Skip to main content
SpringerLink
Log in

Efficacy and Safety of Transarterial Radioembolization Versus Chemoembolization in Patients With Hepatocellular Carcinoma

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Intermediate-stage hepatocellular carcinoma (HCC) is usually treated with locoregional therapy using transarterial chemoembolization (TACE). Transarterial radioembolization (TARE) using β-emitting yttrium-90 integral to the glass matrix of the microspheres is an alternative to TACE. This retrospective case-control study compared the outcomes and safety of TARE versus TACE in patients with unresectable HCC.

Materials and Methods

Patients with unresectable HCC without portal vein thrombosis treated with TARE between 2005 and 2008 (n = 61) were retrospectively frequency-matched by age, sex, and liver dysfunction with TACE-treated patients (n = 55) in the Mayo Clinic Hepatobiliary Neoplasia Registry. Imaging studies were reviewed, and clinical and safety outcomes were abstracted from the medical records.

Results

Complete tumor response was more common after TARE (12 %) than after TACE (4 %) (p = 0.17). When complete response was combined with partial response and stable disease, there was no difference between TARE and TACE. Median survival did not differ between the two groups (15.0 months for TARE and 14.4 months for TACE; p = 0.47). Two-year survival rates were 30 % for TARE and 24 % for TACE. TARE patients received fewer treatments (p < 0.001). Fifty-nine (97 %) TARE patients received outpatient treatment. In contrast, 53 (98 %) TACE patients were hospitalized for ≥1 day (p < 0.001). Compared with TACE, TARE was more likely to induce fatigue (p = 0.003) but less likely to cause fever (p = 0.02).

Conclusion

There was no significant difference in efficacy between TARE and TACE. TARE patients reported more fatigue but had less fever than TACE patients. Treatment with TARE required less hospitalization than treatment with TACE. These findings require confirmation in randomized trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology 136(3):741–754

    Article  PubMed  Google Scholar 

  2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127(12):2893–2917

    Article  PubMed  CAS  Google Scholar 

  3. Schwartz M, Roayaie S, Konstadoulakis M (2007) Strategies for the management of hepatocellular carcinoma. Nat Clin Pract Oncol 4(7):424–432

    Article  PubMed  CAS  Google Scholar 

  4. Yang JD, Roberts LR (2010) Hepatocellular carcinoma: a global view. Nat Rev Gastroenterol Hepatol 7(8):448–458

    Article  PubMed  Google Scholar 

  5. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona 2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35(3):421–430

    Article  PubMed  CAS  Google Scholar 

  6. Geschwind JF, Salem R, Carr BI et al (2004) Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 127(5 Suppl 1):S194–S205

    Article  PubMed  CAS  Google Scholar 

  7. Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42(5):1208–1236

    Article  PubMed  Google Scholar 

  8. Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359(9319):1734–1739

    Article  PubMed  Google Scholar 

  9. Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35(5):1164–1171

    Article  PubMed  CAS  Google Scholar 

  10. Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37(2):429–442

    Article  PubMed  CAS  Google Scholar 

  11. Carr BI (2004) Hepatic arterial 90Yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: Interim safety and survival data on 65 patients. Liver Transpl 10(2 Suppl 1):S107–S110

    Article  PubMed  Google Scholar 

  12. Lewandowski RJ, Kulik LM, Riaz A et al (2009) A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 9(8):1920–1928

    Article  PubMed  CAS  Google Scholar 

  13. Hilgard P, Hamami M, Fouly AE et al (2010) Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology 52(5):1741–1749

    Article  PubMed  CAS  Google Scholar 

  14. Kulik LM, Carr BI, Mulcahy MF et al (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47(1):71–81

    Article  PubMed  Google Scholar 

  15. Salem R, Lewandowski RJ, Mulcahy MF et al (2010) Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 138(1):52–64

    Article  PubMed  CAS  Google Scholar 

  16. EASL-EORTC (2012) Clinical practice guidelines Management of hepatocellular carcinoma. J Hepatol 56(4):908–943

    Google Scholar 

  17. Carr BI, Kondragunta V, Buch SC, Branch RA (2010) Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma: a two-cohort study. Cancer 116(5):1305–1314

