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Kim GM, Kim DY, Won JY, Moon S, Kim SU, Kim BK. Outcome of Transarterial Radioembolization in the Treatment of Hepatocellular Carcinoma: Glass Versus Resin Microsphere. Cardiovasc Intervent Radiol 2024; 47:1210-1221. [PMID: 38744685 DOI: 10.1007/s00270-024-03726-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To compare the treatment outcomes of glass and resin microspheres for the treatment of hepatocellular carcinoma (HCC) and evaluate the prognostic factors that influence the outcomes. MATERIALS AND METHODS We retrospectively reviewed 251 consecutive patients who underwent radioembolization for the treatment of HCC at a single tertiary center. Imaging responses after radioembolization were evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) 1.1. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard models were used to identify the prognostic factors. RESULTS A total of 195 patients were included in this study (glass microsphere, n = 75; resin microsphere, n = 120). The complete and objective response rates were 16.0% and 50.7% in the glass microsphere group and 17.5% and 58.3% in the resin microsphere group, respectively. Median PFS was 241 days in the glass microsphere group and 268 days in the resin microsphere group (p = 0.871). Median OS was 29 months in the glass microsphere group and 40 months in the resin microsphere group (p = 0.669). The only significant prognostic factor was bilobar tumor distribution, which favored resin microspheres (p = 0.023). Procedure-related adverse events occurred more frequently in the resin microsphere group (glass, 2.7% vs. resin, 5.0%; p < 0.001). CONCLUSION Glass and resin microspheres for the treatment of HCC did not show a significant difference in survival, though major adverse events occurred more frequently with the use of resin microspheres.
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Affiliation(s)
- Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
| | - Jong Yun Won
- Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Sungmo Moon
- Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
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Regnault H, Chalaye J, Galetto-Pregliasco A, Perrin C, Derbel H, Amaddeo G, Mulé S, Lequoy M, Kobeiter H, Reizine E, Itti E, Duvoux C, Laurent A, Leroy V, Sommacale D, Rasolonirina D, Luciani A, Calderaro J, Tacher V, Brustia R. Selective internal radiation therapy for unresectable HCC: The SIRT downstaging study. Hepatol Commun 2024; 8:e0475. [PMID: 38934702 PMCID: PMC11213600 DOI: 10.1097/hc9.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/02/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Selective internal radiation therapy (SIRT) is recommended as a downstaging (DS) strategy for solitary unresectable HCC <8 cm. The aim of this study was to report the results of acquired experience in a tertiary center for all unresectable HCCs. METHODS We conducted a retrospective, observational study using data collected from consecutive patients undergoing SIRT between October 2013 and June 2020. DS was considered achieved when a curative treatment could be proposed 6 months after SIRT. RESULTS One hundred twenty-seven patients were included (male = 90%, 64 ± 11 y), of whom 112 (n = 88%) had cirrhosis. HCC was classified as BCLC stage C in 64 patients (50%), with a median diameter of 61 mm, an infiltrative pattern in 51 patients (40%), and portal vein invasion in 62 (49%) patients. Fifty patients (39%) achieved DS 6 months following SIRT, with 29 of them (23%) undergoing curative treatment in a median time of 4.3 months: 17 (13%) were transplanted, 11 (85%) had liver resection, and 1 patient had a radiofrequency ablation. The median overall survival of patients with or without DS was 51 versus 10 months, respectively (p < 0.001). In patients who achieved DS, progression-free survival was higher in patients who underwent surgery: 47 versus 11 months (p < 0.001). Four variables were independently associated with DS: age (OR: 0.96, 95% CI: [0.92, 0.99]; p = 0.032), baseline α-fetoprotein (OR: 1.00, 95% CI: [1.00, 1.00]; p = 0.034), HCC distribution (OR: 0.3, 95% CI: [0.11, 0.75]; p = 0.012), and ALBI grade (OR: 0.34. 95% CI: [0.14, 0.80]; p = 0.014). CONCLUSIONS These results suggest that SIRT in patients with unresectable HCC could be an effective treatment: DS was achieved for around 39% of the patients and more than half of these then underwent curative treatment.
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Affiliation(s)
- Hélène Regnault
- Hepatology Department, Henri Mondor Hospital (AP-HP), Créteil, France
- Team “Viruses, Hepatology, Cancer”, Institut Mondor de Recherche Biomédicale, INSERM U955, Hôpital Henri Mondor (AP-HP), Université Paris-Est, Créteil, France
| | - Julia Chalaye
- Nuclear Medicine Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | | | - Clara Perrin
- Hepatology Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Haytham Derbel
- Radiology Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Giuliana Amaddeo
- Hepatology Department, Henri Mondor Hospital (AP-HP), Créteil, France
- Team “Viruses, Hepatology, Cancer”, Institut Mondor de Recherche Biomédicale, INSERM U955, Hôpital Henri Mondor (AP-HP), Université Paris-Est, Créteil, France
| | - Sébastien Mulé
- Team “Viruses, Hepatology, Cancer”, Institut Mondor de Recherche Biomédicale, INSERM U955, Hôpital Henri Mondor (AP-HP), Université Paris-Est, Créteil, France
- Radiology Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Marie Lequoy
- Hepatology Department, Saint Antoine Hospital (AP-HP), Paris, France
| | - Hicham Kobeiter
- Radiology Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Edouard Reizine
- Radiology Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Emmanuel Itti
- Nuclear Medicine Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Christophe Duvoux
- Hepatology Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Alexis Laurent
- Hepatobiliary Surgery, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Vincent Leroy
- Hepatology Department, Henri Mondor Hospital (AP-HP), Créteil, France
- Team “Viruses, Hepatology, Cancer”, Institut Mondor de Recherche Biomédicale, INSERM U955, Hôpital Henri Mondor (AP-HP), Université Paris-Est, Créteil, France
| | - Daniele Sommacale
- Hepatobiliary Surgery, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Diana Rasolonirina
- Nuclear Medicine Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Alain Luciani
- Team “Viruses, Hepatology, Cancer”, Institut Mondor de Recherche Biomédicale, INSERM U955, Hôpital Henri Mondor (AP-HP), Université Paris-Est, Créteil, France
- Radiology Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Julien Calderaro
- Team “Viruses, Hepatology, Cancer”, Institut Mondor de Recherche Biomédicale, INSERM U955, Hôpital Henri Mondor (AP-HP), Université Paris-Est, Créteil, France
- Department of Pathology, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Vania Tacher
- Team “Viruses, Hepatology, Cancer”, Institut Mondor de Recherche Biomédicale, INSERM U955, Hôpital Henri Mondor (AP-HP), Université Paris-Est, Créteil, France
- Radiology Department, Henri Mondor Hospital (AP-HP), Créteil, France
| | - Raffaele Brustia
- Team “Viruses, Hepatology, Cancer”, Institut Mondor de Recherche Biomédicale, INSERM U955, Hôpital Henri Mondor (AP-HP), Université Paris-Est, Créteil, France
- Hepatobiliary Surgery, Henri Mondor Hospital (AP-HP), Créteil, France
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Behzadi AH, Haghani L, D'Souza DL, Flanagan S, Jones C. Practical Considerations When Choosing Chemoembolization versus Radioembolization for Hepatocellular Carcinoma. Semin Intervent Radiol 2024; 41:48-55. [PMID: 38495267 PMCID: PMC10940042 DOI: 10.1055/s-0044-1779714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are common liver-directed therapies (LDTs) for unresectable HCC. While both deliver intra-arterial treatment directly to the site of the tumor, they differ in mechanisms of action and side effects. Several studies have compared their side effect profile, time to progression, and overall survival data, but often these lack practical considerations when choosing which treatment modality to use. Many factors can impact operator's choice for treatment, and the choice depends on treatment availability, cost, insurance coverage, operator's comfort level, patient-specific factors, tumor location, tumor biology, and disease stage. This review discusses survival data, time to progression data, as well as more practical patient and tumor characteristics for personalized LDT with TACE or TARE.
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Affiliation(s)
- Ashkan Heshmatzadeh Behzadi
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Leila Haghani
- Department of Interventional Radiology, Memorial Sloan Kettering, New York City, New York
| | - Donna L. D'Souza
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Siobhan Flanagan
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Christopher Jones
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
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Lee HA, Lee S, Lee HL, Song JE, Lee DH, Han S, Shim JH, Kim BH, Choi JY, Rhim H, Kim DY. The efficacy of treatment for hepatocellular carcinoma in elderly patients. JOURNAL OF LIVER CANCER 2023; 23:362-376. [PMID: 37705145 PMCID: PMC10565541 DOI: 10.17998/jlc.2023.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/22/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND/AIM Despite the increasing proportion of elderly patients with hepatocellular carcinoma (HCC) over time, treatment efficacy in this population is not well established. METHODS Data collected from the Korean Primary Liver Cancer Registry, a representative cohort of patients newly diagnosed with HCC in Korea between 2008 and 2017, were analyzed. Overall survival (OS) according to tumor stage and treatment modality was compared between elderly and non-elderly patients with HCC. RESULTS Among 15,186 study patients, 5,829 (38.4%) were elderly. A larger proportion of elderly patients did not receive any treatment for HCC than non-elderly patients (25.2% vs. 16.7%). However, OS was significantly better in elderly patients who received treatment compared to those who did not (median, 38.6 vs. 22.3 months; P<0.001). In early-stage HCC, surgery yielded significantly lower OS in elderly patients compared to non-elderly patients (median, 97.4 vs. 138.0 months; P<0.001), however, local ablation (median, 82.2 vs. 105.5 months) and transarterial therapy (median, 42.6 vs. 56.9 months) each provided comparable OS between the two groups after inverse probability of treatment weighting (IPTW) analysis (all P>0.05). After IPTW, in intermediate-stage HCC, surgery (median, 66.0 vs. 90.3 months) and transarterial therapy (median, 36.5 vs. 37.2 months), and in advanced-stage HCC, transarterial (median, 25.3 vs. 26.3 months) and systemic therapy (median, 25.3 vs. 26.3 months) yielded comparable OS between the elderly and non-elderly HCC patients (all P>0.05). CONCLUSIONS Personalized treatments tailored to individual patients can improve the prognosis of elderly patients with HCC to a level comparable to that of non-elderly patients.
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Affiliation(s)
- Han Ah Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sangheun Lee
- Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Hae Lim Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Eun Song
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Dong Hyeon Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sojung Han
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Eulji University School of Medicine, Uijeongbu, Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Hyun Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Jong Young Choi
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Cancer Center, Severance Hospital, Seoul, Korea
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Shannon AH, Manne A, Diaz Pardo DA, Pawlik TM. Combined radiotherapy and immune checkpoint inhibition for the treatment of advanced hepatocellular carcinoma. Front Oncol 2023; 13:1193762. [PMID: 37554167 PMCID: PMC10405730 DOI: 10.3389/fonc.2023.1193762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
Hepatocellular Carcinoma (HCC) is one of the most common cancers and a leading cause of cancer related death worldwide. Until recently, systemic therapy for advanced HCC, defined as Barcelona Clinic Liver Cancer (BCLC) stage B or C, was limited and ineffective in terms of long-term survival. However, over the past decade, immune check point inhibitors (ICI) combinations have emerged as a potential therapeutic option for patients with nonresectable disease. ICI modulate the tumor microenvironment to prevent progression of the tumor. Radiotherapy is a crucial tool in treating unresectable HCC and may enhance the efficacy of ICI by manipulating the tumor microenvironment and decreasing tumor resistance to certain therapies. We herein review developments in the field of ICI combined with radiotherapy for the treatment of HCC, as well as look at challenges associated with these treatment modalities, and review future directions of combination therapy.
