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Patients With Child-Pugh Class A Benefit Most From Yttrium-90 Radioembolisation for Liver Cancer: Presented at SIR By Thomas R. Collins TAMPA, Fla -- March 18, 2010 -- In one of the first serious attempts to track the outcomes of yttrium-90 (90Y) radioembolisation for hepatocellular carcinoma, researchers have found that patients with Child-Pugh class A benefited the most from the treatment. Results were presented here on March 15 at the Society of Interventional Radiology (SIR) 35th Annual Scientific Meeting. “It’s an attempt to start to standardise the reporting of this kind of therapy,” said Riad Salem, MD, Interventional Radiology, Northwestern University Medical School, Chicago, Illinois. “We’ve learned from this that there continues to be a role for 90Y.” Hepatocellular carcinoma has limited treatment options, and the long-term outcomes after radioembolisation are unknown. The analysis included 526 treatments (291 patients) and 1,250 computed tomography or magnetic resonance imaging scans from December 2003 to December 2008. The tumour burden was <=25% in 77% of patients, 26% to 50% in 16%, 51% to 75% in 7%, and >=76% in 0.4%. Eighty-seven percent of the patients had not had prior treatment, adding to the value of the data, Dr. Salem reported. “You have a sort of treatment-naïve cohort being treated with 90Y, allowing you to have an idea in terms of long-term outcomes,” he said. A significant difference in survival times was found between patients in Child-Pugh classes. Those in class A survived 17.2 months versus 7.7 months in class B (P = .002). Patients in class B with portal vein thrombosis fared poorly, surviving just 5.6 months. There were also significant survival differences among Barcelona Clinic Liver Cancer classes. Those in class A survived 26.9 months, versus 17.2 months in class B and 7.3 months in class C (P < .0001). Fifty-seven percent of patients experienced fatigue, 23% had pain, 20% had nausea or vomiting, and 19% experienced grade 3/4 bilirubin toxicity. Dr. Salem noted that determining which of those toxicities were actually due to treatment or to the disease is difficult, but the researchers reported all that were present, regardless of when they occurred. The results showed that age; the presence of portal hypertension; tumour distribution; levels of bilirubin, albumin, and alpha-fetoprotein; and World Health Organization and European Association for the Study of Liver response rates predicted survival. Dr. Salem said he hoped the findings would fill in a gap in the knowledge about radioembolisation, which is now “all over the place,” and serve as guideposts for future research. “We thought that at least this approach would allow you to look at subgroups and think about subgroup analyses -- who benefits, who does not,” he said. “At a minimum, you can start to power your studies and think about what sample sizes you might need.” [Presentation title: Yttrium-90 Radioembolization for Hepatocellular Carcinoma: Comprehensive Analysis of Long-Term Outcomes in 291 Patients. Abstract 34] E-mail this page to a friend or colleague! To print, use this version