Use of Yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis

Andrea Lan Tsai, Charles T. Burke, Andrew S. Kennedy, Dominic T. Moore, Matthew A. Mauro, Robert D. Dixon, Joseph Stavas, Stephen A. Bernard, Amir H. Khandani, Bert H. O'Neil

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43 Scopus citations

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 languageEnglish
Pages (from-to)1377-1384
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume21
Issue number9
DOIs
StatePublished - Sep 2010
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Tsai, A. L., Burke, C. T., Kennedy, A. S., Moore, D. T., Mauro, M. A., Dixon, R. D., Stavas, J., Bernard, S. A., Khandani, A. H., & O'Neil, B. H. (2010). Use of Yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis. Journal of Vascular and Interventional Radiology, 21(9), 1377-1384. https://doi.org/10.1016/j.jvir.2010.04.027