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. 2022 Mar 21;7(4):100948.
doi: 10.1016/j.adro.2022.100948. eCollection 2022 Jul-Aug.

Clinical Outcomes of Patients With Unresectable Primary Liver Cancer Treated With Yttrium-90 Radioembolization With an Escalated Dose

Re-I Chin  1 , Anirudh Bommireddy  2 , Tyler J Fraum  3 , Daniel R Ludwig  3 , Yi Huang  1 , Jacqueline E Zoberi  1 , Jose L Garcia-Ramirez  1 , Nichole M Maughan  1 , William Chapman  4 , Kevin Korenblat  5 , Lauren E Henke  1 , Hyun Kim  1 , Shahed N Badiyan  1
Affiliations

Clinical Outcomes of Patients With Unresectable Primary Liver Cancer Treated With Yttrium-90 Radioembolization With an Escalated Dose

Re-I Chin et al. Adv Radiat Oncol. .

Abstract

Purpose: Yttrium-90 (90Y) radioembolization with an escalated dose has been shown to improve clinical outcomes compared with standard dose radioembolization, but there are few data on the local control of primary liver tumors. We reported the clinical outcomes of patients with unresectable primary liver tumors treated with 90Y radioembolization with an escalated dose.

Methods and materials: Clinical data of patients with unresectable hepatocellular carcinoma (HCC), cholangiocarcinoma (CC), and biphenotypic tumors (cHCC-CC) treated with radioembolization with an escalated dose (≥150 Gy) between 2013 and 2020 with >3 months follow-up were retrospectively reviewed. The primary endpoint was freedom from local progression. Clinical response was defined by Modified Response Evaluation Criteria in Solid Tumours and toxic effects were assessed using Common Terminology Criteria for Adverse Events version 5.0.

Results: Fifty-three patients with HCC and 15 patients with CC/cHCC-CC were analyzed. The median dose delivered was 205 Gy (interquartile range, 183-253 Gy) and 198 Gy (interquartile range, 154-234 Gy) for patients with HCC and CC/cHCC-CC, respectively. The 1-year freedom from local progression rate was 54% (95% confidence interval [CI], 38%-78%) for patients with HCC and 66% (95% CI, 42%-100%) for patients with CC/cHCC-CC. For patients with HCC, United Network for Organ Sharing nodal stage 1 (P = .01), nonsolitary tumors (P = .02), pretreatment α-fetoprotein of >7.7 ng/mL (P = .006), and ≤268 Gy dose delivered (P = .003) were predictors for local progression on multivariate Cox analysis. No patients with HCC who received a dose >268 Gy had a local tumor progression. The 1-year overall survival for patients with HCC was 74% (95% CI, 61%-89%). After radioembolization, 5 (7%) patients had grade 3 ascites, and 4 (6%) patients had grade 3/4 hyperbilirubinemia.

Conclusions: Treatment of unresectable primary liver tumors with 90Y radioembolization with an escalated dose was safe and well tolerated. Delivery of >268 Gy may improve local tumor control of HCC. Determination of the maximum tolerated dose needs to be performed in the context of future prospective dose-escalation trials to further evaluate the safety and efficacy of such an approach.

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Figures

Fig 1
Figure 1
Kaplan-Meier estimates of (A) freedom from local progression (FFLP) stratified by patients with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma (iCCA/cHCC-CC). For patients with HCC, FFLP was stratified by (B) solitary lesions, (C) pretreatment α−fetoprotein (AFP) >7.7 ng/mL, and (D) delivered dose >268 Gy.
Fig 2
Figure 2
Kaplan-Meier estimates of freedom from local progression for patients with hepatocellular carcinoma (HCC) stratified by (A) United Network for Organ Sharing (UNOS) T2, T3, and T4, and (B) UNOS T2-T3 and T4.
Fig 3
Figure 3
Kaplan-Meier estimates of (A) freedom from elsewhere liver progression, (B) regional control, (C) distant progression-free survival, and (D) overall survival stratified by patients with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma (iCCA/cHCC-CC).
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References

    1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2018;68:394–424. - PubMed
    1. Iwatsuki S, Gordon RD, Shaw BW, et al. Role of liver transplantation in cancer therapy. Annal Surg. 1985;202:401–407. - PMC - PubMed
    1. Fortner JG, Maclean BJ, Kim DK, et al. The seventies evolution in liver surgery for cancer. Cancer. 1981;47:2162–2166. - PubMed
    1. Heckman JT, Devera MB, Marsh JW, et al. Bridging locoregional therapy for hepatocellular carcinoma prior to liver transplantation. Annal Surg Oncol. 2008;15:3169–3177. - PubMed
    1. Sapisochin G, Barry A, Doherty M, et al. Stereotactic body radiotherapy vs. TACE or RFA as a bridge to transplant in patients with hepatocellular carcinoma. An intention-to-treat analysis. J Hepatol. 2017;67:92–99. - PubMed

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