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CardioVascular and Interventional Radiology

, Volume 41, Issue 3, pp 459–465 | Cite as

Safety and Efficacy of Transarterial Radioembolization Combined with Chemoembolization for Bilobar Hepatocellular Carcinoma: A Single-Center Retrospective Study

  • Joon Ho Kwon
  • Gyoung Min KimEmail author
  • Kichang Han
  • Jong Yun Won
  • Man Deuk Kim
  • Do Yun Lee
  • Junhyung Lee
  • Woosun Choi
  • Yong Seek Kim
  • Do Young Kim
  • Kwang-Hyub Han
Clinical Investigation

Abstract

Background

Radioembolization induced liver disease (REILD) is a possible sequela of transarterial radioembolization (TARE), particularly in cases of whole-liver treatment. To mitigate this problem, the safety and efficacy of combined transarterial chemoembolization (TACE) and TARE were evaluated for patients with bilobar hepatocellular carcinoma (HCC).

Materials and Methods

Nineteen patients (mean age 60 years; range 27–82 years) treated for HCC between June 2012 and September 2014 were included in the analysis. Each patient was treated with combined TARE and TACE for bilobar HCC, with or without portal vein thrombosis. The hepatic lobe with large HCC was treated with TARE, and the other lobe with small HCC(s) was treated with TACE. Laboratory and clinical data were investigated to determine REILD occurrence. Survival data were analyzed to compare the treatment efficacy of alternative treatment modalities, including TACE and sequential TARE.

Results

All patients underwent TARE for a dominant tumor in one lobe and TACE for small nodule(s) in the other lobe of the liver. The mean yttrium-90 microspheres used in TARE were 2.8 GBq (range; 1.0-3.5 GBq), and the mean doses of doxorubicin and iodized oil were 24.5 mg and 5.2 mL, respectively, for TACE. No statistical differences were noted between laboratory data measured before and after treatment, and no procedure-related major clinical complications occurred. The median time-to-progression of patients was 10.0 months, and the median overall survival was 27.3 months.

Conclusion

Combined radioembolization and chemoembolization appears to be a safe and effective treatment modality for bilobar HCC.

Keywords

Hepatocellular carcinoma Transarterial radioembolization Transarterial chemoembolization Radioembolization induced liver disease Barcelona clinic liver cancer (BCLC) 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts to report.

