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Comparative Study
. 2011 Feb;140(2):497-507.e2.
doi: 10.1053/j.gastro.2010.10.049. Epub 2010 Oct 30.

Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma

Riad Salem  1 , Robert J Lewandowski, Laura Kulik, Edward Wang, Ahsun Riaz, Robert K Ryu, Kent T Sato, Ramona Gupta, Paul Nikolaidis, Frank H Miller, Vahid Yaghmai, Saad M Ibrahim, Seanthan Senthilnathan, Talia Baker, Vanessa L Gates, Bassel Atassi, Steven Newman, Khairuddin Memon, Richard Chen, Robert L Vogelzang, Albert A Nemcek, Scott A Resnick, Howard B Chrisman, James Carr, Reed A Omary, Michael Abecassis, Al B Benson 3rd, Mary F Mulcahy
Affiliations
Comparative Study

Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma

Riad Salem et al. Gastroenterology. 2011 Feb.

Abstract

Background & aims: Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC.

Methods: We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed.

Results: Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42).

Conclusions: Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.

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Conflict of interest statement

Conflict of Interest: Riad Salem, Laura Kulik, Al Benson and Mary Mulcahy are advisors to MDS Nordion. None of the other authors have any conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Survival distribution function by treatment group adjusted for covariates (P = .7803).
See this image and copyright information in PMC

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