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Ablative Transarterial Radioembolization Improves Survival in Patients with HCC and Portal Vein Tumor Thrombus

CardioVascular and Interventional Radiology volume 43, pages 411–422 (2020)Cite this article

Abstract

Purpose

Patients with hepatocellular carcinoma and portal vein tumor thrombus have a poor prognosis and limited therapeutic options. We sought to compare survival, tolerability, and safety in such patients treated with conventional yttrium-90 transarterial radioembolization dosimetric techniques or ablative transarterial radioembolization.

Materials and Methods

This retrospective, single-center cohort study included patients with hepatocellular carcinoma and right, left, and/or main portal vein tumor thrombus, preserved liver function (Child–Pugh class ≤ B7), and good performance status (Eastern Cooperative Oncology Group score ≤ 1) treated with yttrium-90 microspheres from 2011 to 2018 with ablative intent transarterial radioembolization (A-TARE), or conventional technique (cTARE). Statistical models were used to compare overall survival, post-treatment survival, toxicities, and prognosticators of response.

Results

Fifty-seven patients were included (21 [36.8%] ablative and 36 [63.2%] conventional intent). Median overall survival was 15.7 months. Compared to conventional treatment, ablative radioembolization was associated with longer median overall survival (45.3 vs 18.2 months; P = 0.003), longer post-treatment survival (19.1 vs 4.9 months; P = 0.005), a 70% lower risk of death (hazard ratio 0.30; 95% confidence interval, 0.13–0.70; P = 0.005), and improved 4-year survival (53.9% vs 11.2%). Overall survival did not differ significantly between treatment with resin and glass microspheres (27.5 vs 22.2 months; P = 0.62). Acceptable hepatic toxicities were observed after yttrium-90 administration, without statistical differences between the groups.

Conclusion

In patients with advanced hepatocellular carcinoma and portal vein tumor thrombus, A-TARE is associated with longer survival than cTARE. Neither modality is associated with deleterious effects on liver function.

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Acknowledgements

The authors thank Ashley McCrea-Strub, PhD for performing statistical analyses and Sara Gardenghi, PhD; Chantal Caviness, MD, MPH, PhD; Kristina Wasson-Blader, PhD, ELS; Shannon Hach, MD, ELS; Adia Shy, PhD; and Edward Gloria of Eubio for editorial support. D.K. has received personal fees from Merit Medical, Cook Medical, LivaNova, Surefire Medical, Philips Healthcare, grants from Biolife, outside the submitted work. H.L. has received personal fees from Roche, Ipsen, Eisai, Taiho, Lilly, and LEO, outside the submitted work. D.M.L. has received grants and personal fees from Sirtex Medical, Grants and personal fees from BTG, outside the submitted work.

Funding

This study was not supported by any funding. Medical writing support was funded by Sirtex Medical, Inc., and performed by Eubio LLC.

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Authors and Affiliations

  1. Department of Radiology, Vancouver General Hospital, University of British Columbia, 855 W 12th Ave, JP Pavilion G873, Vancouver, BC, V5Z 1M9, Canada

    Leandro Cardarelli-Leite, John Chung, Darren Klass, Frank Chou, Stephen Ho, Henry Walton, Anastasia Hadjivassiliou & David M. Liu

  2. Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada

    Vladimir Marquez

  3. British Columbia Cancer Agency, Vancouver, BC, Canada

    Howard Lim

  4. Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada

    Peter Tae Wan Kim

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  1. Leandro Cardarelli-Leite
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Contributions

LCL, JC, DK, SH, AH, and DML developed the concept and designed the study, acquired and analyzed the data, and interpreted and discussed the results. LCL, VM, HL, AH, PK, and DML participated in drafting the manuscript and critically revised its intellectual content. All authors approved the final version of the manuscript. All authors agreed to be accountable for all aspects of the work.

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Correspondence to Leandro Cardarelli-Leite.

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For this type of study formal consent is not required. The study was approved by the institutional review board.

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Informed consent was obtained from all individual participants included in the study.

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Cardarelli-Leite, L., Chung, J., Klass, D. et al. Ablative Transarterial Radioembolization Improves Survival in Patients with HCC and Portal Vein Tumor Thrombus. Cardiovasc Intervent Radiol 43, 411–422 (2020). https://doi.org/10.1007/s00270-019-02404-5

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Keywords

  • Venous thrombosis
  • Embolization
  • Therapeutic
  • Hepatectomy
  • Yttrium