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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



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).


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.


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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American Association for the Study of Liver Diseases






ALanine transaminase


ASpartate transaminase


Barcelona Clinic Liver Cancer


Confidence interval


Complete response


Eastern Cooperative Oncology Group


European Association for the Study of the Liver


Extended shelf life


Hepatitis B virus


Hepatocellular carcinoma


Hepatitis C virus


interquartile range




Non-alcoholic steatohepatitis


Overall survival


Progressive disease


Portal vein thrombosis


Partial response


Radio frequency ablation


Stable disease


TransArterial ChemoEmbolization


Time to progression


World Health Organization


Yttrium-90 radioembolization


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


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

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Correspondence to Robert J. Lewandowski.

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

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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.

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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).

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