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Affiliation(s)
- Alexander H. Shannon
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Ashish Manne
- Department of Internal Medicine, Division of Medical Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Dayssy A. Diaz Pardo
- Department of Radiation Oncology, The Ohio State University, Comprehensive Cancer Center-James Hospital and Solove Research Institute, Columbus, OH, United States
| | - Timothy M. Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Filippi L, Bagni O, Notarianni E, Saltarelli A, Ambrogi C, Schillaci O. PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study. Biomedicines 2022; 10:biomedicines10112996. [PMID: 36428565 PMCID: PMC9687226 DOI: 10.3390/biomedicines10112996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Our aim was to assess the role of positron emission computed tomography (PET/CT) with 18F-choline (18F-FCH) or 18F-fluorodeoxyglucose (18F-FDG) in hepatocellular carcinoma (HCC) submitted to 90Y-radioembolization (90Y-TARE). We retrospectively analyzed clinical records of 21 HCC patients submitted to PET/CT with 18F-fluorocholine (18F-FCH) or 18F-fluodeoxyglucose (18F-FDG) before and 8 weeks after 90Y-TARE. On pre-treatment PET/CT, 13 subjects (61.9%) were 18F-FCH-positive, while 8 (38.1%) resulted 18F-FCH-negative and 18F-FDG-positive. At 8-weeks post 90Y-TARE PET/CT, 13 subjects showed partial metabolic response and 8 resulted non-responders, with a higher response rate among 18F-FCH-positive with respect to 18F-FDG-positive patients (i.e., 76.9% vs. 37.5%, p = 0.46). Post-treatment PET/CT influenced patients’ clinical management in 10 cases (47.6%); in 8 subjects it provided indication for a second 90Y-TARE targeting metabolically active HCC remnant, while in 2 patients it led to a PET-guided radiotherapy on metastatic nodes. By Kaplan−Meier analysis, patients’ age (≤69 y) and post 90Y-TARE PET/CT’s impact on clinical management significantly correlated with overall survival (OS). In Cox multivariate analysis, PET/CT’s impact on clinical management remained the only predictor of patients’ OS (p < 0.001). In our real-world study, PET/CT with 18F-FCH or 18F-FDG influenced clinical management and affected the final outcome for HCC patients treated with 90Y-TARE.
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Affiliation(s)
- Luca Filippi
- Nuclear Medicine Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
- Correspondence: ; Tel.: +39-07736553591
| | - Oreste Bagni
- Nuclear Medicine Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Ermanno Notarianni
- Diagnostic and Interventional Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Adelchi Saltarelli
- Diagnostic and Interventional Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Cesare Ambrogi
- Diagnostic and Interventional Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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Prognostic factors of elderly patients with hepatocellular carcinoma: should we be more courageous in treatment? Eur J Gastroenterol Hepatol 2022; 34:956-960. [PMID: 35830357 DOI: 10.1097/meg.0000000000002396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis, its incidence increases with age. The risk of developing HCC is highest in the seventh decade. In this study, we aimed to determine the clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC in the elderly and young populations. METHODS All patients aged ≥18 years who were diagnosed histologically between 2016 and 2020 were included in the study. Patients were divided into two groups: <70 years and ≥70 years. The clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC were compared in the elderly and young populations. RESULTS A total of 407 patients were evaluated. There were 164 patients (40.3%) in the geriatric age group. There was no significant difference in the female/male ratio, the laboratory values, survival time between the two groups. There was no significant difference between the two groups in terms of tumor focality and portal vein invasion ( P > 0.05). The presence of NAFLD, maximal tumor diameter (MTD), and portal invasion were found to be significant for survival according to the univariate analysis in elderly group ( P < 0.05). In the multivariate analysis, presence of NAFLD etiologically, and MTD independent risk factors were observed in elderly group ( P < 0.05). CONCLUSION If the clinicomorphological features of the tumor and prognostic risk factors can be determined by examining the patients in detail, all treatments can be easily applied in the geriatric group.
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Inflammatory Indexes as Prognostic Factors of Survival in Geriatric Patients with Hepatocellular Carcinoma: A Case Control Study of Eight Slovak Centers. J Clin Med 2022; 11:jcm11144183. [PMID: 35887947 PMCID: PMC9318669 DOI: 10.3390/jcm11144183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background and Aims: Hepatocellular cancer (HCC) often occurs in geriatric patients. The aim of our study was to compare overall survival and progression-free survival between geriatric patients (>75 years) and patients younger than 75 years and to identify predictive factors of survival in geriatric patients with HCC. Material and Methods: We performed a retrospective analysis of patients with HCC diagnosed in Slovakia between 2010−2016. Cases (HCC patients ≥75 years) were matched to controls (HCC patients <74 years) based on the propensity score (gender, BCLC stage and the first-line treatment). Results: We included 148 patients (84 men, 57%) with HCC. There were no differences between cases and controls in the baseline characteristics. The overall survival in geriatric patients with HCC was comparable to younger controls (p = 0.42). The one-, two-, and three-year overall survival was 42% and 31%, 19% and 12%, and 12% and 9% in geriatric patients and controls, respectively (p = 0.2, 0.4, 0.8). Similarly, there was no difference in the one- and two-year progression-free survival: 28% and 18% vs. 10% and 7% in geriatric HCC patients and controls, respectively (p = 0.2, 1, -). There was no case−control difference between geriatric HCC patients and younger HCC controls in the overall survival in the subpopulation of patients with no known comorbidities (p = 0.5), one and two comorbidities (p = 0.49), and three or more comorbidities (p = 0.39). Log (CRP), log (NLR), log (PLR), and log (SII) were all associated with the three-year survival in geriatric HCC patients in simple logistic regression analyses. However, this time, only log (NLR) remained associated even after controlling for the age and BCLC confounding (OR 5.32, 95% CI 1.43−28.85). Conclusions. We found no differences in overall survival and progression-free survival between older and younger HCC patients. Parameters of subclinical inflammation predict prognosis in geriatric patients with HCC. A limitation of the study is small number of the treated patients; therefore, further investigation is warranted.
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Machida K, Tahara SM. Immunotherapy and Microbiota for Targeting of Liver Tumor-Initiating Stem-like Cells. Cancers (Basel) 2022; 14:2381. [PMID: 35625986 PMCID: PMC9139909 DOI: 10.3390/cancers14102381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 02/08/2023] Open
Abstract
Cancer contains tumor-initiating stem-like cells (TICs) that are resistant to therapies. Hepatocellular carcinoma (HCC) incidence has increased twice over the past few decades, while the incidence of other cancer types has trended downward globally. Therefore, an understanding of HCC development and therapy resistance mechanisms is needed for this incurable malignancy. This review article describes links between immunotherapies and microbiota in tumor-initiating stem-like cells (TICs), which have stem cell characteristics with self-renewal ability and express pluripotency transcription factors such as NANOG, SOX2, and OCT4. This review discusses (1) how immunotherapies fail and (2) how gut dysbiosis inhibits immunotherapy efficacy. Gut dysbiosis promotes resistance to immunotherapies by breaking gut immune tolerance and activating suppressor immune cells. Unfortunately, this leads to incurable recurrence/metastasis development. Personalized medicine approaches targeting these mechanisms of TIC/metastasis-initiating cells are emerging targets for HCC immunotherapy and microbiota modulation therapy.
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Affiliation(s)
- Keigo Machida
- Southern California Research Center for ALPD and Cirrhosis, Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, 2011 Zonal Ave., 503C-HMR, Los Angeles, CA 90033, USA;
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Selective internal radiation therapy in older patients with hepatocellular carcinoma: a retrospective analysis. Eur J Gastroenterol Hepatol 2022; 34:417-421. [PMID: 34284416 DOI: 10.1097/meg.0000000000002255] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Selective internal radiation therapy (SIRT) is applied to hepatocellular carcinoma (HCC), a disease with increased incidence in the elderly. However, SIRT has rarely been specifically studied in elderly population. The aim of this study was to investigate efficacy and safety of SIRT in elderly HCC patients. METHODS We studied retrospectively data from patients treated with SIRT for HCC. Clinical and laboratory data were retrieved. We used 70-years old as threshold between younger and elderly populations, to compare outcomes. RESULTS A total of 222 patients treated with SIRT for HCC were studied, of which 134 patients were younger and 88 older. Median overall survival (OS) was not significantly different between younger and elderly group: 15.6 months (95% CI, 11.7-19.5) and 14.8 months (95% CI, 9.4-20.3) (P = 0.86). Age was not associated with OS in multivariable analysis, with a Hazard ratio of 1.09 (95% CI, 0.82-1.45, P = 0.55). Results of progression-free survival and responses were also similar in both groups. Toxicities were similar between the two groups, including the occurrence of radioembolization-induced liver disease (11.5 vs. 11.4%, P = 0.97). CONCLUSION SIRT appears to be a well-tolerated treatment with the same efficacy in elderly compared to younger patients in HCC. Our study is the first to study its impact with glass microspheres. This warrants confirmation in large prospective studies.
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Yang C, Feng H, Dai C. Development and validation of an immune‐related prognosis signature associated with hypoxia and ferroptosis in hepatocellular carcinoma. Cancer Med 2022; 11:2329-2341. [PMID: 35092175 PMCID: PMC9160815 DOI: 10.1002/cam4.4556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Hypoxia and ferroptosis are crucial in the occurrence and development of hepatocellular carcinoma (HCC), and they both affect the immune status of the tumor microenvironment. Previous studies have also shown a link between hypoxia and ferroptosis. Patients and methods In all, 814 HCC cases from The Cancer Genome Atlas and Gene Expression Omnibus databases were used as the discovery cohort, and 230 HCC cases from the International Cancer Genome Consortium database were used as the validation cohort. Hypoxia subtypes and ferroptosis subtypes were identified by consensus cluster analysis according to 174 hypoxia‐related genes and 193 ferroptosis‐related genes. The prognostic signature was constructed using the Cox and LASSO regression analyses, and two risk groups were identified. A comprehensive analysis of the clinical and immune characteristics between the two risk groups was further performed. Results Two hypoxia subtypes and two ferroptosis subtypes were distinguished and verified; subsequently, a five‐gene prognostic signature was constructed and the risk score could be acquired by the following formula: risk score = 0.0604*Expression (CA9)−0.0714*Expression (ANXA10) + 0.1501*Expression (CDC20)−0.0853*Expression (CYP7A1) + 0.0530*Expression (SPP1). Compared with the low‐risk group, the high‐risk group had a worse prognosis. The high‐risk group also showed a higher level of immune infiltration than the low‐risk group, and immune checkpoints were generally upregulated in the high‐risk group. The antigen presentation ability of the low‐risk group was poor, which may be related to the immune escape mechanism. Drug sensitivity analysis indicated that the high‐ and low‐risk groups were sensitive to tyrosine kinase inhibitors and chemotherapeutic drugs, respectively. Conclusion The hypoxia‐, ferroptosis‐, and immune‐associated prognostic signature we constructed could stratify patients with HCC and guide precise treatment.
