A multicenter study conducted across Europe indicates that the liver-directed therapy, radioembolization, can be used to achieve survival in persons with hepatocellular carcinoma (HCC)—including those with advanced disease and few treatment options. Radioembolization involves the injection of plastic or glass microspheres incorporating the radioactive isotope Yttrium-90 directly into tumors.
More than half of the 325 HCC patients (56.8%) from eight facilities were classified as having advanced-stage cancer and 26.8% as having intermediate-stage, based on the Barcelona Clinic Liver Cancer (BCLC) staging system. A total of 83% had hepatic function categorized as Child-Pugh class A, 79% had underlying cirrhosis, and 88% had a good Eastern Oncology Group (ECOG) performance status.
Most of the patients received a single administration of 90Y-resin microspheres between September 2003 and December 2009; approximately 6% underwent two and 0.9% underwent three treatments (median activity for all patients was 1.6 GBq, predominantly as whole-liver (45.2%) or right-lobe (38.5%) infusions.
Overall median survival with radioembolization was 12.8 months, with significant variations seen according to BCLC class: Those with less progressed disease and liver involvement (BCLC A) survived a median of 24.4 months, whereas the BCLC B patients had a median overall survival of 16.9 months and the BCLC C patients, 10.0 months.
Survival also varied significantly by ECOG status, hepatic function (Child-Pugh class, ascites, and baseline total bilirubin), tumor burden (number of nodules, alpha-fetoprotein), and presence of extrahepatic disease.
“The most significant independent prognostic factors for survival upon multivariate analysis were ECOG status, tumor burden (nodules >5), international normalized ratio greater than 1.2, and extrahepatic disease,” reported Bruno Sangro, MD, PhD, of the Clinica Universitaria de Navarra in Pamplona, Spain, and colleages in Hepatology.
The most common adverse events were: fatigue, nausea/vomiting, and abdominal pain. Grade 3 or higher increases in bilirubin occurred in 5.8% of patients.