According to the largest to-date multi-center study in Europe, published in the September issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, survival for patients with hepatocellular carcinoma (HCC) can be achieved by using 90Y-resin microsphere radioembolization. The procedure is likely to offer survival chances at different tumor stages, including patients with advanced liver cancer and with limited treatment options.
In 2008, almost 700,000 people died of HCC with more than 80% of cases due to hepatitis B and C infections according to the World Health Organization (WHO).
Studies revealed increased incidence of liver cancer in developed countries, such as the U.S., with the disease also affecting younger individuals. In 2011 alone, the National Cancer Institute estimates there will be over 26,000 new cases of liver and bile duct cancer in the U.S., resulting in close to 20,000 deaths.
Bruno Sangro, MD, PhD, at the Clinica Universitaria de Navarra in Pamplona, Spain explained,
“Hepatologists make decisions on treatment based upon the patient’s underlying disease as well as tumor stage, taking into account whether tumor progression or advanced cirrhosis is more life-threatening. Patients with the disease confined to the liver, but who are not eligible for resection or transplantation need liver-directed therapies that reduce tumor burden, relieve symptoms and increase survival.”
Researchers examined the survival chances of radioembolization, the liver-directed therapy, by assessing 325 HCC patients at eight European centers. The study was conducted between September 2003 and December 2009 with most patients receiving a single administration of microspheres, while approximately 6% of patients received two, and 0.9% received three treatments. The average activity of administered treatment was 1.6 GBq with approximately 45% of patients having whole liver and 39% having right-lobe infusions.
From all HCC patients included in the analysis, 83% were Child-Pugh class A, 79% had underlying cirrhosis, and 88% had a good Eastern Oncology Group (ECOG) performance status. Researchers used the Barcelona Clinic Liver Cancer (BCLC) staging system to measure the extent of HCC and liver function, which classified more than half of the patients as advanced (BCLC C) and a quarter of patients being at intermediate (BCLC B) stage.
The results of the analysis revealed an average overall survival rate of almost 13 months with radioembolization. Survival rates varied depending upon BCLC class ranging from 24 months in those having less progressed disease and liver involvement (BCLC A), to almost 17 months in patients with BCLC B and 10 months in BCLC C patients. Researchers discovered that the most significant factors that affected the prognosis were ECOG performance status, tumor burden, coagulation test score (INR greater than 1.2), and disease outside the liver.
The most common adverse events with radioembolization were fatigue, nausea, vomiting, and abdominal pain. All-cause mortality rates in this high-risk patient group were 0.6% and approximately 7% at 30 and 90 days, respectively.
In a concluding statement Dr. Sangro said,
“Our findings show strong evidence of the survival benefit with radioembolization, even in patients with advanced disease who have few treatments options. Further study of the procedure in patients with advanced disease is warranted.”
Written by Petra Rattue