of unresectable HCC with intrahepatic portal vein thrombosis were treated in our center with radioembolization using 90-yttrium resin microspheres. A 3-year enrollment period and a 5-year follow-up were planned to adequately investigate survivals. Results: Twenty-four patients were enrolled, five were downstaged to surgery, eight did not reach downstaging but achieved partial response or stable disease, and eleven showed HCC progression despite radioembolization. High tumor absorbed radiation doses (454 vs. 248 and 138 Gy, P=0.005) and low serum AFP levels (53 vs. 1,447 and 4,603 ng/mL, P=0.05) were the variables significantly associated with successful downstaging. Mean and median survivals were 54, 30 and 11 months and 70, 24 and 11 months in the three groups respectively. No severe side effects were registered. Conclusions: In our center, about 20% of patients with locally advanced unresectable hepatocellular carcinoma were successfully downstaged to surgery after radioembolization. This strategy increases survival and is associated with an excellent safety profile.

Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

“…Tabone et al. used radioembolization to downstage unresectable HCC, and 5 of 24 (20.8%) patients were downstaged to surgery ( 24 ). Lee et al.…”

Radioembolization vs sorafenib in locally advanced hepatocellular carcinoma with portal vein tumor thrombosis: A propensity score and Bayesian analysis

“…TARE can be used with safety in patients with portal vein thrombosis (PVT) for its low risk of liver ischemia 16,17 . It has been successfully performed in downstaging strategy to liver transplantation or surgical resection 18–20 …”

To 1000 Gy and back again: a systematic review on dose-response evaluation in selective internal radiation therapy for primary and secondary liver cancer

“…Eight retrospective studies [ 5 , 28 , 32 , 34 , 37 , 38 , 40 , 42 ] have also found a significant survival benefit in patients of whom the tumour dose reaches their reported threshold (range 100–205 Gy), most of which are a two to threefold increase in overall survival.…”

“…One study has attempted to make an estimation of the T/N ratio by incorporating the hypervascularization status (based on CT imaging) into a volumetric partition model [30]. A total of 11 studies have predicted the tumour doses based on 99m Tc-MAA SPECT [5,12,26,[31][32][33][34][35][36][37][38], four have imaged the microsphere distribution with 90 Y-SPECT [39][40][41][42], and six studies have utilized 90 Y-PET [3,12,[43][44][45][46]. This has also resulted in a very wide range of reported dose thresholds, varying from 61 Gy to 1000 Gy, with the majority being between 100 and 250 Gy (13/19 studies; 68%).…”