    Article  PubMed  CAS  Google Scholar 

  18. D’Avola D, Lnarrairaegui M, Bilbao JI et al (2009) A retrospective comparative analysis of the effect of Y90-radioembolization on the survival of patients with unresectable hepatocellular carcinoma. Hepatogastroenterology 56(96):1683–1688

    PubMed  Google Scholar 

  19. Kooby DA, Egnatashvili V, Srinivasan S et al (2010) Comparison of yttrium-90 radioembolization and transcatheter arterial chemoembolization for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol 21(2):224–230

    Article  PubMed  Google Scholar 

  20. Lambert B, Sturm E, Mertens J et al (2011) Intra-arterial treatment with 90Y microspheres for hepatocellular carcinoma: 4 years experience at the Ghent University Hospital. Eur J Nucl Med Mol Imaging 38(12):2117–2124

    Article  PubMed  CAS  Google Scholar 

  21. Lance C, McLennan G, Obuchowski N et al (2011) Comparative analysis of the safety and efficacy of transcatheter arterial chemoembolization and yttrium-90 radioembolization in patients with unresectable hepatocellular carcinoma. J Vasc Interv Radiol 22(12):1697–1705

    Article  PubMed  Google Scholar 

  22. Salem R, Lewandowski RJ, Kulik L, et al. (2011) Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 140(2):497–507, e492

    Google Scholar 

  23. Sangro B, Carpanese L, Cianni R et al (2011) Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona Clinic liver cancer stages: a European evaluation. Hepatology 54(3):868–878

    Article  PubMed  Google Scholar 

  24. Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30(1):52–60

    Article  PubMed  CAS  Google Scholar 

  25. Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022

    Article  PubMed  Google Scholar 

  26. Llovet JM, Di Bisceglie AM, Bruix J et al (2008) Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 100(10):698–711

    Article  PubMed  Google Scholar 

  27. Sangro B, Gil-Alzugaray B, Rodriguez J et al (2008) Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer 112(7):1538–1546

    Article  PubMed  Google Scholar 

  28. Wong CY, Qing F, Savin M et al (2005) Reduction of metastatic load to liver after intraarterial hepatic yttrium-90 radioembolization as evaluated by [18F]fluorodeoxyglucose positron emission tomographic imaging. J Vasc Interv Radiol 16(8):1101–1106

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Grants from the National Institutes of Health (Grants No. CA100882, CA128633 and CA165076) and Nordion to L. R. R.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Laura E. Moreno-Luna, Ju Dong Yang, William Sanchez, Teresa A. Mettler, Piet C. de Groen, Konstantinos N. Lazaridis, K. V. Narayanan Menon, Nicholas F. LaRusso, Gregory J. Gores & Lewis R. Roberts

  2. Department of Radiology, College of Medicine, Mayo Clinic, Jacksonville, FL, USA

    Ricardo Paz-Fumagalli

  3. Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Jacksonville, FL, USA

    Denise M. Harnois

  4. Department of Oncology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA

    Steven R. Alberts

  5. Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA

    Seth W. Slettedahl, William S. Harmsen & Terry M. Therneau

  6. Department of Radiology, College of Medicine, Mayo Clinic, Rochester, MN, USA

    Denise N. Gansen, Chad J. Fleming, Gregory A. Wiseman & James C. Andrews

Authors
  1. Laura E. Moreno-Luna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ju Dong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ricardo Paz-Fumagalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Denise M. Harnois
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Teresa A. Mettler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Denise N. Gansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Piet C. de Groen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Konstantinos N. Lazaridis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. K. V. Narayanan Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nicholas F. LaRusso
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Steven R. Alberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Gregory J. Gores
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Chad J. Fleming
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Seth W. Slettedahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. William S. Harmsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Terry M. Therneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Gregory A. Wiseman
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. James C. Andrews
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Lewis R. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lewis R. Roberts.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (TIFF 1973 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moreno-Luna, L.E., Yang, J.D., Sanchez, W. et al. Efficacy and Safety of Transarterial Radioembolization Versus Chemoembolization in Patients With Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 36, 714–723 (2013). https://doi.org/10.1007/s00270-012-0481-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-012-0481-2

Keywords

Search

Navigation