Is Segmental Radioembolization for Localized HCC More Effective Than Segmental Chemoembolization?

Patients who undergo segmental radioembolization for localized, unresectable hepatocellular carcinoma (HCC) have higher complete response rates and local tumor control than those treated with segmental chemoembolization, researchers reported in the June issue of JVIR. The study also showed that the treatments have similar toxicity profiles.

Prior to this study, comparisons of radioembolization and chemoembolization have focused on lobar treatment. However, Siddharth A. Padia, MD, and colleagues, believed a comparison specific to localized HCC was necessary to address any differences in response and toxicity profile between the two modalities.

The retrospective study included all patients at a single institution who were treated with yttrium-90 radioembolization or chemoembolization between 2010 and 2015. There were 101 patients with 132 tumors who underwent segmental radioembolization, and there were 77 patients with 103 tumors who underwent segmental doxorubicin-based drug-eluting embolic or conventional chemoembolization. Tumor response and progression, as well as toxicity and survival, were compared between the 2 groups.

The radioembolization group showed improvements compared with the chemoembolization group in several areas. For those who received radioembolization, the complete response rate per tumor was 92%, compared with 74% for chemoembolization. Overall tumor response was 84% in patients treated with radioembolization versus 58% in patients treated with chemoembolization.

At 1 year, the index tumor progression was 8% in the radioembolization group, and at 2 years it was 15%. The index tumor progression in the chemoembolization group was 30% at 1 year and 42% at 2 years.

In addition, the radioembolization group had a median progression-free survival of 564 days and median overall survival of 1,198 days, compared with a median of 271 days and 1,043 days for the chemoembolization group.

Analysis showed that both segmental radioembolization and segmental chemoembolization had low toxicity rates.

“Although prospective, randomized studies are needed to confirm these findings, segmental radioembolization has the potential to achieve durable local control with an acceptable toxicity profile,” the study’s authors concluded.

Reference

Padia SA, Johnson GE, Horton KJ, et al. Segmental Yttrium-90 radioembolization versus segmental chemoembolization for localized hepatocellular carcinoma: results of a single-center, retrospective, propensity score–matched study. JVIR. 2017;28(6):77-785.e1.