Y-90 Is Safe and Effective for HCC Recurring After Resection

Patients who have recurrent hepatocellular carcinoma (HCC) following resection may benefit from radioembolization, which is safe and effective in those circumstances, researchers reported.

When HCC recurs, patients who have already undergone resection often have limited hepatic reserve, making additional surgery infeasible. In such a scenario, an alternative therapy such as radioembolization can be considered. The authors conducted their study to add to the little data available on clinical outcomes for this method of treatment following resection.

The study was a single-center, retrospective review that included 41 patients who were part of the researchers’ prospectively acquired database for patients who received Y-90 treatment for recurrent disease after resection. Patients were assessed at baseline before Y-90, and bilirubin toxicities were noted after Y-90 treatment.

Of the patients, 63% had undergone minor resections, and 37% had undergone major resections. There were 2 patients who had biliary-enteric anastomoses created during surgical resection. A median of 17 months passed from the HCC resection to the first radioembolization, and patients received a median of 1 radioembolization treatment.

There were 10 patients who received lobar Y-90 treatment that included the entire remnant, whereas 31 patients had selective treatment that involved 2 or fewer hepatic segments.

Bilirubin toxicity (Grades 1/2/3/4) was observed in some patients after Y-90 treatment—9 patients had Grade 1 toxicity, 4 had Grade 2, and 4 had Grade 3. There were no patients who had Grade 4 toxicity. When lobar was compared with selective approaches, bilirubin toxicities were the same. Additionally, there were no infectious complications following Y-90 treatment. The median time to progression was 11.3 months, and the median overall survival was 22.1 months.

Although the study was limited by its retrospective design, the authors stated that “we do have robust post Y-90 clinical and imaging follow-up data that represents the focus of the analysis. We also have complete post Y-90 treatment follow-up; 15 patients received other therapies after Y-90.”

They concluded, “Y-90 is safe in HCC patients who exhibit recurrence following curative resection. The toxicity profile does not appear to be different from other published series in unresected patients.”

Reference

Ali R, Riaz A, Gabr A, Abouchaleh N, et al. Clinical outcomes of Y90 radioembolization for recurrent hepatocellular carcinoma following curative resection. Eur J Nucl Med Mol Imaging. 2017;44(13):2195-2202.