Variable Survival Benefit of Radioembolization in HCC

Disease stage, ECOG status, hepatic function, tumor burden, extrahepatic disease affect survival

WEDNESDAY, Aug. 31 (HealthDay News) -- The survival benefit for patients with hepatocellular carcinoma (HCC) treated with radioembolization with yttrium-90-labeled resin microspheres is affected by numerous factors with the most significant, independent prognostic factors including Eastern Cooperative Oncology Group (ECOG) performance status, international normalized ratio >1.2, tumor burden and extrahepatic disease, according to a study published online June 30 in Hepatology.

Bruno Sangro, M.D., Ph.D., from the Clinica Universidad de Navarra Avda in Spain, and colleagues evaluated the prognostic factors driving survival after radioembolization with yttrium-90labeled resin microspheres in 325 HCC patients who received median activity of 1.6 GBq in whole-liver or right-lobe infusions between September 2003 and December 2009. Most patients (82.5 percent) were Child-Pugh class A, with underlying cirrhosis (78.5 percent) and good ECOG performance status (87.7 percent). Many had multinodular disease (75.9 percent) invading both lobes and/or the portal vein. More than 50 and 25 percent had advanced and intermediate Barcelona Clinic Liver Cancer (BCLC) staging, respectively.

The investigators found that the median overall survival of 12.8 months varied significantly by disease stage, ECOG status, hepatic function, tumor burden, and extrahepatic disease. With references to BCLC staging, tumor burden and liver function were additional factors in determining prognosis. Multivariate analysis confirmed ECOG status, tumor burden, international normalized ratio >1.2, and extrahepatic disease as the most significant independent prognostic factors. Common adverse events were fatigue, nausea/vomiting, and abdominal pain. All-cause mortality at 30 and 90 days was 0.6 percent and 6.8 percent, respectively.

"This analysis provides robust evidence of the survival achieved with radioembolization, including those with advanced disease and few treatment options," the authors write.

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