Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis

Abstract

This study was undertaken to present data from a phase 2 study in which patients with unresectable hepatocellular carcinoma (HCC) with and without portal vein thrombosis underwent radioembolization with Yttrium ( 90 Y) microspheres. Patients treated were stratified by Okuda, Child-Pugh, baseline bilirubin, tumor burden, Eastern Cooperative Oncology Group (ECOG), presence of cirrhosis and portal vein thrombosis (PVT) (none, branch, and main). Clinical and biochemical data were obtained at baseline and at 4-week intervals following treatment for up to 6 months. Tumor response was obtained using computed tomography (CT). Patients were followed for survival. One hundred eight patients were treated during the study period. Thirty-seven (34%) patients had PVT, 12 (32%) of which involved the main PV. The cumulative dose for those with and without PVT was 139.7 Gy and 131.9 Gy, respectively. The partial response rate using world Health Organization

Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

“…Patients with unresectable HCC complicated by PVT do not seem to be at increased risk for hepatic failure, hepatic encephalopathy, worsening of pre-existing portal hypertension, or extension of pre-existing portal vein occlusion when administered 90 Y microspheres. Efficacy of 90 Y microspheres in patients with PVT was shown by Kulik et al In this study, 37 patients with unresectable HCC had PVT (34 %), and demonstrated favorable toxicity after radioembolization [24]. Finally, in their large single cohort prospective observational series, Salem et al have demonstrated safety of 90 Y glass microspheres in the setting of PVT, with median survival of 16 months in patients with Child A cirrhosis and branch PVT and without any increased toxicity compared to non-PVT patients [25].…”

Portal Vein Thrombosis

“…186 Similarly conformal radiotherapy induced a 45.8% objective response rate for PV obstruction in HCC and may be considered an important treatment option. 187 Patients with PV obstruction in the setting of HCC has a poor patient outcome. Patients should be assessed preoperatively whether the thrombus is associated with tumor invasion or with stagnant flow.…”

“…Only one third experienced tumor recurrence in first year post transplant and one third became long term survivors (median 36 months) with no evidence of tumor recurrence. 187 Radiation therapy is considered to be treatment of choice for selected patients with HCC and PV invasion especially for those with a favorable performance status. 188 A recent phase 2 study of Yttrium 90 radioembolization (TARE-trans arterial radioembolization) in intermediate and advanced HCC showed a median survival of 15 months with no significant difference between PV obstruction present or absent.…”

Radiation enhances long-term metastasis potential of residual hepatocellular carcinoma in nude mice through TMPRSS4-induced epithelial–mesenchymal transition

“…[1][2][3] However, even with high dose of radiation and improving delivery method, a significant number of HCC patients still have local failure and exhibit a substantially higher rate of distant metastasis than those who achieve permanent local control. Similar observations have also been found in the clinical study of other tumors.…”