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Affiliation(s)
- Chun‐Bo Yang
- Department of General Surgery Shengjing Hospital of China Medical University Shenyang Liaoning China
| | - Han‐Xin Feng
- Department of General Surgery Shengjing Hospital of China Medical University Shenyang Liaoning China
| | - Chao‐Liu Dai
- Department of General Surgery Shengjing Hospital of China Medical University Shenyang Liaoning China
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12
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Kim MA, Jang H, Choi NR, Nam JY, Lee YB, Cho EJ, Lee JH, Yu SJ, Kim HC, Chung JW, Yoon JH, Kim YJ. Yttrium-90 Radioembolization Is Associated with Better Clinical Outcomes in Patients with Hepatocellular Carcinoma Compared with Conventional Chemoembolization: A Propensity Score-Matched Study. J Hepatocell Carcinoma 2021; 8:1565-1577. [PMID: 34909425 PMCID: PMC8665867 DOI: 10.2147/jhc.s335879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background Both trans-arterial radioembolization (TARE) and conventional trans-arterial chemoembolization (TACE) can effectively control hepatocellular carcinoma (HCC) in patients who are not suitable for curative resection. This study compared the effectiveness of TARE and conventional TACE as the initial trans-arterial treatment for hepatocellular carcinoma (HCC) assessed by tumor response and clinical outcomes. Material and Methods Data were retrospectively analyzed the propensity score-matched cohort for overall survival (OS), progression-free survival (PFS), and intrahepatic PFS in patients who have received TARE or TACE as the first HCC treatment from March 2012 to December 2017. Results A total of 138 patients initially treated with TARE (n = 54) or TACE (n = 84) was included in this study. Of 138 patients, median age was 59 years and the mean follow-up period was 27.6 months. TARE showed better OS (hazard ratio [HR] = 0.54, 95% confidence interval [CI] = 0.31–0.92, log-rank P = 0.02), better PFS (HR = 0.51, 95% CI = 0.36–0.97, log-rank P = 0.04), and better intrahepatic PFS (HR = 0.51, 95% CI = 0.30–0.88, log-rank P = 0.01) compared with TACE. TARE was an independent prognostic factor for OS (adjusted HR [aHR] = 0.52, 95% CI = 0.30–0.90, P = 0.02), PFS (aHR = 0.57, 95% CI = 0.35–0.94, P = 0.03), and intrahepatic PFS (aHR = 0.49, 95% CI = 0.28–0.84, P = 0.01). Conclusion TARE as initial trans-arterial treatment is associated with better clinical outcomes such as longer OS compared with TACE in patients with HCC.
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Affiliation(s)
- Minseok Albert Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Heejoon Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Na Ryung Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Joon Yeul Nam
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Lakhoo J, Perez TH, Borgmann AJ, Brown DB. Lobar Radioembolization for Intermediate and Advanced Hepatocellular Carcinoma: Retrospective and Prospective Data. Semin Intervent Radiol 2021; 38:412-418. [PMID: 34629707 DOI: 10.1055/s-0041-1733903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Historically, outcomes reporting for radioembolization with yttrium-90 ( 90 Y) of hepatocellular carcinoma has included patients across the range of Barcelona Clinic Liver Cancer (BCLC) stages. With the potential for curative radiation segmentectomy for BCLC 0/A patients and evolution of systemic therapy for BCLC C patients, focused review by group is of increasing interest. In this review, we report on efficacy of 90 Y in patients with intermediate (BCLC B) and advanced (BCLC C) hepatocellular carcinoma as well as expected toxicities. Additionally, we review existing trials comparing 90 Y to transarterial chemoembolization and systemic treatments in these patient groups and outline future studies.
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Affiliation(s)
- Janesh Lakhoo
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas H Perez
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony J Borgmann
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Pollock RF, Colaone F, Shergill S, Brennan VK, Agirrezabal I. Effects of Trial Population Selection on Quality of Life and Healthcare Decision-Making: A Systematic Review and Example in the Treatment of Hepatocellular Carcinoma with Radioembolization. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:835-841. [PMID: 34588788 PMCID: PMC8473933 DOI: 10.2147/ceor.s319857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Quality of life is among the most important considerations in the treatment of hepatocellular carcinoma (HCC), arguably second only to overall survival. Measuring and modeling patient quality of life is also crucial in the evaluation of the cost-effectiveness of health interventions. In the present study, we aimed to identify cost-utility analyses comparing selective internal radiation therapy (SIRT) with systemic therapy in patients with unresectable HCC and to compare the modeled incremental quality of life differences between the two therapies. Methods A systematic literature review was conducted. PubMed, EMBASE, the Cochrane Library, and health technology assessment agency websites were searched to identify cost–utility studies of SIRT versus systemic therapies in the treatment of HCC. Key characteristics of the studies, modeled populations and incremental quality of life outcomes were extracted from the included studies. Results The systematic literature review retrieved 1140 studies, of which four were ultimately included. Hand searches then identified two distinct analyses, and an updated version of one of the four studies identified initially. From these seven studies, 18 analyses were included. Analyses using data from the overall trial populations reported incremental quality-of-life estimates spanning −0.09 to +0.28 quality-adjusted life years (QALYs), with that range expanding to −0.09 to +0.60 QALYs when also considering post hoc sub-group analyses. Conclusion The wide range of incremental QALYs, with substantial differences between overall trial populations and subgroups, illustrates the impact that the choice of target population may have on the relative quality of life outcomes of the compared interventions, which may in turn affect clinical decision-making. The small differences also highlight both the importance of reporting measures of dispersion around the findings, and the limitations of the incremental cost-effectiveness ratio (ICER) for assessing the relative cost-effectiveness of interventions that are predicted to result in similar quality-of-life outcomes.
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Affiliation(s)
- Richard F Pollock
- Health Economics and Outcomes Research, Covalence Research Ltd, London, UK
| | - Fabien Colaone
- Global Health Economics, Pricing, Reimbursement & Market Access, Sirtex Medical United Kingdom Ltd, London, UK
| | - Suki Shergill
- Global Health Economics, Pricing, Reimbursement & Market Access, Sirtex Medical United Kingdom Ltd, London, UK
| | - Victoria K Brennan
- Global Health Economics, Pricing, Reimbursement & Market Access, Sirtex Medical United Kingdom Ltd, London, UK
| | - Ion Agirrezabal
- Global Health Economics, Pricing, Reimbursement & Market Access, Sirtex Medical United Kingdom Ltd, London, UK
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15
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Management of Liver Tumors during the COVID-19 Pandemic: The Added Value of Selective Internal Radiation Therapy (SIRT). J Clin Med 2021; 10:jcm10194315. [PMID: 34640332 PMCID: PMC8509348 DOI: 10.3390/jcm10194315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background: In the context of the coronavirus disease 2019 (COVID-19) pandemic, liver-directed therapies (LDTs) may offer minimally invasive integrative tools for tumor control. Among them, selective internal radiation therapy (SIRT) represents a safe, flexible and effective treatment. Purpose of this study is to present our experience with SIRT during the first wave of COVID-19 pandemic and provide an overview of the indications and challenges of SIRT in this scenario. Methods: We retrospectively analyzed the number of patients evaluated by Multidisciplinary Liver Tumor Board (MLTB) and who were undergoing LDTs between March and July 2020 and compared it with 2019. For patients treated with SIRT, clinical data, treatment details and the best radiological response were collected. Results: Compared to 2019, we observed a 27.5% reduction in the number of patients referred to MLTB and a 28.3% decrease in percutaneous ablations; transarterial chemoembolizations were stable, while SIRT increased by 64%. The majority of SIRT patients (75%) had primary tumors, mostly HCC. The best objective response and disease control rates were 56.7% and 72.2%, respectively. Conclusion: The first wave of the COVID-19 pandemic was characterized by an increased demand for SIRT, which represents a safe, flexible and effective treatment, whose manageability will further improve by simplifying the treatment workflow, developing user-friendly and reliable tools for personalized dosimetry and improving interdisciplinary communication.
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16
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Shah RM, Sheikh S, Shah J, Vivian E, Mejia A, Shahin I, Mantry PS. Prognostic factors of unresectable hepatocellular carcinoma treated with yttrium-90 radioembolization: results from a large cohort over 13 years at a single center. J Gastrointest Oncol 2021; 12:1718-1731. [PMID: 34532122 DOI: 10.21037/jgo-20-435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background A previous study of patients with unresectable hepatocellular carcinoma (HCC) was extended to further examine factors associated with overall survival (OS) after selective internal radiation therapy with yttrium-90 resin microspheres (Y90 SIRT). Methods Data from patients of any age diagnosed with unresectable HCC and treated with Y90 SIRT at our institution from 2004 through 2017 were retrospectively analyzed. Among other criteria, patients had to have Eastern Cooperative Oncology Group performance status 0 to 2, not have received Y90 SIRT previously, and not have extrahepatic disease. Primary outcome was OS; secondary outcomes included tumor response and adverse events (AEs). Kaplan-Meier survival analyses and multivariable Cox proportional hazards models were used to evaluate prognostic factors for OS. Results Of the 226 patients, 59% were White, 77% were male, and the mean age at first SIRT procedure was 65.1±9.4 years. More than half had received previous treatment for HCC. The most common etiology was hepatitis C (n=138/224 available, 62%), followed by alcohol use (n=45, 20%), and nonalcoholic steatohepatitis (n=27, 12%). The mean model for end-stage liver disease score at baseline was 8.8±2.2. Patients were followed-up for a median of 12.2 months (95% CI, 0.0-62.6). Median OS was 16.6 months (95% CI, 13.1 to not reached). Bilobar disease, higher albumin-bilirubin score at baseline, prior treatment with sorafenib, alcohol use etiology, and higher administered dose were associated with shorter survival, whereas subsequent liver transplant [in 26 patients (11.5%)] was associated with longer survival. Of the 186 patients with AEs data, 75 (40.3%) patients reported an event and, of these, 13 (17.3%) patients had grade 4 bilirubin values. Conclusions In a large, diverse population treated at a single center over 13 years, Y90 SIRT produced a median OS of 16.6 months in patients with unresectable HCC and enabled subsequent transplantation in a subset of patients. Factors affecting the length of survival should be considered when making treatment decisions for unresectable HCC.
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Affiliation(s)
- Rucha M Shah
- Gastroenterology and Hepatology, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Sarah Sheikh
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Jimmy Shah
- Methodist Digestive Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Elaina Vivian
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Alejandro Mejia
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Islam Shahin
- Interventional Radiology, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Parvez S Mantry
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
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17
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Van Thai N, Thinh NT, Ky TD, Bang MH, Giang DT, Ha LN, Son MH, Tien DD, Lee HW. Efficacy and safety of selective internal radiation therapy with yttrium-90 for the treatment of unresectable hepatocellular carcinoma. BMC Gastroenterol 2021; 21:216. [PMID: 33980171 PMCID: PMC8114697 DOI: 10.1186/s12876-021-01805-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/30/2021] [Indexed: 02/01/2023] Open
Abstract
Background This retrospective analysis was undertaken to evaluate the efficiency of SIRT with Y-90 microspheres and determined prognostic factors affecting patients with unresectable HCC. Methods A total of 97 patients diagnosed with unresectable HCC who underwent SIRT with Y-90 microspheres. Patient survival was assessed using the Kaplan–Meier method, and prognostic factors affecting survival were assessed using log-rank tests and Cox proportional hazards regression. Results Among the 97 patients (90 males, mean age 60.4 ± 12.3 years) who underwent SIRT, the median clinical follow-up was 16.4 (1.8–62) months. The median overall survival (OS) was 23.9 ± 2.4 months. Tumor response according to the Modified RECIST in patients followed up beyond 6 months included a complete response (CR) to treatment in 12 patients (18.8%), partial response (PR) in 23 (35.8%), stable disease (SD) in 8 (12.5%), and progressive disease (PD) in 21 (32.8%). Factors associated with longer OS included age > 65 years, BCLC stage B, tumor size < 5 cm, tumor burden < 25%, and tumor response (CR/PR). In multivariate analysis, unilobar disease and objective tumor response (CR/PR) were predictors of longer OS. Conclusion SIRT was an effective treatment for unresectable HCC. Unilobar disease before SIRT and tumor response (CR/PR) were positive prognostic factors.
