Abstract
Purpose: Patients with portal vein thrombosis (PVT) and hepatocellular carcinoma (HCC) have limited treatment options because of increased disease burden and diminished hepatic perfusion. Yttrium-90 (90Y) microspheres may be better tolerated than chemoembolization in these patients. The present study reviews the safety and efficacy of 90Y microspheres in HCC with major PVT. Materials and Methods: A retrospective review of HCC with main (n = 10) or first-branch (n = 12) PVT treated with 90Y microspheres (N = 22) was conducted. Cancer of the Liver Italian Program (CLIP) scores ranged from 2 to 5, with 18% of patients having a score of 4 or greater. Imaging response at 812 was based on Response Evaluation Criteria In Solid Tumors. Overall survival (OS) was estimated by the Kaplan-Meier method. Results: A total of 32 microsphere treatments (26 glass, six resin) were administered to 22 patients. Common grade 1/2 toxicities included abdominal pain (38%), nausea (28%), and fatigue (22%). Four posttreatment hospitalizations occurred, all less than 48 hours in duration. One death occurred 10 days after therapy. The partial response rate was 8% and progressive disease was seen in 42% of patients. Stable disease was achieved in 50% of treatments. Median OS was 7 months from initial treatment. Patients with Child-Pugh class A disease had a median OS of 7.7 months; those with class B/C disease had an OS of 2.7 months (P = .01). Median OS for patients with CLIP scores of 2/3 was 7 months, versus 1.3 months for those with scores of 4/5 (P = .04). Conclusions: Yttrium-90 microspheres are tolerated in patients with HCC and major PVT. Compared with chemoembolization, rates of severe adverse events appear low. Radiographic response rates are low. The median OS of 7 months is promising and warrants further study versus systemic therapy.
| Original language | English |
|---|---|
| Pages (from-to) | 1377-1384 |
| Number of pages | 8 |
| Journal | Journal of Vascular and Interventional Radiology |
| Volume | 21 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 2010 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine
Cite this
Use of Yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis. / Tsai, Andrea Lan; Burke, Charles T.; Kennedy, Andrew S.; Moore, Dominic T.; Mauro, Matthew A.; Dixon, Robert D.; Stavas, Joseph; Bernard, Stephen A.; Khandani, Amir H.; O'Neil, Bert H.
In: Journal of Vascular and Interventional Radiology, Vol. 21, No. 9, 09.2010, p. 1377-1384.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Use of Yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis
AU - Tsai, Andrea Lan
AU - Burke, Charles T.
AU - Kennedy, Andrew S.
AU - Moore, Dominic T.
AU - Mauro, Matthew A.
AU - Dixon, Robert D.
AU - Stavas, Joseph
AU - Bernard, Stephen A.
AU - Khandani, Amir H.
AU - O'Neil, Bert H.
PY - 2010/9
Y1 - 2010/9
N2 - Purpose: Patients with portal vein thrombosis (PVT) and hepatocellular carcinoma (HCC) have limited treatment options because of increased disease burden and diminished hepatic perfusion. Yttrium-90 (90Y) microspheres may be better tolerated than chemoembolization in these patients. The present study reviews the safety and efficacy of 90Y microspheres in HCC with major PVT. Materials and Methods: A retrospective review of HCC with main (n = 10) or first-branch (n = 12) PVT treated with 90Y microspheres (N = 22) was conducted. Cancer of the Liver Italian Program (CLIP) scores ranged from 2 to 5, with 18% of patients having a score of 4 or greater. Imaging response at 812 was based on Response Evaluation Criteria In Solid Tumors. Overall survival (OS) was estimated by the Kaplan-Meier method. Results: A total of 32 microsphere treatments (26 glass, six resin) were administered to 22 patients. Common grade 1/2 toxicities included abdominal pain (38%), nausea (28%), and fatigue (22%). Four posttreatment hospitalizations occurred, all less than 48 hours in duration. One death occurred 10 days after therapy. The partial response rate was 8% and progressive disease was seen in 42% of patients. Stable disease was achieved in 50% of treatments. Median OS was 7 months from initial treatment. Patients with Child-Pugh class A disease had a median OS of 7.7 months; those with class B/C disease had an OS of 2.7 months (P = .01). Median OS for patients with CLIP scores of 2/3 was 7 months, versus 1.3 months for those with scores of 4/5 (P = .04). Conclusions: Yttrium-90 microspheres are tolerated in patients with HCC and major PVT. Compared with chemoembolization, rates of severe adverse events appear low. Radiographic response rates are low. The median OS of 7 months is promising and warrants further study versus systemic therapy.
AB - Purpose: Patients with portal vein thrombosis (PVT) and hepatocellular carcinoma (HCC) have limited treatment options because of increased disease burden and diminished hepatic perfusion. Yttrium-90 (90Y) microspheres may be better tolerated than chemoembolization in these patients. The present study reviews the safety and efficacy of 90Y microspheres in HCC with major PVT. Materials and Methods: A retrospective review of HCC with main (n = 10) or first-branch (n = 12) PVT treated with 90Y microspheres (N = 22) was conducted. Cancer of the Liver Italian Program (CLIP) scores ranged from 2 to 5, with 18% of patients having a score of 4 or greater. Imaging response at 812 was based on Response Evaluation Criteria In Solid Tumors. Overall survival (OS) was estimated by the Kaplan-Meier method. Results: A total of 32 microsphere treatments (26 glass, six resin) were administered to 22 patients. Common grade 1/2 toxicities included abdominal pain (38%), nausea (28%), and fatigue (22%). Four posttreatment hospitalizations occurred, all less than 48 hours in duration. One death occurred 10 days after therapy. The partial response rate was 8% and progressive disease was seen in 42% of patients. Stable disease was achieved in 50% of treatments. Median OS was 7 months from initial treatment. Patients with Child-Pugh class A disease had a median OS of 7.7 months; those with class B/C disease had an OS of 2.7 months (P = .01). Median OS for patients with CLIP scores of 2/3 was 7 months, versus 1.3 months for those with scores of 4/5 (P = .04). Conclusions: Yttrium-90 microspheres are tolerated in patients with HCC and major PVT. Compared with chemoembolization, rates of severe adverse events appear low. Radiographic response rates are low. The median OS of 7 months is promising and warrants further study versus systemic therapy.
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U2 - 10.1016/j.jvir.2010.04.027
DO - 10.1016/j.jvir.2010.04.027
M3 - Article
VL - 21
SP - 1377
EP - 1384
JO - Journal of Vascular and Interventional Radiology
JF - Journal of Vascular and Interventional Radiology
SN - 1051-0443
IS - 9
ER -