Liver Decompensation as Late Complication in HCC Patients with Long-Term Response following Selective Internal Radiation Therapy

Abstract

Selective internal radiation therapy (SIRT) is used as a treatment for hepatocellular carcinoma (HCC). The aim of this study was to assess long-term liver-related complications of SIRT in patients who had not developed radioembolization-induced liver disease (REILD). The primary outcome was the percentage of patients without REILD that developed Child-Pugh (CP) ≥ B7 liver decompensation after SIRT. The secondary outcomes were overall survival (OS) and tumor response. These data were compared with a matched cohort of patients treated with sorafenib. Eighty-five patients were included, of whom 16 developed REILD. Of the remaining 69 patients, 38 developed liver decompensation CP ≥ B7. The median OS was 18 months. In patients without REILD, the median OS in patients with CP ≥ B7 was significantly shorter compared to those without CP ≥ B7; 16 vs. 31 months. In the case-matched analysis, the median OS was significantly longer in SIRT-treated patients; 16 vs. 8 months in sorafenib. Liver decompensation CP ≥ B7 occurred significantly more in SIRT when compared to sorafenib; 62% vs. 27%. The ALBI score was an independent predictor of liver decompensation (OR 0.07) and OS (HR 2.83). After SIRT, liver decompensation CP ≥ B7 often developed as a late complication in HCC patients and was associated with a shorter OS. The ALBI score was predictive of CP ≥ B7 liver decompensation and the OS, and this may be a valuable marker for patient selection for SIRT.

LiMAx Prior to Radioembolization for Hepatocellular Carcinoma as an Additional Tool for Patient Selection in Patients with Liver Cirrhosis

“…In a retrospective analysis, patients with Child–Pugh score A and ALBI grade 2 were at substantially higher mortality risk due to hepatic dysfunction after RE than patients with ALBI grade 1 [ 30 ]. Previous studies confirmed ALBI score as a helpful predictor of hepatic deterioration after RE [ 30 , 31 ]. However, it still harbors several pitfalls in tumor patients, such as inflammation and malnutrition, that can undoubtedly influence relevant parameters such as albumin as an integral part of those scores.…”

Comparison of the efficacy and safety of selective internal radiotherapy and sorafenib alone or combined for hepatocellular carcinoma: a systematic review and Bayesian network meta-analysis

“…We conducted full-text reviews of 50 potentially eligible articles, and 41 articles were excluded for not reporting relevant outcomes. Finally, our NMA included 9 original articles, with a total of 1954 patients [ 13 – 16 , 20 – 24 ]. The selection process for the study is illustrated in Fig.…”

“…We included 7 [ 13 , 14 , 20 – 24 ] studies with SIRT and sorafenib interventions, and first conducted a systematic pairwise meta-analysis of these 7 studies. A record of OS is available for all 7 studies.…”

“…SIRT is a microembolization procedure that minimizes changes in hepatic artery blood flow compared with other transarterial therapies [ 30 ]. Previous results from several retrospective studies of SIRT in patients with HCC combined with PVTT have shown that the efficacy and safety profile of SIRT was better than sorafenib [ 13 , 21 , 24 ]. This is consistent with the results of our subgroup analysis, in which SIRT prolonged OS more significantly in 100% of HCC patients with combined PVTT (HR 0.48, 95% CI 0.34–0.68).…”

Nutritional status in patients with hepatocellular carcinoma: Potential relevance for clinical outcome

“…Although decreased liver function could be due to tumor progression, potential negative effects of the anti-tumor treatment itself could also have contributed. Similarly, a recent study comparing transarterial radioembolization and sorafenib with the aid of propensity score matching analyses [47] identified decreased liver function after the radioembolization as an important negative prognostic factor. In that study, only liver decompensation occurring longer than four months post-treatment was taken into account (with the rationale to exclude earlier decompensation due to radiation-induced liver disease).…”