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Affiliation(s)
- Nguyen Van Thai
- Department of Hepato-Gastroenterology, 108 Military Central Hospital, 1 Tran Hung Dao Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Nguyen Tien Thinh
- Department of Hepato-Gastroenterology, 108 Military Central Hospital, 1 Tran Hung Dao Street, Hai Ba Trung District, Hanoi, Vietnam.
| | - Thai Doan Ky
- Department of Hepato-Gastroenterology, 108 Military Central Hospital, 1 Tran Hung Dao Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Mai Hong Bang
- Department of Hepato-Gastroenterology, 108 Military Central Hospital, 1 Tran Hung Dao Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Dinh Truong Giang
- Department of Hepato-Gastroenterology, 108 Military Central Hospital, 1 Tran Hung Dao Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Le Ngoc Ha
- Department of Nuclear Medicine, 108 Military Central Hospital, Hanoi, Vietnam
| | - Mai Hong Son
- Department of Nuclear Medicine, 108 Military Central Hospital, Hanoi, Vietnam
| | - Dao Duc Tien
- Department of Hepato-Gastroenterology, 175 Military Hospital, Ho Chi Minh, Vietnam
| | - Hyun Woong Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
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Selective Internal Radiation Therapy for Hepatocellular Carcinoma Across the Barcelona Clinic Liver Cancer Stages. Dig Dis Sci 2021; 66:899-911. [PMID: 32281043 DOI: 10.1007/s10620-020-06245-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the second most common lethal cancer, and there is a need for effective therapies. Selective internal radiation therapy (SIRT) has been increasingly used, but is not supported by guidelines due to a lack of solid evidence. AIMS Determine the efficacy and safety of SIRT in HCC across the Barcelona Clinic Liver Cancer (BCLC) stages A, B, and C. METHODS Consecutive patients that received SIRT between 2006 and 2016 at two centers in Canada were evaluated. RESULTS We analyzed 132 patients, 12 (9%), 62 (47%), and 58 (44%) belonged to BCLC stages A, B, and C; mean age was 61.2 (SD ± 9.2), and 89% were male. Median survival was 12.4 months (95% CI 9.6-16.6), and it was different across the stages: 59.7 (95% CI NA), 12.8 (95% CI 10.2-17.5), and 9.3 months (95% CI 5.9-11.8) in BCLC A, B, and C, respectively (p = 0.009). Independent factors associated with survival were previous HCC treatment (HR 2.01, 95% CI 1.23-3.27, p = 0.005), bi-lobar disease (HR 2.25, 95% CI 1.30-3.89, p = 0.003), ascites (HR 1.77, 95% CI 0.99-3.13, p = 0.05), neutrophil-to-lymphocyte ratio (HR 1.11, 95% CI 1.02-1.20, p = 0.01), Albumin-Bilirubin (ALBI) grade-3 (HR 2.69, 95% CI 1.22-5.92, p = 0.01), tumor thrombus (HR 2.95, 95% CI 1.65-5.24, p < 0.001), and disease control rate (HR 0.62, 95% CI 0.39-0.96, p = 0.03). Forty-four (33%) patients developed severe adverse events, and ALBI-3 was associated with higher risk of these events. CONCLUSIONS SIRT has the potential to be used across the BCLC stages in cases with preserved liver function. When using it as a rescue treatment, one should consider variables reflecting liver function, HCC extension, and systemic inflammation, which are associated with mortality.
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Meriggi F, Graffeo M. Clinical Characterisation and Management of the Main Treatment-Induced Toxicities in Patients with Hepatocellular Carcinoma and Cirrhosis. Cancers (Basel) 2021; 13:584. [PMID: 33540870 PMCID: PMC7867371 DOI: 10.3390/cancers13030584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) continues to increase worldwide, particularly in Western countries. In almost all cases, HCC develops in subjects with hepatic cirrhosis, often as the result of hepatitis B or C virus infection, alcohol abuse or metabolic forms secondary to non-alcoholic steatohepatitis. Patients with HCC and hepatic symptoms can therefore present symptoms that are attributable to both conditions. These patients require multidisciplinary management, calling for close interaction between the hepatologist and the oncologist. Indeed, the treatment of HCC requires, depending on the disease stage and the degree of hepatic impairment, locoregional therapies that can in turn be broken down into surgical and nonsurgical treatments and systemic treatments used in the event of progression after the administration of locoregional treatments. The past decade has seen the publication of countless papers of great interest that have radically changed the scenario of treatment for HCC. Novel therapies with biological agents and immunotherapy have come to be standard options in the approach to treatment of this cancer, obtaining very promising results where in the past chemotherapy was almost never able to have an impact on the course of the disease. However, in addition to being costly, these drugs are not devoid of adverse effects and their management cannot forgo the consideration of the underlying hepatic impairment. Patients with HCC and cirrhosis therefore require special attention, starting from the initial characterisation needed for an appropriate selection of those to be referred for treatment, as these patients are almost never fit. In this chapter, we will attempt to investigate and clarify the key points of the management of the main toxicities induced by locoregional and systemic treatments for HCC secondary to cirrhosis.
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Affiliation(s)
- Fausto Meriggi
- Oncology Department, Istituto Ospedaliero Fondazione Poliambulanza, Via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Massimo Graffeo
- Hepatology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Via Leonida Bissolati 57, 25124 Brescia, Italy;
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Marqueen KE, Kim E, Ang C, Mazumdar M, Buckstein M, Ferket BS. Cost-Effectiveness Analysis of Selective Internal Radiotherapy With Yttrium-90 Versus Sorafenib in Locally Advanced Hepatocellular Carcinoma. JCO Oncol Pract 2021; 17:e266-e277. [PMID: 33417490 DOI: 10.1200/op.20.00443] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The recent sorafenib versus radioembolization in advanced hepatocellular carcinoma (SARAH) and selective internal radiation therapy versus sorafenib in locally advanced hepatocellular carcinoma (SIRveNIB) trials showed no statistically significant difference in overall survival for randomization to selective internal radiotherapy (SIRT) versus sorafenib for locally advanced hepatocellular carcinoma, although SIRT was better tolerated. Given the high cost of both treatments, we investigated their comparative cost-effectiveness from a US healthcare sector perspective. PATIENTS AND METHODS We constructed a state-transition microsimulation model to simulate patients allocated to SIRT versus sorafenib according to an intention-to-treat principle. Hazard rates of disease progression and death were based on pooled individual patient data generated from the SARAH and SIRveNIB trials' Kaplan-Meier curves. Inputs for adverse events, treatment adherence, and quality of life utility weights were derived from trial data as well. Costs were based on Medicare reimbursement rates and literature. We performed probabilistic sensitivity analysis and estimated costs and quality-adjusted life years (QALYs) over a 5-year time horizon. We evaluated sensitivity to uncertainty of key model parameters. RESULTS Costs were $78,859 v $58,397 (difference $20,462; 95% uncertainty interval $14,444 to 27,205) and QALYs were 0.88 v 0.87 (difference 0.02, -0.02 to 0.05) for sorafenib versus SIRT, respectively. The incremental cost-effectiveness ratio (ICER) of sorafenib was $1,280,224/QALY. The likelihood that sorafenib would be cost effective did not exceed 1%, assuming cost-effectiveness thresholds up to $200k/QALY. If the monthly price of sorafenib decreased from $16,390 to below $7,000, the ICER of sorafenib fell below $200k/QALY, and an ICER < $100k/QALY was reached if the monthly price fell below $6,600. CONCLUSION Sorafenib is unlikely to provide a gain in quality-adjusted survival compared with SIRT at an acceptable cost for the US healthcare sector. Only if the current price decreased by more than 50% would sorafenib be considered economically attractive.
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Affiliation(s)
- Kathryn E Marqueen
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edward Kim
- Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Madhu Mazumdar
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bart S Ferket
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Auditore L, Amato E, Boughdad S, Meyer M, Testart N, Cicone F, Beigelman-Aubry C, Prior JO, Schaefer N, Gnesin S. Monte Carlo 90Y PET/CT dosimetry of unexpected focal radiation-induced lung damage after hepatic radioembolisation. Phys Med Biol 2020; 65:235014. [PMID: 33245055 DOI: 10.1088/1361-6560/abbc80] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Transarterial radioembolization (TARE) with 90Y-loaded microspheres is an established therapeutic option for inoperable hepatic tumors. Increasing knowledge regarding TARE hepatic dose-response and dose-toxicity correlation is available but few studies have investigated dose-toxicity correlation in extra-hepatic tissues. We investigated absorbed dose levels for the appearance of focal lung damage in a case of off-target deposition of 90Y microspheres and compared them with the corresponding thresholds recommended to avoiding radiation induced lung injury following TARE. A 64-year-old male patient received 1.6 GBq of 90Y-labelled glass microspheres for an inoperable left lobe hepatocellular carcinoma. A focal off-target accumulation of radiolabeled microspheres was detected in the left lung upper lobe at the post-treatment 90Y-PET/CT, corresponding to a radiation-induced inflammatory lung lesion at the 3-months 18F-FDG PET/CT follow-up. 90Y-PET/CT data were used as input for Monte-Carlo based absorbed dose estimations. Dose-volume-histograms were computed to characterize the heterogeneity of absorbed dose distribution. The dose level associated with the appearance of lung tissue damage was estimated as the median absorbed dose measured at the edge of the inflammatory nodule. To account for respiratory movements and possible inaccuracy of image co-registration, three different methods were evaluated to define the irradiated off-target volume. Monte Carlo-derived absorbed dose distribution showed a highly heterogeneous absorbed dose pattern at the site of incidental microsphere deposition (volume = 2.13 ml) with a maximum dose of 630 Gy. Absorbed dose levels ranging from 119 Gy to 133 Gy, were estimated at the edge of the inflammatory nodule, depending on the procedure used to define the target volume. This report describes an original Monte Carlo based patient-specific dosimetry methodology for the study of the radiation-induced damage in a focal lung lesion after TARE. In our patient, radiation-induced focal lung damage occurred at significantly higher absorbed doses than those considered for single administration or cumulative lung dose delivered during TARE.
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Affiliation(s)
- Lucrezia Auditore
- Section of Radiological Sciences, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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van Roekel C, Braat AJAT, Smits MLJ, Bruijnen RCG, de Keizer B, Lam MGEH. Radioembolization. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arora SP, Liposits G, Caird S, Dunne RF, Moffat GT, Okonji D, Rodriquenz MG, Dua D, Dotan E. Hepatocellular carcinoma in older adults: A comprehensive review by Young International Society of Geriatric Oncology. J Geriatr Oncol 2019; 11:557-565. [PMID: 31704038 DOI: 10.1016/j.jgo.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/12/2019] [Accepted: 10/03/2019] [Indexed: 02/08/2023]
Abstract
Given the prevalence and the rising incidence of hepatocellular carcinoma (HCC) in older adults worldwide, there is an urgent need to improve our understanding of the implications of treatment modalities in this population. The care of older patients with HCC is challenging due to the lack of evidence-based recommendations in this population. The current treatment approach for older patients relies on extrapolation of data from clinical trials conducted mostly in younger patients or fit older adults. Further, in the last few years, the arsenal of systemic treatments has increased with currently seven FDA-approved therapies available for patients with advanced HCC. Therefore, understanding how to apply current data to this unique and diverse patient population is necessary. This review will aim to shed light on the approach to older adults with HCC through an assessment of available data in the literature.
