Imaging and Advanced TechnologyRadioembolization for Hepatocellular Carcinoma Using Yttrium-90 Microspheres: A Comprehensive Report of Long-term Outcomes
Section snippets
Patient Cohort
Between January 1, 2004, and December 31, 2008, 291 patients with HCC were treated with Y90 at one institution as part of a cohort study. A comprehensive review of toxicity, imaging, and survival outcomes was performed. Data were collected prospectively. The study was Health Insurance Portability and Accountability Act compliant, approved by the institutional review board, and registered (NCT00530010).
Pretreatment Evaluation and Staging
Patients underwent pretreatment assessment, including clinical history, physical examination,
Patient Population
Patient demographics, tumor characteristics, and stage are presented in Table 1. The median age was 65 years (range, 26–90 years), and 22% were 75 years of age or older. Most were male (77%), with hepatitis C (34%) and alcohol (19%) as the most common etiologies. A majority were ECOG 0 (56%) or 1 (36%) and were treatment naive (87%). A total of 51% were confirmed to have HCC by biopsy. Most patients were cirrhotic (87%) and had portal hypertension (69%). A total of 73% exhibited multifocal
Discussion
Significant progress has been made in surgical, locoregional, and systemic treatment options for HCC. Our study includes a comprehensive analysis of TTP using strict imaging criteria in 291 patients with HCC who were treated with Y90. Given that PR and TTP are both prognosticators for survival, our analyses included both parameters.10, 15 Such imaging outcomes of Y90 for HCC obtained in a systematic manner have not been reported and represent the largest reported experience to date. Although it
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Conflicts of interest The authors disclose the following: Dr Salem is an advisor to and receives research support from MDS Nordion. Dr Mulcahy and Dr Benson receive research support from MDS Nordion. Dr Lewandowski, Dr Riaz, Dr Ryu, Dr Ibrahim, Dr Atassi, Dr Baker, Dr Gates, Dr Miller, Dr Sato, Dr Wang, Dr Gupta, Dr Newman, Dr Omary, Dr Abecassis, and Dr Kulik disclose no conflicts.