Radioembolization results in longer time-toprogression and reduced toxicity compared with

chemoembolization in patients with hepatocellular

carcinoma
RFS Journal Primer

Quick Summary
BOTTOM LINE

Patients with hepatocellular carcinoma were treated by either chemoembolization or

radioembolization over a 9 year period. Though there was no difference in overall survival,
radioembolization resulted in longer time-to-progression and less toxicity.

90Y
90Y

MAJOR POINTS

There was no significant difference in median survival times between chemoembolization and
radioembolization groups (17.4 vs. 20.5 months, p=0.232)

90Y

Time-to-progression was longer for 90Y radioembolization compared to chemoembolization (17.4 vs

20.5 months, p=0.046)

Patients treated with 90Y radioembolization seemed to have a higher response rates than those
treated with chemoembolization (49% vs 36%, p=0.104)

CRITICISM

Sample size is insufficient to demonstrate significant differences in median survival times between
chemoembolization and 90Y radioembolization groups

Lack of direct or randomized comparative data

Bias of using chemoemboliztion for younger patients to bridge to transplant and

radioembolization for older patients as it is better tolerated (66 vs 61, p<.001)

90Y

Study design
RETROSPECTIVE COMPARATIVE
EFFECTIVENESS ANALYSIS

463 patients with chemoembolization

or 90Y radioembolization

Time range: 9 years

INCLUSION CRITERIA

Patients with unresectable HCC as

determined by transplant surgery and
bilirubin < 3.0 mg/dL

EXCLUSION CRITERIA

Patients previously treated with both

chemoembolization and 90Y at any time

Patients who exhibit portal vein

thrombosis

Patients with extrahepatic metastases

Patients lacking imaging follow-up

from expedited transplantation

Figure 1. Study flow chart

Purpose

This study is seeks to compare 90Y radioembolization with chemembolization, the standard
treatment for unresectable, non-advanced hepatocellular carcinoma in terms of adverse
effects, response time, time-to-progression, and overall survival.

Retrieved from http://ami-ir.com/pages/what-interventional-oncology

Intervention

Patients were treated with either chemoembolization or 90Y radioembolization

Chemoembolization: 30mg mitomycin, 30mg adriamycin, and 100mg cisplatin mixed
with lipiodol followed by arterial embolization using occlusive 300-500 micron
particles. Median number of treatments was 2 [inter-quartile range: 1-3].

90Y

Radioembolization: glass-based microspheres (ThereSphere) were comprised of

20-30 micron beta-emitting particles given after pre-treatment with mesenteric
angiography and technetium-99m macroaggregated albumin scans to asses for GI flow
and lung shunting. Median number of treatments was 1 [inter-quartile range: 1-2].

Patients were followed for adverse events every 2-3 months until death for clinical and
laboratory events using the National Cancer Institute Common Terminology Criteria
v3.0.

Patient AFP levels were followed, along with imaging analysis to determine response
rate as per the WHO size and European Association for Study of the Liver necrosis
criteria.

Outcome

AFP levels were significantly reduced by >50% post treatment for both chemoembolization and
90Y radioembolization (59% and 80%, respectively).

Imaging Outcomes
Response rate as determined by WHO size criteria trended towards 90Y radioembolization
vs chemoembolization (49% vs 36%, p=0.104). Median time to WHO partial response also
trended towards 90Y radioembolization (6.6 vs 10.3 months, p=0.05)

Time-to-Progression (as determined by progression by WHO, EASL, UNOS stage,

development of PVT, or appearance of new or extrahepatic lesions) was significantly
increased in 90Y radioembolization vs chemoemboliazation (13.3 months vs 8.4 months,
p=0.046).
Clinical/Laboratory Toxicities showed that

Figure 2. Survival distribution function by treatment

Group adjusted for covarities (p=0.780)

fatigue and fever were increased with 90Y

radioembolization but diarrhea, abdominal
pain (p<.001) and transaminitis (p=.004) were
decreased.
Survival rates were not significantly different
between patients treated with
chemoembolization or 90Y radioembolization
(17.4 vs 20.5 months, p=0.232) and were even
more similar in patients with intermediatestage disease (17.5 vs 17.2 months, p=0.42)

Credits

SUMMARY BY:

Dean Thongkham, MS4

St. Georges University
Salen R, Lewandowski RJ, Kulik L et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with
chemoembolization in patients with hepatocellular carcinoma. Gastroenterology. 2011 Feb; 140(2):497-507.

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