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Title: Radioembolization Super Survivors: Extended Survival in Non-operative Hepatocellular Carcinoma

Abstract

PurposeTo identify baseline characteristics and long-term prognostic factors in non-transplant patients with unresectable hepatocellular carcinoma (HCC) who had prolonged survival after treatment with yttrium-90 radioembolization (Y90).Materials and MethodsSixty-seven “Super Survivors” (defined as ≥ 3-year survival after Y90) were identified within our 1000-patient Y90 database (2003–2017). Baseline imaging and follow-up occurred at 1 month and every 3 months thereafter. Overall survival (OS) was calculated with Kaplan–Meier estimates with log-rank test in subgroups: Child–Pugh (CP) score, distribution of disease, portal vein thrombus (PVT), and technique (segmental vs lobar Y90).Results Median age 69.5 years (range 45–94 years); 69% male; 60% solitary HCC; 79% unilobar disease; 12% PVT; 10% ascites; Barcelona Clinic Liver Cancer Stage A—54%/B—28%/C—16%/D—2%; CP A—70%/B—28%/C—2%. Longest baseline tumor diameter was 5.4 ± 4.0 cm (mean ± SD). All patients had an imaging response (either partial or complete response). Median OS was 67.5 months (95% CI 55.2–82.5). CP score and main PVT stratified median OS (p = 0.0007 and p = 0.0187, respectively). Beyond 3 years, segmental versus lobar Y90 was associated with improved OS with a median OS of 80.2 versus 46.7 months, respectively (p = 0.0024). Dosing > 200 Gy was not a significant predictor of improved OS.ConclusionsSuper Survivors spanning the BCLC staging system maintained durable OS after radioembolization that was stratified by the extent of underlying liver disease. The common variable amongmore » all patients was an imaging response. Segmental versus lobar Y90 may have a long-term associated OS benefit.« less

Authors:
; ; ; ; ; ; ; ;  [1]
  1. Northwestern University, Section of Interventional Radiology, Department of Radiology (United States)
Publication Date:
OSTI Identifier:
22749781
Resource Type:
Journal Article
Journal Name:
Cardiovascular and Interventional Radiology
Additional Journal Information:
Journal Volume: 41; Journal Issue: 10; Other Information: Copyright (c) 2018 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0174-1551
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; GY RANGE; HEPATOMAS; PATIENTS; RADIOEMBOLIZATION; YTTRIUM 90

Citation Formats

Gordon, Andrew C., E-mail: andrew-gordon@northwestern.edu, Gabr, Ahmed, Riaz, Ahsun, Uddin, Omar M., Abouchaleh, Nadine, Ali, Rehan, Kallini, Joseph, Salem, Riad, and Lewandowski, Robert J., E-mail: r-lewandowski@northwestern.edu. Radioembolization Super Survivors: Extended Survival in Non-operative Hepatocellular Carcinoma. United States: N. p., 2018. Web. doi:10.1007/S00270-018-2008-Y.
Gordon, Andrew C., E-mail: andrew-gordon@northwestern.edu, Gabr, Ahmed, Riaz, Ahsun, Uddin, Omar M., Abouchaleh, Nadine, Ali, Rehan, Kallini, Joseph, Salem, Riad, & Lewandowski, Robert J., E-mail: r-lewandowski@northwestern.edu. Radioembolization Super Survivors: Extended Survival in Non-operative Hepatocellular Carcinoma. United States. doi:10.1007/S00270-018-2008-Y.
Gordon, Andrew C., E-mail: andrew-gordon@northwestern.edu, Gabr, Ahmed, Riaz, Ahsun, Uddin, Omar M., Abouchaleh, Nadine, Ali, Rehan, Kallini, Joseph, Salem, Riad, and Lewandowski, Robert J., E-mail: r-lewandowski@northwestern.edu. Mon . "Radioembolization Super Survivors: Extended Survival in Non-operative Hepatocellular Carcinoma". United States. doi:10.1007/S00270-018-2008-Y.
@article{osti_22749781,
title = {Radioembolization Super Survivors: Extended Survival in Non-operative Hepatocellular Carcinoma},
author = {Gordon, Andrew C., E-mail: andrew-gordon@northwestern.edu and Gabr, Ahmed and Riaz, Ahsun and Uddin, Omar M. and Abouchaleh, Nadine and Ali, Rehan and Kallini, Joseph and Salem, Riad and Lewandowski, Robert J., E-mail: r-lewandowski@northwestern.edu},
abstractNote = {PurposeTo identify baseline characteristics and long-term prognostic factors in non-transplant patients with unresectable hepatocellular carcinoma (HCC) who had prolonged survival after treatment with yttrium-90 radioembolization (Y90).Materials and MethodsSixty-seven “Super Survivors” (defined as ≥ 3-year survival after Y90) were identified within our 1000-patient Y90 database (2003–2017). Baseline imaging and follow-up occurred at 1 month and every 3 months thereafter. Overall survival (OS) was calculated with Kaplan–Meier estimates with log-rank test in subgroups: Child–Pugh (CP) score, distribution of disease, portal vein thrombus (PVT), and technique (segmental vs lobar Y90).Results Median age 69.5 years (range 45–94 years); 69% male; 60% solitary HCC; 79% unilobar disease; 12% PVT; 10% ascites; Barcelona Clinic Liver Cancer Stage A—54%/B—28%/C—16%/D—2%; CP A—70%/B—28%/C—2%. Longest baseline tumor diameter was 5.4 ± 4.0 cm (mean ± SD). All patients had an imaging response (either partial or complete response). Median OS was 67.5 months (95% CI 55.2–82.5). CP score and main PVT stratified median OS (p = 0.0007 and p = 0.0187, respectively). Beyond 3 years, segmental versus lobar Y90 was associated with improved OS with a median OS of 80.2 versus 46.7 months, respectively (p = 0.0024). Dosing > 200 Gy was not a significant predictor of improved OS.ConclusionsSuper Survivors spanning the BCLC staging system maintained durable OS after radioembolization that was stratified by the extent of underlying liver disease. The common variable among all patients was an imaging response. Segmental versus lobar Y90 may have a long-term associated OS benefit.},
doi = {10.1007/S00270-018-2008-Y},
journal = {Cardiovascular and Interventional Radiology},
issn = {0174-1551},
number = 10,
volume = 41,
place = {United States},
year = {2018},
month = {10}
}