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The Pattern of Progression Defines Post-progression Survival in Patients with Hepatocellular Carcinoma Treated with SIRT

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

Abstract

Purpose

In patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib, post-progression survival (PPS) is marked by the pattern of progression. Our aim was to assess the influence of the pattern of progression to selective internal radiotherapy (SIRT) in PPS among patients with HCC.

Methods

A retrospective analysis of patients treated with SIRT between 2003 and 2015 was conducted, excluding those with a single nodule < 5 cm or with metastases. Four patterns of progression to SIRT were defined: target tumour growth, non-target tumour growth, new intrahepatic disease, and new extrahepatic disease. PPS was calculated from the time of progression based on RECIST 1.1 criteria.

Results

Out of the 102 patients who met the selection criteria, 76 progressed after a median follow-up of 15 months. Median PPS was 6.5 months (95% CI 3.8–9.3 months). Patients who progressed at pre-existing lesions had a better PPS (median 12.5 months) than those who progressed with new lesions inside or outside the liver (median 4.2 months) (p = 0.02). In a Cox model adjusted by liver function and systemic inflammation, the pattern of progression had a hazard ratio of 1.64 (95% CI 0.92–2.93; p = 0.093).

Conclusion

In a cohort of HCC patients treated with SIRT, the pattern of progression associated with worst survival was the development of new intrahepatic lesions or extrahepatic metastases.

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Abbreviations

HCC:

Hepatocellular carcinoma

TACE:

Transarterial chemoembolization

SIRT:

Selective internal radiotherapy

PPS:

Post-progression survival

BCLC:

Barcelona clinic liver cancer

CT:

Computed tomography

MRI:

Magnetic resonance imaging

tTG:

Target tumour growth

ntTG:

Non-target tumour growth

NIH:

New intrahepatic disease

NEH:

New extrahepatic disease

OS:

Overall survival

TTP:

Time to progression

HCV:

Hepatitis C viral infection

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Acknowledgements

We thank Carmen Fuertes for her work in taking care of the patients treated with SIRT and her commitment to medical research.

Funding

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) is supported by Instituto de Salud Carlos III.

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Authors and Affiliations

  1. Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain

    Manuel de la Torre-Aláez, Carlota Jordán-Iborra, Delia D’Avola, José Ignacio Herrero, Mercedes Iñarrairaegui & Bruno Sangro

  2. Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Andrea Casadei-Gardini

  3. Department of Radiology, Clínica Universidad de Navarra-IDISNA, Pamplona, Spain

    José Ignacio Bilbao

  4. Department of Nuclear Medicine, Clínica Universidad de Navarra-IDISNA, Pamplona, Spain

    Macarena Rodriguez-Fraile & Lidia Sancho

  5. IDISNA, Pamplona, Spain

    José Ignacio Bilbao, Macarena Rodriguez-Fraile, Delia D’Avola, José Ignacio Herrero, Mercedes Iñarrairaegui & Bruno Sangro

  6. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain

    Delia D’Avola, José Ignacio Herrero, Mercedes Iñarrairaegui & Bruno Sangro

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  1. Manuel de la Torre-Aláez
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Contributions

Carlota Jordán-Iborra, Manuel de la Torre-Aláez and Bruno Sangro conceived and designed the study. Carlota Jordán-Iborra completed the database and performed the statistical analysis. All authors evaluated the initial results and discussed the findings for further analysis. Carlota Jordán-Iborra, Manuel de la Torre-Aláez and Bruno Sangro wrote the first draft of the manuscript that was revised by all authors upon completion. Guarantor of the article: Bruno Sangro.

Corresponding author

Correspondence to Manuel de la Torre-Aláez.

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Conflict of interest

José Ignacio Bilbao has received consulting and lecture fees from Sirtex Medical. Macarena Rodriguez-Fraile has received lecture fees from Sirtex Medical. Bruno Sangro has received consulting fees and/or lecture fees from Astra Zeneca, Bayer, BMS, BTG, Novartis, Sirtex Medical, and Terumo. Mercedes Iñarrairaegui has been supported by a grant from the Instituto de Salud Carlos III (PI13/01184).

Ethics Approval

The local Ethics committee approved this retrospective study and a waiver of patient’s informed consent was granted due to the retrospective nature of this study.

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Figure S1

Time to progression according to the pattern of progression (JPEG 49 kb)

Figure S2

Post-progression survival according to pattern of progression in patients fit for second line treatments at progression (JPEG 57 kb)

Supplemental table 1

Treatment received prior to SIRT and after progression in the entire cohort and in patients fit for second line treatments at progression (DOCX 14 kb)

Supplemental table 2

Selective internal radiation therapy details according to the pattern of progression (DOCX 15 kb)

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de la Torre-Aláez, M., Jordán-Iborra, C., Casadei-Gardini, A. et al. The Pattern of Progression Defines Post-progression Survival in Patients with Hepatocellular Carcinoma Treated with SIRT. Cardiovasc Intervent Radiol 43, 1165–1172 (2020). https://doi.org/10.1007/s00270-020-02444-2

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