Study Assesses Long-Term Outcomes for Y-90 Treatment
A long-term analysis of yttrium 90 (Y90) radioembolization for patients with advanced stage hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) shows that Y90 is safe and effective.
Researchers analyzed data from a subset of 1,000 consecutive patients with HCC who were treated with Y90 radioembolization. Treatment occurred between December 2003 and March 2017, and patients were excluded if they did not exhibit PVT at baseline or if they had metastases. After exclusions, a cohort of 183 patients with PVT related to HCC remained. At baseline and at 1 month after Y-90 treatment, clinical and laboratory data were obtained.
Of the 183 patients, 74 were Child-Pugh (CP)-A, 51 were CP-B7, and 60 were CP-8 or greater. Patients who were CP-A had a median overall survival of 13.3 months, while CP-B7 patients had a median overall survival of 6.9 months. Overall survival in patients who were CP-8 or greater was 3.9 months.
“Y-90 radioembolization for HCC patients with PVT appears to have an acceptable safety profile, with survivals in CP-A patients outperforming CP-B,” the researchers wrote.
Multivariate analysis revealed several significant prognosticators—baseline bilirubin, ascites, and alpha-fetoprotein. The researchers found that 12 out of 123 patients with high alpha-fetoprotein restored normal alpha-fetoprotein levels after Y-90 treatment and had a median survival of 23.9 months.
“This study confirms prior reports of survival in PVT patients treated with Y-90, and appears to exceed similar patients treated with systemic therapies,” the study’s authors concluded. They added, “Despite the negative studies recently reported, Y-90 is a reasonable treatment option in properly selected PVT patients. Further controlled studies are needed to confirm its role in treating advanced stage HCC patients in comparison to systemic therapies or other locoregional treatments.”
Abouchaleh N, Gabr A, Ali R, et al. Y90 radioembolization for locally advanced hepatocellular carcinoma with portal vein thrombosis: long-term outcomes in a 185-patient cohort. J Nucl Med. 2017 Dec 7. pii: jnumed.117.199752. doi: 10.2967/jnumed.117.199752. [Epub ahead of print].