Y-90 Radioembolization Studied for Locally Advanced HCC With Portal Vein Thrombosis

December 21, 2017—Online in Journal of Nuclear Medicine, Nadine Abouchaleh et al reported survival outcomes for advanced stage hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) treated with yttrium-90 (Y-90) radioembolization. The investigators were led by Riad Salem, MD, at Northwestern University in Chicago, Illinois.

With approval of Northwestern's Institutional Review Board, the investigators searched their prospectively acquired database for patients treated with Y-90 between 2003 and 2017. The study included patients who had advanced stage HCC with tumor PVT. To minimize confounding effect, patients with metastases were excluded. Clinical and laboratory data were collected at baseline and 1-month after Y-90 treatment.

The investigators reported long-term survival outcomes stratified by Child-Pugh (CP) score. Overall survival was calculated using Kaplan-Meier analysis. Multivariate analysis was conducted using Cox proportion hazards. Additionally, the investigators conducted a subanalysis for patients with high alpha-fetoprotein (AFP) (> 100 ng/dL).

As summarized in Journal of Nuclear Medicine, 185 patients with PVT related to HCC received Y-90 treatment between 2003 and 2017. Seventy-four patients (40%) were CP-A, 51 (28%) were CP-B7, and 60 (32%) were ≥ CP-B8.

Median overall survival was 13.3 months for CP-A patients (95% confidence interval [CI], 8.7–15.7), 6.9 months for CP-B7 patients (95% CI, 5.3–10.1), and 3.9 months (95% CI, 2.9–5) for ≥ CP-B8 patients.

On multivariate analysis, the investigators found that baseline bilirubin, ascites, and AFP were more significant prognosticators. Of 123 patients with high AFP (> 100 ng/dL), 12 patients restored normal AFP levels (< 13 ng/dL) and exhibited median overall survival of 23.9 months (CI, 20.1–124.1).

The investigators concluded that Y-90 radioembolization can serve as a safe and effective treatment for advanced stage HCC patients with tumor PVT. The overall survival outcomes are affected by baseline liver function, tumor size, and AFP level, noted the investigators in Journal of Nuclear Medicine.