Radioembolization Results in Longer Time-to-Progression and Reduced Toxicity Compared With Chemoembolization in Patients With Hepatocellular Carcinoma

Abstract

Background and Aims Chemoembolization is a standard treatment for hepatocellular carcinoma (HCC). Radioembolization with 90Y microspheres is a new, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. Methods We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up timepoints. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multi-variate analyses were performed. Results Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P<.05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs. 36%, P=0.104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, P=0.046), median survival times were not statistically different (17.4 months vs 20.5 months, P=0.232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P=0.42). Conclusion Patients with HCC treated by chemoembolization or radioembolization with 90Y microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post-hoc analyses of sample size indicated that a randomized study with >1000 patients would be required to establish equivalence of survival times between patients given the different therapies.

Is the treatment of hepatocellular carcinoma on the waiting list necessary?

“…38 A recent study retrospectively analyzed transarterial radioembolization (TARE) and TACE in similar patients (122 and 123, respectively); 44 TARE patients and 46 TACE patients were at stage T2 (they were not analyzed separately). 42 Although there was no survival benefit for TARE, the time to disease progression and the AFP responses were significantly more favorable with TARE, and this suggests that this treatment could be a promising modality before OLT.…”

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

“…(19) A comprehensive understanding of updated efficacy and safety data of lipiodol TACE in the treatment of HCC is important, especially considering that alternate options for regional hepatic tumor treatment-including arterial embolization with drug-eluting beads and internal radiation with yttrium-90 microspheres-have been proposed and are currently undergoing clinical investigation. (20,21) Therefore, we performed a systematic literature review of the available evidence on the efficacy and safety of lipiodol TACE in treatment of HCC.…”

Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation

“…This helped to minimize the risk of radiation pneumonitis due to the shunting. (98,99,103)In case of vascular shunting more than >20%, it could be embolized before therapy began. It appeared to be a safe treatment modality.…”

“…Reports found a trend towards shorter times to tumor response and longer times to tumor progression were apparent with TARE when compared with TACE (98,99), suggesting a potential advantage as a bridging therapy in patients waiting for LT.…”