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Affiliation(s)
- Sukeshi Patel Arora
- Mays Cancer Center, University of Texas Health San Antonio, Leader in Gastrointestinal Malignancies, 7979 Wurzbach Rd, 78229 San Antonio, TX, USA.
| | | | - Susan Caird
- Gold Coast University Hospital, Southport, Australia, Griffith University, School of Medicine, Australia
| | - Richard F Dunne
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - David Okonji
- Wellington Blood and Cancer Centre, Wellington Regional Hospital, Wellington, New Zealand
| | | | | | - Efrat Dotan
- Fox Chase Cancer Center, Philadelphia, PA, USA
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Schotten C, Bechmann LP, Manka P, Theysohn J, Dechêne A, El Fouly A, Barbato F, Neumann U, Radünz S, Sydor S, Heider D, Venerito M, Canbay A, Gerken G, Herrmann K, Wedemeyer H, Best J. NAFLD-Associated Comorbidities in Advanced Stage HCC Do Not Alter the Safety and Efficacy of Yttrium-90 Radioembolization. Liver Cancer 2019; 8:491-504. [PMID: 31799206 PMCID: PMC6883476 DOI: 10.1159/000501484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/12/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patients with advanced hepatocellular carcinoma (HCC) arising in nonalcoholic fatty liver disease (NAFLD) may not be suitable for systemic therapy due to metabolic syndrome-related diseases. Recent trials did not show a survival benefit of radioembolization (RE) compared to sorafenib in advanced stage HCC but RE may represent an adequate alternative in patients with contraindications to systemic therapy due to its favorable safety profile. AIM To investigate the impact of NAFLD-related comorbidities on safety and efficacy of RE for HCC treatment in a retrospective monocentric cohort study. PATIENTS AND METHODS Safety and efficacy of RE were evaluated in patients with NAFLD-associated HCC. Hepatitis B virus (HBV)-related HCC patients served as controls, exhibiting matching Barcelona Liver Cancer Clinic (BCLC) stages while showing significantly fewer metabolic comorbidities. RESULTS Overall, 87 HCC patients with NAFLD (mean age 71.3 ± 6.9 years) and 62 HCC patients with HBV (mean age 58.8 ± 10.9 years) not amenable to surgical or conventional locoregional treatments were included. Patients with HBV-related HCC had a comparable liver function to HCC patients with NAFLD. RE treatment-related toxicity did not differ between the two groups (increase in bilirubin Common Terminology Criteria for Adverse Events grade in 29 [38.7%] NAFLD and 20 [39.2%] HBV patients, p = 0.91). Overall survival was similar in HCC patients with NAFLD and HBV (11.1 [interquartile range, IQR, 18.27] vs. 9.3 months [IQR 14.73], p = 0.38), also in the subgroup analyses of BCLC B and C stages. CONCLUSION RE showed similar survival outcomes at a comparable toxicity profile in HCC patients with NAFLD and HBV. NAFLD-associated metabolic comorbidities did not exhibit limitations for RE while offering comparable therapeutic efficacy as compared to HBV patients.
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Affiliation(s)
- Clemens Schotten
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Lars P. Bechmann
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
| | - Paul Manka
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Jens Theysohn
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany
| | - Alexander Dechêne
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany,Department of Internal Medicine 6, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Amr El Fouly
- Endemic Medicine Department, Helwan University, Cairo, Egypt
| | - Francesco Barbato
- Department of Nuclear Medicine, Essen University Hospital, Essen, Germany
| | - Ursula Neumann
- Department of Mathematics and Computer Science, Philipps University of Marburg, Marburg, Germany
| | - Sonia Radünz
- Department of General Surgery and Transplantation, Essen University Hospital, Essen, Germany
| | - Svenja Sydor
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
| | - Dominik Heider
- Department of Mathematics and Computer Science, Philipps University of Marburg, Marburg, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
| | - Ali Canbay
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, Essen University Hospital, Essen, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Jan Best
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany,Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg, Germany,*Jan Best, MD, Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Otto von Guericke University, Leipziger Strasse 44, DE–39120 Magdeburg (Germany), E-Mail
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Microvascular invasion and grading in hepatocellular carcinoma: correlation with major and ancillary features according to LIRADS. Abdom Radiol (NY) 2019; 44:2788-2800. [PMID: 31089780 DOI: 10.1007/s00261-019-02056-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess major and ancillary parameters that could be correlated with Microvascular Invasion (MIV) and with histologic grade of HCC. MATERIALS AND METHODS In this retrospective study, we assessed 62 patients (14 women-48 men; mean age, 63 years; range 38-80 years) that underwent hepatic resection for HCC. All patients were subject to Multidetector computed tomography (MDCT); 40 to Magnetic Resonance (MR) study. The radiologist assessed major and ancillary features according to LIRADS (v. 2018) and reported any radiological accessory findings if detected. RESULTS No major feature showed statistically significant differences and correlation with grading. Mean ADC value was correlated with grading and with MIV status. No major feature was correlated to MIV; progressive contrast enhancement and satellite nodules showed statistically different percentages with respect to the presence of MIV, so as at the monovariate correlation analysis, satellite nodules were correlated with the presence of MIV. At multivariate regression analysis, no factor proved to be strong predictors of grading while progressive contrast enhancement and satellite nodules were significantly associated with the MIV. CONCLUSION Mean ADC value is correlated to HCC grading and MIV status. Progressive contrast enhancement and the presence of satellite nodules are correlated to MIV status.
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Wang J, Luo J, Yin X, Huang W, Cao H, Wang G, Wang J, Zhou J. Jiedu Granule Combined with Transcatheter Arterial Chemoembolization and Gamma Knife Radiosurgery in Treating Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4696843. [PMID: 31341898 PMCID: PMC6614979 DOI: 10.1155/2019/4696843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/08/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The potential advantages of Jiedu granule (a compound Chinese herbal medicine) combined therapeutic strategies compared with non-Jiedu granule therapeutic strategies for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remain unclear. Thus, the purpose of the study was to investigate the safety and efficacy of Jiedu granule for HCC with PVTT. METHODS We retrospectively reviewed the clinical data of 190 patients (94 for non-Jiedu and 96 for Jiedu) with HCC and PVTT from March 2012 to October 2016. Patients were followed up by outpatient examination and telephone till November 2018. RESULTS It was statistically insignificant between the two groups in baseline characteristics. Procedure-related adverse events (AEs) were observed and compared and most of them were not serious which were easily controlled or subsided naturally. No AE-induced death happened. The median overall survival (OS) rates in the single TACE plus GKR and Jiedu granule combined group were 11.3 months (95% CI: 9.168-13.435) and 15.8 months (95% CI: 13.244-18.339), respectively (p = 0.00047). CONCLUSIONS Jiedu granule combined with TACE plus GKR is safe in HCC patients with PVTT and this Chinese herbal medicine is worthy to be promoted because of better prognosis which needs further research.
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Affiliation(s)
- Jianchu Wang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Jinhong Luo
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaolan Yin
- Department of Radiotherapy, Changhai Hospital Hongkou District Affiliated to Naval Medical University, Shanghai 200081, China
| | - Wei Huang
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huangming Cao
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guilin Wang
- Department of Radiotherapy, Changhai Hospital Hongkou District Affiliated to Naval Medical University, Shanghai 200081, China
| | - Jincheng Wang
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Zhou
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Abstract
With the increasing incidence of hepatocellular carcinoma (HCC) and its high mortality rates, effective treatment options are of urgent need, preferably in a multidisciplinary setting. In the management of those patients, interventional radiologists play a key role. In this article, we reviewed the current literature for regional, intraarterial treatment strategies of advanced-stage HCC including conventional transarterial chemoembolization, transarterial embolization, transarterial embolization with drug-eluting beads, and selective internal radiation therapy.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Radosa CG, Radosa JC, Grosche-Schlee S, Zöphel K, Plodeck V, Kühn JP, Kotzerke J, Hoffmann RT. Holmium-166 Radioembolization in Hepatocellular Carcinoma: Feasibility and Safety of a New Treatment Option in Clinical Practice. Cardiovasc Intervent Radiol 2019; 42:405-412. [PMID: 30603976 DOI: 10.1007/s00270-018-2133-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/22/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate clinical feasibility, technical success and toxicity of 166Ho-radioembolization (166Ho-RE) as new approach for treatment of hepatocellular carcinomas (HCC) and to assess postinterventional calculation of exact dosimetry through quantitative analysis of MR images. MATERIALS AND METHODS From March 2017 to April 2018, nine patients suffering from HCC were treated with 166Ho-RE. To calculate mean doses on healthy liver/tumor tissue, MR was performed within the first day after treatment. For evaluation of hepatotoxicity and to rule out radioembolization-induced liver disease (REILD), the Model for End-Stage Liver Disease (MELD) Score, the Common Terminology Criteria for Adverse Events and specific laboratory parameters were used 1-day pre- and posttreatment and after 60 days. After 6 months, MR/CT follow-up was performed. RESULTS In five patients the right liver lobe, in one patient the left liver lobe and in three patients both liver lobes were treated. Median administered activity was 3.7 GBq (range 1.7-5.9 GBq). Median dose on healthy liver tissue was 41 Gy (21-55 Gy) and on tumor tissue 112 Gy (61-172 Gy). Four patients suffered from mild postradioembolization syndrome. No significant differences in median MELD-Score were observed pre-, posttherapeutic and 60 days after 166Ho-RE. No deterioration of liver function and no indicators of REILD were observed. One patient showed a complete response, four a partial response, three a stable disease and one a progressive disease at the 6 months follow-up. CONCLUSION 166Ho-RE seems to be a feasible and safe treatment option with no significant hepatotoxicity for treatment of HCC.
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Affiliation(s)
- Christoph G Radosa
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Julia C Radosa
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Germany
| | - Sabine Grosche-Schlee
- Department of Nuclear Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Klaus Zöphel
- Department of Nuclear Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Verena Plodeck
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jens P Kühn
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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Shen J, Li C, Yan L, Li B, Xu M, Yang J, Wang W, Wen T. Short- and Long-term Outcomes between Young and Older HCC Patients Exceeding The Milan Criteria after Hepatectomy. Ann Hepatol 2018; 17:134-143. [PMID: 29311397 DOI: 10.5604/01.3001.0010.7545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM The objective of this study was to evaluate short- and long-term survival after surgical treatment between young and older hepatocellular carcinoma (HCC) patients beyond the Milan criteria. MATERIAL AND METHODS One hundred fifty-seven HCC patients (≤ 55 years old) were categorized into group A, and one hundred fifty-eight HCC patients (> 55 years old) were categorized into group B. Postoperative complications and overall survival were retrospectively analyzed. RESULTS Older HCC patients had a higher rate of delayed extubation after surgery and suffered more complications after surgery, especially major complications. Intraoperative blood transfusion, liver fibrosis/cirrhosis and delayed extubation were risk factors related to postoperative complications. Microvascular invasion (MVI), tumor diameter, postoperative alpha-fetoprotein and the presence of satellites were independent risk factors for long-term survival. Young patients had more advanced tumors. Overall survival rates at 1, 3 and 5-years were 78.1%, 45.1% and 27.4% for young patients, respectively, and 86.5%, 57.5% and 42.4% for older patients, respectively (p = 0.007). CONCLUSION The category A group had poorer tumor characteristics and worse prognoses than the category B group.
