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

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

Abstract

Purpose

To 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 Methods

Sixty-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.

Conclusions

Super 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.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

AFP:

Alpha-Fetoprotein

ALBI:

Albumin–bilirubin

ALT:

ALanine transaminase

AST:

ASpartate transaminase

BCLC:

Barcelona Clinic Liver Cancer

CI:

Confidence interval

CR:

Complete response

ECOG:

Eastern Cooperative Oncology Group

EASL:

European Association for the Study of the Liver

ESL:

Extended shelf life

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

IQR:

interquartile range

KM:

Kaplan–Meier

NASH:

Non-alcoholic steatohepatitis

OS:

Overall survival

PD:

Progressive disease

PVT:

Portal vein thrombosis

PR:

Partial response

RFA:

Radio frequency ablation

SD:

Stable disease

TACE:

TransArterial ChemoEmbolization

TTP:

Time to progression

WHO:

World Health Organization

Y90:

Yttrium-90 radioembolization

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Acknowledgements

The authors thank Carlene del Castillo, Karen Grace, Krystina Salzig, and Melissa Williams for their commitment to patient care and dedication to clinical research.

Funding

ACG is a Medical Scientist Training Program student (T32GM008152).

Author information

Authors and Affiliations

  1. Section of Interventional Radiology, Department of Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA

    Andrew C. Gordon, Ahmed Gabr, Ahsun Riaz, Omar M. Uddin, Nadine Abouchaleh, Rehan Ali, Joseph Kallini, Riad Salem & Robert J. Lewandowski

  2. Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, IL, USA

    Riad Salem & Robert J. Lewandowski

  3. Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA

    Riad Salem & Robert J. Lewandowski

Authors
  1. Andrew C. Gordon
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  2. Ahmed Gabr
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  4. Omar M. Uddin
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  5. Nadine Abouchaleh
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  7. Joseph Kallini
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  8. Riad Salem
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  9. Robert J. Lewandowski
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Corresponding author

Correspondence to Robert J. Lewandowski.

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Conflict of interest

RJL and RS serve as advisors to BTG. None of the other authors report a conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

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

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Gordon, A.C., Gabr, A., Riaz, A. et al. Radioembolization Super Survivors: Extended Survival in Non-operative Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 41, 1557–1565 (2018). https://doi.org/10.1007/s00270-018-2008-y

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  • DOI: https://doi.org/10.1007/s00270-018-2008-y

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