Radioembolization for hepatocellular carcinoma: Statistical confirmation of improved survival in responders by landmark analyses

Abstract

Response to radioembolization in patients with solitary HCC can prognosticate improved survival. EASL necrosis criteria outperformed RECIST 1.1 size criteria in predicting survival. The therapeutic objective of radioembolization should be radiologic response and not solely to prevent progression. (Hepatology 2018;67:873-883).

Radioembolization Super Survivors: Extended Survival in Non-operative Hepatocellular Carcinoma

“…The appropriate clinical endpoint for Y90 in the treatment of HCC for improved OS is an imaging response rather than freedom from progression [17]. This is further emphasized in the present study as ALL Super Survivors had an imaging response (either WHO or EASL) in primary index lesions over the course of follow up.…”

The role of external beam radiotherapy in the treatment of hepatocellular cancer

“…Tumors derive nearly their entire blood supply from the hepatic arteries, whereas normal parenchyma derives blood supply from the portal venous system. 22 However, there have been no randomized studies comparing the survival benefits of TARE with supportive management, because both transarterial chemoembolization (TACE) and sorafenib are established standard-of-care therapies with associated survival benefit over supportive management in randomized trials. Once the microspheres become lodged at the tumor site, localized b-emission radiation treats cancer cells with limited tissue penetrance (range, 2.5-11 mm), sparing liver parenchyma.…”

“…20 In addition to high histopathologic response rates (RR), radioembolization has a reported radiologic RR of 70% for the treatment of HCC, 21 and radiologic RR have been directly correlated with survival. 22 However, there have been no randomized studies comparing the survival benefits of TARE with supportive management, because both transarterial chemoembolization (TACE) and sorafenib are established standard-of-care therapies with associated survival benefit over supportive management in randomized trials. 15,23 Retrospective reviews have reported comparable or improved OS with TARE versus TACE, [24][25][26] and a randomized trial reported a significantly longer median time to progression after TARE (>26 vs 6.8 months) but no difference in OS.…”

Intra‐arterial locoregional therapy in the management of hepatocellular carcinoma

“…EASL/Modified RECIST (mRECIST) criteria and image subtraction had excellent diagnostic performance for predicting CPN in HCC treated with LRT. A recent US study reported response to radioembolization (EASL necrosis) in patients with solitary HCC could prognosticate improved survival with accuracy.…”