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Affiliation(s)
- Junyi Shen
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University. China
| | - Chuan Li
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University. China
| | - Lvnan Yan
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University. China
| | - Bo Li
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University. China
| | - Mingqing Xu
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University. China
| | - Jiayin Yang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University. China
| | - Wentao Wang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University. China
| | - Tianfu Wen
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University. China
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Shen X, Ma S, Tang X, Wang T, Qi X, Chi J, Wang Z, Cui D, Zhang Y, Li P, Zhai B. Clinical outcome in elderly Chinese patients with primary hepatocellular carcinoma treated with percutaneous microwave coagulation therapy (PMCT): A Strobe-compliant observational study. Medicine (Baltimore) 2018; 97:e11618. [PMID: 30170369 PMCID: PMC6393083 DOI: 10.1097/md.0000000000011618] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Percutaneous microwave ablation therapy (PMCT) has been recommended for elderly hepatocellular carcinoma (HCC) patients who cannot tolerate surgery due to their age or presence of comorbidities. Few studies have investigated efficacy and treatment outcomes for PMCT treatment in these patients, especially in China, where patients are more often diagnosed and treated early in life. This study evaluated the safety and efficacy of ultrasound-guided PMCT in treatment-naive elderly HCC patients, and analyzed risk factors associated with poor treatment outcomes.The 65 HCC patients in this retrospective study were divided into 2 groups: <65 years old or ≥65 years old. Patients received PMCT every month until tumor was unobservable and were then followed for 1 month after ablation. The primary clinical endpoint was the rate of complete tumor ablation, and secondary endpoints were progression-free survival and overall survival.Patients ≥65 years old had significantly poorer performance status than younger patients, but similar rates of complete ablation. Multiple tumors and hypertension were associated with a significantly higher risk of death, while higher postoperative alanine aminotransferase levels were associated with a significantly lower risk of death. Patients with tumor sizes >5 to ≤ 10 cm were at a significantly higher risk for disease progression than patients with tumor sizes >1 to ≤ 3 cm. Complete ablation significantly lowered the risk of disease progression.PMCT is safe and effective for patients ≥65 years of age, achieving total ablation in more than 90% of patients. Age and comorbidities did not affect clinical outcome.
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Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, Schirmacher P, Vilgrain V. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69:182-236. [PMID: 29628281 DOI: 10.1016/j.jhep.2018.03.019] [Citation(s) in RCA: 5295] [Impact Index Per Article: 882.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 02/06/2023]
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Shen J, Wen T, Chen W, Lu C, Yan L, Yang J. Model predicting the microvascular invasion and satellite lesions of hepatocellular carcinoma after hepatectomy. ANZ J Surg 2018; 88:E761-E766. [PMID: 29687553 DOI: 10.1111/ans.14473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/18/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Microvascluar invasion and satellite lesion (MS), important unfavourable pathological factors, significantly contribute to tumour recurrence and impair the prognosis in hepatocellular carcinoma. We aimed to construct a model for the prediction of MS in order to plan treatment better. METHODS A total of 1135 consecutive patients with hepatocellular carcinoma who received radical hepatectomy at West China Hospital were randomly assigned to a training set and a validation set. Multivariate analysis was preformed to identify independent risk factors of MS in the training set, and a nomogram was then constructed based on the risk factors. The concordance index (C-index) and a calibration curve were used to assess the predictive performance of the model. RESULTS The occurrence rate of MS was about 36.5%. Based on the multivariate analysis, the following six variables were incorporated into the nomogram: age (hazard ratio (HR): 0.531), alpha fetoprotein (HR: 1.327), neutrophil-to-lymphocyte ratio (>2.8, HR: 1.732), international normalized ratio (>1.07, HR: 1.702), tumour size (HR: 1.116) and tumour number (HR: 1.842). The model showed satisfactory discrimination abilities, with a C-index of 0.721 for the training set and 0.704 for the validation set. The receiver operating characteristic curve confirmed the predictive power. Meanwhile, the calibration curve presented a goodness of fit between prediction of the model and actual observations. CONCLUSIONS The user-friendly model may be useful for prediction of the occurrence of MS and to plan treatment more rationally preoperatively.
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Affiliation(s)
- Junyi Shen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tianfu Wen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Weixia Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Changli Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Lvnan Yan
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayin Yang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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Yu B, Ding Y, Liao X, Wang C, Wang B, Chen X. Radiofrequency ablation versus surgical resection in elderly patients with early-stage hepatocellular carcinoma in the era of organ shortage. Saudi J Gastroenterol 2018; 24:317-325. [PMID: 30117492 PMCID: PMC6253917 DOI: 10.4103/sjg.sjg_261_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS To compare the survival benefits of surgical resection (SR) with those of radiofrequency ablation (RFA) in elderly patients (≥65 years) with single hepatocellular carcinoma (HCC) ≤5 cm. PATIENTS AND METHODS Using the Surveillance, Epidemiology, and End Results database, a total of 461 patients who underwent SR and 575 patients who underwent RFA were enrolled from 2004 to 2012. Overall survival (OS) and liver-cancer-specific survival (LCSS) comparisons were conducted between the two groups before and after propensity score matching (PSM). RESULTS Elderly patients with early-stage HCC had a lower rate of utilization of liver transplantation, and they were more likely to receive SR or RFA as their first-line treatment compared with younger patients (P < 0.05). In the whole cohort, the SR group had significantly better OS [RFA, hazard ratio (HR) = 1.680 (1.390, 2.031), P < 0.001] and LCSS (RFA, HR = 1.658 (1.327, 2.070), P < 0.001) than the RFA group. After PSM, the improved survival in the SR group was further confirmed (all P < 0.001). In the subgroup analyses, according to patients' age (65-75, >75 years) and tumor size (≤3.0, 3.1-5.0 cm), the SR group still presented better OS and LCSS than the RFA group (all P < 0.05), except for those older than 75 years with tumors ≤3.0 cm (all P > 0.05), both before and after PSM. CONCLUSION Treatment strategies for elderly patients (≥65 years) with single HCC ≤5 cm should emphasize SR as the primary therapy, while RFA can be an alternative to SR for those> 75 years with single HCC ≤3 cm.
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Affiliation(s)
- Bin Yu
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Youming Ding
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China,Address for correspondence: Prof. Youming Ding, Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China. E-mail:
| | - Xiaofeng Liao
- Department of General Surgery, Xiangyang Central Hospital, Xiangyang, China
| | - Changhua Wang
- Department of Pathology and Pathophysiology, Wuhan University School of Basic Medical Sciences, Wuhan, China
| | - Bin Wang
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoyan Chen
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Ettorre GM, Levi Sandri GB, Laurenzi A, Colasanti M, Meniconi RL, Lionetti R, Santoro R, Lepiane P, Sciuto R, Pizzi G, Cianni R, Golfieri R, D'Offizi G, Pellicelli AM, Antonini M, Vennarecci G. Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation. World J Surg 2017; 41:241-249. [PMID: 27495316 DOI: 10.1007/s00268-016-3682-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT. METHODS From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT. RESULTS Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 % of cases, a successful downstaging was observed, and in 100 % of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations. CONCLUSIONS We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.
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Affiliation(s)
- Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
| | - Giovanni Battista Levi Sandri
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy.
| | - Andrea Laurenzi
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Roberto Luca Meniconi
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Raffaella Lionetti
- Division of Hepatology and Infectious Disease, National Institute for Infectious Disease "L. Spallanzani", via Portuense 292, 00152, Rome, Italy
| | - Roberto Santoro
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Pasquale Lepiane
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Rosa Sciuto
- Division of Nuclear Medicine, IFO Regina Elena National Cancer Institute, via Elio Chianesi 53, 00100, Rome, Italy
| | - Giuseppe Pizzi
- Division of Interventional Radiology, IFO Regina Elena National Cancer Institute, via Elio Chianesi 53, 00100, Rome, Italy
| | - Roberto Cianni
- Division of Interventional Radiology, S.M. Goretti Hospital, via Guido Reni, 04010, Latina, Italy
| | - Rita Golfieri
- Division of Radiology, S. Orsola-Malpighi Hospital, via Pietro Albertoni 15, 40138, Bologna, Italy
| | - Gianpiero D'Offizi
- Division of Hepatology and Infectious Disease, National Institute for Infectious Disease "L. Spallanzani", via Portuense 292, 00152, Rome, Italy
| | - Adriano M Pellicelli
- Liver Unit, San Camillo Forlanini Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
| | - Mario Antonini
- Anesthesiology and Intensive Care Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, circ.ne Gianicolense 87, 00152, Rome, Italy
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Wang EA, Stein JP, Bellavia RJ, Broadwell SR. Treatment options for unresectable HCC with a focus on SIRT with Yttrium-90 resin microspheres. Int J Clin Pract 2017; 71. [PMID: 28758319 DOI: 10.1111/ijcp.12972] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/10/2017] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED Hepatocellular carcinoma (HCC), the predominant form of primary liver cancer, is the second leading cause of cancer-related deaths across the globe. Only a small percentage of HCC patients (~20%-30%) are diagnosed at an early stage when first-line treatment options may be effective. The majority of HCC patients (>70%) are diagnosed with unresectable disease and given a poor overall prognosis. Current treatment guidelines recommend locoregional therapy with transarterial chemoembolisation (TACE) and systemic therapy with sorafenib as first-line treatment for patients with intermediate and advanced stage HCC. However, multiple factors including contraindications, technical considerations and treatment-related toxicities pose significant challenges in achieving favourable treatment outcomes, underscoring the need for a paradigm shift in managing these patients. In 2002, yttrium-90 (Y-90) resin microspheres was approved by the U.S. Food and Drug Administration (FDA) for the treatment of unresectable metastatic colorectal cancer to the liver with adjuvant floxuridine chemotherapy. However, thousands of patients with unresectable HCC have also been treated with resin Y-90. For over two decades, several small-scale prospective trials and retrospective studies have investigated and reported on the efficacy of locoregional selective internal radiation therapy (SIRT) with Y-90 microspheres in treating unresectable HCC. Although it is currently a treatment option for intermediate-stage HCC patients, mainstream clinical application of resin Y-90 has been largely limited because of the lack of sufficient clinical data from a randomised controlled trial. This could change with the imminent announcement of results from the phase 3 Sorafenib vs Radioembolization in Advanced Hepatocellular carcinoma (SARAH) trial. To provide the foundation and context for interpreting results from the SARAH trial, this article provides an overview of treatment modalities and current challenges in managing unresectable HCC. There is also a review of key prospective and retrospective studies evaluating the use of Y-90 SIRT, specifically Y-90 resin microspheres in unresectable HCC, which led to the development of the SARAH trial. METHODS To identify relevant publications, the PubMed database was queried using one or more of the following search terms alone or in combination with Boolean operators: epidemiology, hepatocellular, hepatocellular cancer, hepatocellular carcinoma, unresectable, radioembolisation, selective internal radiation therapy, SIR-Spheres, yttrium 90, TACE, and sorafenib. The results were sorted or filtered by "Author", "Publication dates" or "Article types" to identify articles relevant to each section of the review. To ensure that information on ongoing clinical trials involving Y-90 resin was included, we conducted a search on "ClinicalTrials.gov", by combining the search terms "HCC" OR "hepatocellular carcinoma" with "Y 90" OR "yttrium 90" OR "radioembo", and screened for studies that involved treatment with Y-90 resin microspheres.
