Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma

Abstract

Background & aims: The European Network on Radioembolization with Yttrium-90 resin microspheres study group (ENRY) conducted a retrospective study to evaluate the outcomes among elderly (≥ 70 years) and younger patients (<70 years) with unresectable hepatocellular carcinoma (HCC) who received radioembolization at 8 European centers.

Methods: Patients with confirmed diagnosis of unresectable HCC who either progressed following resection or locoregional treatment and/or who were considered poor candidates for chemoembolization were evaluated by a multidisciplinary team for radioembolization with (90)Y-resin microspheres (SIR-Spheres; Sirtex Medical). The survival outcome and all adverse events were compared between the two age groups.

Results: Between 2003 and 2009, 128 elderly and 197 younger patients received radioembolization. Patients in both groups had similar demographic characteristics. Many elderly and younger patients alike had multinodular, BCLC stage C disease, invading both lobes (p = 0.648). Elderly patients had a lower tumor burden, a smaller median target liver volume (p = 0.016) and appeared more likely to receive segmental treatment (p = 0.054). Radioembolization was equally well tolerated in both cohorts and common procedure-related adverse events were predominantly grade 1-2 and of short duration. No significant differences in survival between the groups were found (p = 0.942) with similar median survival in patients with early, intermediate or advanced BCLC stage disease.

Conclusions: Radioembolization appears to be as well-tolerated and effective for the elderly as it is for younger patients with unresectable HCC. Age alone should not be a discriminating factor for the management of HCC patients.

Keywords: (90)Y; (99m)Tc-MAA; AEs; AFP; ALT; ANOVA; BCLC; Barcelona Clinic Liver Cancer; CT; CTCAE; EASL; ECOG; ENRY; Elderly patients; European Association for the Study of the Liver; European Cooperative Oncology Group; European Network on Radioembolization with Yttrium-90; GBq; GGTP; GI; HBV; HCC; HCV; Hepatocellular carcinoma; INR; International Normalized Ratio; MELD; Model for End-Stage Liver Disease; NASH; PEI; REILD; RFA; Radioembolization; SD; SIRT; Safety; Survival; TACE; Technetium-99m macroaggregated albumin; Tolerability; Yttrium-90; adverse events; alanine transaminase; alpha fetoprotein; analysis of variance; common toxicity criteria adverse events; computed tomography; gamma-glutamyl transpeptidase; gastrointestinal; gigabecquerel; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; non-alcoholic steatohepatitis; percutaneous ethanol injection; radioembolization-induced liver disease; radiofrequency ablation; selective internal radiation therapy; standard deviation; transarterial chemoembolization.