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.CrossRefPubMedGoogle Scholar
  2. 2.
    El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365(12):1118–27.CrossRefPubMedGoogle Scholar
  3. 3.
    Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379(9822):1245–55.CrossRefPubMedGoogle Scholar
  4. 4.
    Sangro B. Chemoembolization and radioembolization. Best Pract Res Clin Gastroenterol. 2014;28(5):909–19.CrossRefPubMedGoogle Scholar
  5. 5.
    Di Marco V, De Vita F, Koskinas J, et al. Sorafenib: from literature to clinical practice. Ann Oncol. 2013;24(Suppl 2):ii30–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Cho YY, Lee M, Kim HC, et al. Radioembolization is a safe and effective treatment for hepatocellular carcinoma with portal vein thrombosis: a propensity score analysis. PLoS ONE. 2016;11(5):e0154986.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rostambeigi N, Dekarske AS, Austin EE, et al. Cost effectiveness of radioembolization compared with conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. J Vasc Interv Radiol. 2014;25(7):1075–84.CrossRefPubMedGoogle Scholar
  8. 8.
    Lobo L, Yakoub D, Picado O, et al. Unresectable hepatocellular carcinoma: radioembolization versus chemoembolization: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2016;39(11):1580–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Gil-Alzugaray B, Chopitea A, Inarrairaegui M, et al. Prognostic factors and prevention of radioembolization-induced liver disease. Hepatology. 2013;57(3):1078–87.CrossRefPubMedGoogle Scholar
  10. 10.
    Sangro B, Gil-Alzugaray B, Rodriguez J, et al. Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer. 2008;112(7):1538–46.CrossRefPubMedGoogle Scholar
  11. 11.
    Denys A, Pracht M, Duran R, et al. How to prepare a patient for transarterial radioembolization? A practical guide. Cardiovasc Intervent Radiol. 2015;38(4):794–805.CrossRefPubMedGoogle Scholar
  12. 12.
    Piana PM, Gonsalves CF, Sato T, et al. Toxicities after radioembolization with yttrium-90 SIR-spheres: incidence and contributing risk factors at a single center. J Vasc Interv Radiol. 2011;22(10):1373–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Kao YH, Tan EH, Ng CE, et al. Clinical implications of the body surface area method versus partition model dosimetry for yttrium-90 radioembolization using resin microspheres: a technical review. Ann Nucl Med. 2011;25(7):455–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Salem R, Thurston KG. Radioembolization with yttrium-90 microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: part 3: comprehensive literature review and future direction. J Vasc Interv Radiol. 2006;17(10):1571–93.CrossRefPubMedGoogle Scholar
  15. 15.
    Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19(3):329–38.CrossRefPubMedGoogle Scholar
  16. 16.
    Kim DY, Ryu HJ, Choi JY, et al. Radiological response predicts survival following transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma. Aliment Pharmacol Ther. 2012;35(11):1343–50.CrossRefPubMedGoogle Scholar
  17. 17.
    El Fouly A, Ertle J, El Dorry A, et al. In intermediate stage hepatocellular carcinoma: radioembolization with yttrium 90 or chemoembolization? Liver Int. 2015;35(2):627–35.CrossRefPubMedGoogle Scholar
  18. 18.
    Salem R, Lewandowski RJ. Chemoembolization and radioembolization for hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2013;11(6):604–11 (quiz e43–4).CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sangiovanni A, Prati GM, Fasani P, et al. The natural history of compensated cirrhosis due to hepatitis C virus: a 17-year cohort study of 214 patients. Hepatology. 2006;43(6):1303–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Kulik LM, Carr BI, Mulcahy MF, et al. Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology. 2008;47(1):71–81.CrossRefPubMedGoogle Scholar
  21. 21.
    Riaz A, Lewandowski RJ, Kulik LM, et al. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol. 2009;20(9):1121–30 (quiz 1131).CrossRefPubMedGoogle Scholar
  22. 22.
    Kennedy AS, McNeillie P, Dezarn WA, et al. Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors. Int J Radiat Oncol Biol Phys. 2009;74(5):1494–500.CrossRefPubMedGoogle Scholar
  23. 23.
    Ward TJ, Tamrazi A, Lam MG, et al. Management of high hepatopulmonary shunting in patients undergoing hepatic radioembolization. J Vasc Interv Radiol. 2015;26(12):1751–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Leung TW, Lau WY, Ho SK, et al. Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttrium-microspheres for inoperable hepatic tumors. Int J Radiat Oncol Biol Phys. 1995;33(4):919–24.CrossRefPubMedGoogle Scholar
  25. 25.
    Ho S, Lau WY, Leung TW, et al. Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med. 1997;24(3):293–8.PubMedGoogle Scholar
  26. 26.
    Bester L, Salem R. Reduction of arteriohepatovenous shunting by temporary balloon occlusion in patients undergoing radioembolization. J Vasc Interv Radiol. 2007;18(10):1310–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Moreno-Luna LE, Yang JD, Sanchez W, et al. Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma. Cardiovasc Intervent Radiol. 2013;36(3):714–23.CrossRefPubMedGoogle Scholar
  28. 28.
    Kolligs FT, Bilbao JI, Jakobs T, et al. Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma. Liver Int. 2015;35(6):1715–21.CrossRefPubMedGoogle Scholar
  29. 29.
    Kooby DA, Egnatashvili V, Srinivasan S, et al. Comparison of yttrium-90 radioembolization and transcatheter arterial chemoembolization for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol. 2010;21(2):224–30.CrossRefPubMedGoogle Scholar
  30. 30.
    Carr BI, Kondragunta V, Buch SC, et al. Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma: a two-cohort study. Cancer. 2010;116(5):1305–14.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Salem R, Lewandowski RJ, Kulik L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011;140(2):497–507 (e2).CrossRefPubMedGoogle Scholar
  32. 32.
    Hilgard P, Hamami M, Fouly AE, et al. Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology. 2010;52(5):1741–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Bhangoo MS, Karnani DR, Hein PN, et al. Radioembolization with yttrium-90 microspheres for patients with unresectable hepatocellular carcinoma. J Gastrointest Oncol. 2015;6(5):469–78.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017

Authors and Affiliations

  • Joon Ho Kwon
    • 1
  • Gyoung Min Kim
    • 1
    • 3
    Email author
  • Kichang Han
    • 1
  • Jong Yun Won
    • 1
  • Man Deuk Kim
    • 1
  • Do Yun Lee
    • 1
  • Junhyung Lee
    • 1
  • Woosun Choi
    • 1
  • Yong Seek Kim
    • 1
  • Do Young Kim
    • 2
  • Kwang-Hyub Han
    • 2
  1. 1.Department of RadiologyYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Internal Medicine, Institution of GastroenterologyYonsei University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Radiology, Severance Hospital, Research Institute of Radiological ScienceYonsei University College of MedicineSeoulRepublic of Korea

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