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Affiliation(s)
- Eric A Wang
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
| | - Jeff P Stein
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
| | - Ross J Bellavia
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
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Mantry PS, Mehta A, Madani B, Mejia A, Shahin I. Selective internal radiation therapy using yttrium-90 resin microspheres in patients with unresectable hepatocellular carcinoma: a retrospective study. J Gastrointest Oncol 2017; 8:799-807. [PMID: 29184683 PMCID: PMC5674259 DOI: 10.21037/jgo.2017.08.03] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/24/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Selective internal radiation therapy (SIRT) with yttrium-90 resin (Y-90 resin) microspheres has been used as a locoregional therapy for patients with unresectable hepatocellular carcinoma (HCC). We examined patient and disease characteristics that might affect survival after Y-90 resin, as well as treatment tolerability. METHODS Data from patients with unresectable HCC treated with Y-90 resin at a single institution were reviewed retrospectively. Survival was assessed with Kaplan-Meier curves and log-rank tests. Response was evaluated with the response evaluation criteria in solid tumors (RECIST) criteria. Adverse events (AEs) were noted, and laboratory values were graded with CTCAE v3.0. RESULTS Data from 111 patients were analyzed. AEs occurred in 23 patients at 1 week after treatment and in 46 at 3 months. At 6 months, 13 patients had a complete response and 13 had a partial response. Factors associated with longer overall survival (OS) included early-stage disease [27.8 months for patients with Barcelona-Clinic Liver Cancer (BCLC) A vs. 9.2 months for BCLC C]; treatment with other locoregional therapies (69.0 vs. 11.4 months); and lack of bilobar disease (23.5 vs. 9.4 months), portal vein thrombosis (16.2 vs. 8.6 months), ascites (16.6 vs. 10.3 months), and treatment with sorafenib (17.2 vs. 10.3 months). In six patients, Y-90 resin was used as a bridge to liver transplantation, which greatly improved survival (69.0 vs. 12.1 months). CONCLUSIONS Several characteristics may prove useful for selecting patients likely to respond well to Y-90 resin. These results should be confirmed in prospective studies.
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Affiliation(s)
- Parvez S. Mantry
- The Liver Institute and Interventional Radiology, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Ashwini Mehta
- Department of Gastroenterology, Plaza Medical Center, Fort Worth, TX, USA
| | | | - Alejandro Mejia
- The Liver Institute and Interventional Radiology, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Islam Shahin
- The Liver Institute and Interventional Radiology, Methodist Dallas Medical Center, Dallas, TX, USA
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The Role of Age in Change in Unmet Supportive Care Needs in Hepatocellular Carcinoma Patients During Transition From Hospital to Home. Cancer Nurs 2017; 40:245-254. [PMID: 27281033 DOI: 10.1097/ncc.0000000000000403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Age might affect the change in care needs in patients with hepatocellular carcinoma after treatment during their transition process from hospital to home. However, there have been no studies that focus on this. OBJECTIVE The aim of this study is to examine changes in unmet supportive care needs in young (<65 years old) and elderly (≥65 years old) groups of patients with hepatocellular carcinoma from before discharge to 2 months after discharge. METHODS A longitudinal prospective study design was used with recruited participants at a teaching hospital in Taiwan. Data were collected 3 times: within 3 days before discharge and at 1 and 2 months after discharge. A set of questionnaires was used to assess participants' levels of supportive care needs, symptom distress, anxiety, and depression. RESULTS A total of 104 patients completed the data collection process. Supportive care needs decreased monthly after discharge, with health system and information being the domain with the highest level of unmet needs in the 2 groups. The young group had a higher level of overall unmet needs before discharge, but they had a lower level of overall needs compared with the elderly group after 2 months of discharge. CONCLUSIONS Age could be a significant potential factor to affect change in unmet needs during transition. IMPLICATIONS FOR PRACTICE Comprehensive assessment in care needs especially in the health system and information and physical and daily living domains before discharge is recommended to design personalized education programs before discharge.
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Extermann M. Cancer in the Elderly: Moving the Needle Toward Evidence-Based Personalized Oncology. Int J Radiat Oncol Biol Phys 2017; 98:718-720. [PMID: 28602406 DOI: 10.1016/j.ijrobp.2016.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 11/26/2022]
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Wang EA, Broadwell SR, Bellavia RJ, Stein JP. Selective internal radiation therapy with SIR-Spheres in hepatocellular carcinoma and cholangiocarcinoma. J Gastrointest Oncol 2017; 8:266-278. [PMID: 28480066 PMCID: PMC5401864 DOI: 10.21037/jgo.2016.11.08] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) often present at stages where patients have limited treatment options. Use of selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) resin microspheres has progressed as data increasingly speak to its utility in patients with both intermediate and late stage disease in these cancers. In anticipation of the pending completion of several prospective randomized controlled multicenter studies exploring the use of Y-90 resin microspheres in primary liver cancers, this article outlines mechanisms involved in SIRT administration and reviews key efficacy and safety data that are currently available in the literature involving use of this therapy in both HCC and ICC.
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Affiliation(s)
- Eric A Wang
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Ross J Bellavia
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
| | - Jeff P Stein
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
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Effect of Substituting 50% Isovue for Sterile Water as the Delivery Medium for SIR-Spheres: Improved Dose Delivery and Decreased Incidence of Stasis. Clin Nucl Med 2017; 42:176-179. [PMID: 28072623 DOI: 10.1097/rlu.0000000000001532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to evaluate the effect of substituting 50% Isovue (Bracco Diagnostics Inc, Monroe Township, NJ) for sterile water on the delivery of Y resin microspheres (SIR-Spheres [Sirtex Medical Limited, Sydney, Australia]). MATERIALS AND METHODS The authors retrospectively reviewed all SIR-Spheres radioembolizations at the authors' institution from January 1, 2011, to February 10, 2014. From January 1, 2011, to April 30, 2013, all users performed SIR-Spheres radioembolization per the manufacturer's original instructions using sterile water in the B and D lines and intermittently checking the progress of the embolization by injecting contrast via the B line. Beginning May 1, 2013, a modified technique using Isovue diluted 50% with saline in place of sterile water in both the B and D lines of the infusion set. The authors compared the prepared versus administered activity of Y SIR-Spheres, fluoroscopy time, administration time, and frequency of radioembolizations terminated for stasis when using water versus dilute contrast in the B and D lines. RESULTS One hundred seventy-five radioembolizations were performed, 132 (75%) with water as the delivery medium and 43 (25%) with 50% contrast as delivery medium. The mean percentage of the Y activity administered was 98% with contrast versus 87% with water (P < 0.01). More than 95% of cases using contrast resulted in 90% or more delivery of the prepared Y activity versus 59% of cases with water (P < 0.01). For cases using water, 17% were terminated for stasis, whereas 2% (1 case) using contrast was terminated for stasis. The mean Y administration time was 7 minutes with contrast versus 22 minutes with water (P = 0.015). Excluding the 37 cases involving coil embolization, the mean fluoroscopy time was 8.3 minutes with contrast versus 11.5 minutes with water (P < 0.05). No complications occurred with the contrast method; however, there were 4 complications with water, including 1 nontarget gastric ulceration. CONCLUSIONS Using dilute contrast as the delivery medium for SIR-Spheres resulted in a significantly greater percentage of the prepared activity administered to the patient with substantially shorter administration time. Termination for stasis occurred less often with dilute contrast. No complications were observed when using dilute contrast, which allowed continuous real-time monitoring of the Y microsphere administration.
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Pre-therapeutic factors for predicting survival after radioembolization: a single-center experience in 389 patients. Eur J Nucl Med Mol Imaging 2017; 44:1185-1193. [PMID: 28197686 DOI: 10.1007/s00259-017-3646-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/02/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine pre-therapeutic predictive factors for overall survival (OS) after yttrium (Y)-90 radioembolization (RE). METHODS We retrospectively analyzed the pre-therapeutic characteristics (sex, age, tumor entity, hepatic tumor burden, extrahepatic disease [EHD] and liver function [with focus on bilirubin and cholinesterase level]) of 389 consecutive patients with various refractory liver-dominant tumors (hepatocellular carcinoma [HCC], cholangiocarcinoma [CCC], neuroendocrine tumor [NET], colorectal cancer [CRC] and metastatic breast cancer [MBC]), who received Y-90 radioembolization for predicting survival. Predictive factors were selected by univariate Cox regression analysis and subsequently tested by multivariate analysis for predicting patient survival. RESULTS The median OS was 356 days (95% CI 285-427 days). Stable disease was observed in 132 patients, an objective response in 71 (one of which was complete remission) and progressive disease in 122. The best survival rate was observed in patients with NET, and the worst in patients with MBC. In the univariate analyses, extrahepatic disease (P < 0.001), large tumor burden (P = 0.001), high bilirubin levels (>1.9 mg/dL, P < 0.001) and low cholinesterase levels (CHE <4.62 U/I, P < 0.001) at baseline were significantly associated with poor survival. Tumor entity, tumor burden, extrahepatic disease and CHE were confirmed in the multivariate analysis as independent predictors of survival. Sex, applied RE dose and age had no significant influence on OS. CONCLUSIONS Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.
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Abstract
Radioembolization (RE) is a relatively novel treatment modality for primary and secondary hepatic malignancies. Microspheres embedded with a β-emitting radioisotope are injected into the hepatic artery, resulting in microsphere deposition in the tumor arterioles and normal portal triads. Microsphere deposition in nontumorous parenchyma can result in radiation-induced liver injury, with lethal RE-induced liver disease (REILD) at the outer end of the spectrum. The primary aim of this study was to evaluate RE-related hepatotoxicity and present an overview of the currently applied definitions and clinically relevant characteristics of REILD. A systematic literature search on REILD was performed. Studies after the introduction of the term REILD (2008) were screened for definitions of REILD. Hepatotoxicity and applied definitions of REILD were compared. Liver biochemistry test abnormalities occur in up to 100% of patients after RE, mostly self-limiting. The incidence of symptomatic REILD varied between 0 and 31%, although in most reports, the incidence was 0-8%, with a lethal outcome in 0-5%. With the exception of bilirubin, the presentation of hepatotoxicity and REILD was similar for cirrhotic and noncirrhotic patients. No uniform definition of REILD was established in the current literature. Here, we propose a unifying definition and grading system for REILD. RE-related hepatotoxicity is a common phenomenon; symptomatic REILD, however, is rare. Currently, reporting of REILD is highly variable, precluding reliable comparison between studies, identification of risk factors, and treatment developments.
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Braat MNGJA, de Jong HW, Seinstra BA, Scholten MV, van den Bosch MAAJ, Lam MGEH. Hepatobiliary scintigraphy may improve radioembolization treatment planning in HCC patients. EJNMMI Res 2017; 7:2. [PMID: 28058660 PMCID: PMC5215993 DOI: 10.1186/s13550-016-0248-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/15/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Routine work-up for transarterial radioembolization, based on clinical and laboratory parameters, sometimes fails, resulting in severe hepatotoxicity in up to 5% of patients. Quantitative assessment of the pretreatment liver function and its segmental distribution, using hepatobiliary scintigraphy may improve patient selection and treatment planning. A case series will be presented to illustrate the potential of this technique. Hepatocellular carcinoma patients with cirrhosis (Child-Pugh A and B) underwent hepatobiliary scintigraphy pre- and 3 months post-radioembolization as part of a prospective study protocol, which was prematurely terminated because of limited accrual. Included patients were analysed together with their clinical, laboratory and treatment data. RESULTS Pretreatment-corrected 99mTc-mebrofenin liver uptake rates were marginal (1.8-3.0%/min/m2), despite acceptable clinical and laboratory parameters. Posttreatment liver functions seriously declined (corrected 99mTc-mebrofenin liver uptake rates: 0.6-2.4%/min/m2), resulting in lethal radioembolization-induced liver disease in two out of three patients. CONCLUSIONS Hepatobiliary scintigraphy may be of added value during work-up for radioembolization, to estimate liver function reserve and its segmental distribution, especially in patients with underlying cirrhosis, for whom analysis of clinical and laboratory parameters may not be sufficient.
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Affiliation(s)
- Manon N G J A Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Hugo W de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Beatrijs A Seinstra
- Department of Radiology and Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Mike V Scholten
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Lu XJ, Dong J, Ji LJ, Xiao LX, Ling CQ, Zhou J. Tolerability and efficacy of gamma knife radiosurgery on hepatocellular carcinoma with portal vein tumor thrombosis. Oncotarget 2016; 7:3614-22. [PMID: 26473291 PMCID: PMC4823131 DOI: 10.18632/oncotarget.6118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/24/2015] [Indexed: 12/13/2022] Open
Abstract
This is a retrospective study on the safety and efficacy of gamma knife radiosurgery (GKR) in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Patients with confirmed HCC and PVTT were allocated into two groups based on the treatments they received (palliative or GKR). A total of 138 patients were included (74 in the palliative group, 64 in GKR group). No significant differences in baseline characteristics existed between the two groups. Treatment-related adverse events (AEs) were recorded and compared between groups. The majority of AEs were mild to moderate and subsided naturally or after medication. There was no AE-induced death. The influences of baseline characteristics and treatment options on patients' OS were analyzed. The median OS of patients in the palliative and GKR group were 3.0 months (95% CI: 2.719-3.281) and 6.1 months (95% CI: 4.706-7.494) respectively (p = 0.003). Multivariate analysis revealed that GKR treatment, performance status 0-1, Child A, smaller tumor diameter and monolobar distribution were significant favorable prognosticators. Subgroup analyses showed OS benefit of GKR regardless of PVTT location (main or branch of PVTT). In conclusion, GKR is well tolerated in selected HCC-PVTT patients and can confer OS benefit, which needs validation in future prospective studies.
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Affiliation(s)
- Xiao-Jie Lu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Dong
- Outpatient Department, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Li-Juan Ji
- Department of Rehabilitation, The Affiliated Huai'an Hospital of Xuzhou Medical College and The Second People's Hospital of Huai'an, Huai'an, China
| | - Li-Xin Xiao
- Department of Gamma Knife, The 411st Hospital of Chinese People's Liberation Army, Shanghai, China
| | - Chang-Quan Ling
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Jun Zhou
- Department of Oncology and Hematology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Early treatment response to transcatheter arterial chemoembolization is associated with time to the development of extrahepatic metastasis and overall survival in intermediate-stage hepatocellular carcinoma. Cancer Chemother Pharmacol 2016; 79:81-88. [PMID: 27913882 DOI: 10.1007/s00280-016-3202-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/13/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Transcatheter arterial chemoembolization (TACE) is the treatment of choice for intermediate-stage hepatocellular carcinoma (HCC). The absence of an early response to TACE might indicate alternative therapeutic strategies early in the course of the disease, thus improving outcomes. Therefore, our purpose was to identify the relationship between treatment response after two sessions of TACE and the time to the development of extrahepatic metastasis and overall survival. METHODS In total, 108 treatment-naïve intermediate-stage HCC patients who received at least two consecutive sessions of TACE as the first-line treatment were analyzed. RESULTS The median follow-up duration was 28.5 months. Extrahepatic metastasis developed in 32 patients (29.6%). Patient age >60 years (P = 0.027), alpha-fetoprotein (AFP) >200 ng/ml (P = 0.039), and objective response after two TACE treatments (P = 0.001) were the predictive factors for time to the development of metastasis. The median survival time for the patients who achieved objective response after two sessions of TACE was 45.9 and 14.4 months for the patients who failed to achieve objective response (P = 0.0001). Objective response after two TACE treatments (P = 0.0001) and the occurrence of extrahepatic metastasis (P = 0.002) were associated with overall survival. CONCLUSIONS Early objective tumor response after two sessions of TACE was associated with prolonged time to metastasis and improved survival. Therefore, surveillance for metastasis should be performed more frequently when an objective response is not obtained after two sessions of TACE and in younger intermediate-stage HCC patients with high AFP levels.
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Tan JT, Zhao C, Peng NF, Yang Y, Zhong JH, Yang T, Zheng MH, Wang YY, Gong WF, Xiang BD, Li LQ. Association between age and overall survival of patients with hepatocellular carcinoma after hepatic resection. J Surg Oncol 2016; 114:966-970. [PMID: 27633143 DOI: 10.1002/jso.24434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/19/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Jun-Tao Tan
- Department of Surgical Oncology; Affiliated Tumor Hospital of Guangxi Medical University; Nanning P.R. China
| | - Chang Zhao
- Department of Surgical Oncology; Affiliated Tumor Hospital of Guangxi Medical University; Nanning P.R. China
| | - Ning-Fu Peng
- Department of Surgical Oncology; Affiliated Tumor Hospital of Guangxi Medical University; Nanning P.R. China
| | - Yang Yang
- Department of Hematology; The First Affiliated Hospital of Guangxi Medical University; Nanning P.R. China
| | - Jian-Hong Zhong
- Department of Surgical Oncology; Affiliated Tumor Hospital of Guangxi Medical University; Nanning P.R. China
| | - Tian Yang
- Department of Hepatobiliary Surgery; Eastern Hepatobiliary Surgery Hospital, Second Military Medical University; Shanghai P.R. China
| | - Ming-Hua Zheng
- Department of Hepatology; Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University; Wenzhou P.R. China
| | - Yan-Yan Wang
- Department of Surgical Oncology; Affiliated Tumor Hospital of Guangxi Medical University; Nanning P.R. China
| | - Wen-Feng Gong
- Department of Surgical Oncology; Affiliated Tumor Hospital of Guangxi Medical University; Nanning P.R. China
| | - Bang-De Xiang
- Department of Surgical Oncology; Affiliated Tumor Hospital of Guangxi Medical University; Nanning P.R. China
| | - Le-Qun Li
- Department of Surgical Oncology; Affiliated Tumor Hospital of Guangxi Medical University; Nanning P.R. China
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The circular RNA ciRS-7 (Cdr1as) acts as a risk factor of hepatic microvascular invasion in hepatocellular carcinoma. J Cancer Res Clin Oncol 2016; 143:17-27. [PMID: 27614453 DOI: 10.1007/s00432-016-2256-7] [Citation(s) in RCA: 247] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Circular RNAs (circRNA) represent a novel class of widespread and diverse endogenous RNAs that regulate gene expression in mammals. microRNA-7 (miR-7) is a well-demonstrated suppressor of hepatocellular carcinoma (HCC). Recent studies have showed that one such circRNA, ciRS-7 (also termed as Cdr1as) was the inhibitor and sponge of miR-7 in the embryonic zebrafish midbrain and islet cells. However, the relationships among ciRS-7, miR-7 and clinical features of HCC remain to be clarified. METHODS Expression levels of ciRS-7, miR-7 and three miR-7-targeted mRNAs in 108 pairs of HCC and their matched non-tumor tissues were examined by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The protein production of these three miR-7-targeted mRNAs was further verified by Western blot. The relationship between ciRS-7 level and clinicopathological features as well as the recurrence of HCC patients was analyzed. The univariate and multivariate logistic regression analyses were used to detect the risk factors of hepatic microvascular invasion (MVI). The correlation among ciRS-7, miR-7 and miR-7-targeted mRNAs was evaluated using Spearman's correlation test. RESULTS There was no significant difference of ciRS-7 expression levels between the HCC tissues and the matched non-tumor tissues (0.67 ± 1.49 vs. 0.44 ± 0.45, p = 0.13), and the ciRS-7 levels in more than half of HCC tissues (65 out of 108, 60.2 %) were down-regulated when compared with their matched non-tumor tissues. However, the expression of ciRS-7 was significantly correlated with the following three clinicopathological characteristics of HCC patients: age <40 years (p = 0.02), serum AFP ≥400 ng/µl (p < 0.01) and hepatic MVI (p = 0.03). Meanwhile, up-regulated ciRS-7 expression was not only an independent risk factor of hepatic MVI but also had a capable predictive ability for MVI (AUC = 0.68, p = 0.001) at the cut-off value of 0.135. Furthermore, the expression of ciRS-7 in HCC tissues with concurrent MVI was inversely correlated with that of miR-7 (r = -0.39, p = 0.007) and positively related with that of two miR-7-targeted genes [PIK3CD (r = 0.55, p < 0.001) and p70S6K (r = 0.34, p = 0.021)]. In addition, the median recurrent time of patients from higher ciRS-7 level group was shorter than that of lower ciRS-7 group (18 vs. 25 months), but no significant difference was observed (p = 0.38). CONCLUSIONS The expression levels of ciRS-7 were comparable between HCC and matched non-tumor tissues. However, the highly ciRS-7 expression in HCC tissues was significantly correlated with hepatic MVI, AFP level and younger age and thus partly related with the deterioration of HCC. Especially, ciRS-7 was one of the independent factors of hepatic MVI. These data suggested that ciRS-7 may be a promising biomarker of hepatic MVI and a novel therapy target for restraining MVI.
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Lau WY, Teoh YL, Win KM, Lee RC, de Villa VH, Kim YHJ, Liang PC, Santos-Ocampo RS, Lo RHG, Lim KBL, Tai DWM, Ng DCE, Irani FG, Gogna A, Chow PKH. Current role of selective internal radiation with yttrium-90 in liver tumors. Future Oncol 2016; 12:1193-204. [PMID: 27007495 DOI: 10.2217/fon-2016-0035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
An expert panel met to review the evidence for selective internal radiation therapy (SIRT) using yttrium-90 microspheres in hepatocellular carcinoma and metastases from colorectal cancer and neuroendocrine tumors. There is now convincing evidence for the safety and efficacy of SIRT in these situations albeit mostly from retrospective cohort studies. There are a number of ongoing prospective randomized controlled clinical trials investigating the role of SIRT in liver tumors; however, data from these trials are still several years away (although the SIRFLOX study has been recently published). In this evolving environment, published evidence and the authors' experience were used to summarize the current and potential role of SIRT in the management of hepatocellular carcinoma of intermediate or advanced stage and in liver-dominant metastatic colorectal cancer and metastatic neuroendocrine tumors.
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Affiliation(s)
- Wan Yee Lau
- Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | | | - Khin Maung Win
- Department of Hepatology, University of Medicine 1, Yangon, Ministry of Health, Myanmar
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital & School of Medicine, National Yang-Ming University Taipei, Taiwan
| | - Vanessa H de Villa
- Department of Surgery, The Medical City, Pasig City, Metro Manila, Philippines.,Center for Liver Disease Management & Transplantation, The Medical City, Pasig City, Metro Manila, Philippines
| | | | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Kieron Boon Leng Lim
- Division of Gastroenterology & Hepatology, National University Centre for Organ Transplantation, National University Hospital, Singapore
| | | | - David Chee Eng Ng
- Department of Nuclear Medicine & PET, Singapore General Hospital, Singapore
| | - Farah Gillan Irani
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Apoorva Gogna
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Pierce Kah-Hoe Chow
- Department of Surgical Oncology, National Cancer Centre Singapore, 169610 Singapore.,Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
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Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide. This cancer commonly arises against a background of chronic liver disease. As a result, a patient with HCC requires multidisciplinary care. Treatment options vary widely based on tumor burden and metastases. The most widely utilized staging system is the Barcelona Clinic Liver Cancer staging system, which recommends treatments based on tumor size and the underlying liver disease and functional status of the patient. Treatment options range from surgical resection or transplantation to locoregional therapies with modalities such as radiofrequency ablation and transarterial chemoembolization to systemic chemotherapies. Future care involves the development of combination therapies that afford the best tumor response, further clarification of the patients best suited for therapies and the development of new oral chemotherapeutic agents.
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Affiliation(s)
- Jennifer S Au
- Division of Gastroenterology and Hepatology, Scripps Clinic
| | - Catherine T Frenette
- Liver Transplantation, Center for Organ and Cell Transplantation, Scripps Clinic, La Jolla, CA, USA
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