RT Journal Article
SR Electronic
T1 Y90 Radioembolization for Locally Advanced Hepatocellular Carcinoma with Portal Vein Thrombosis: Long-Term Outcomes in a 185-Patient Cohort
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP jnumed.117.199752
DO 10.2967/jnumed.117.199752
A1 Nadine Abouchaleh
A1 Ahmed Gabr
A1 Rehan Ali
A1 Ali Al Asadi
A1 Ronald A Mora
A1 Joseph Ralph Kallini
A1 Karen Marshall
A1 laura Kulik
A1 Samdeep Mouli
A1 Daniela P Ladner
A1 Michael Abecassis
A1 Juan C Caicedo
A1 Ahsun Riaz
A1 Robert J Lewandoski
A1 Riad Salem
YR 2017
UL http://jnm.snmjournals.org/content/early/2017/12/06/jnumed.117.199752.abstract
AB Purpose: To report survival outcomes for advanced stage hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) treated with radioembolization (Y90). Methods: With IRB approval we searched our prospectively acquired database for patients treated with Y90 between 2003 and 2017. Inclusion criteria were patients who had advanced stage HCC with tumor PVT. In order to minimize confounding effect, patients with metastases were excluded. Clinical and laboratory data were collected at baseline and 1 month post-Y90. Long-term survival outcomes were reported stratified by Child-Pugh (CP). Overall survival (OS) was calculated using Kaplan Meier. Multivariate analysis was conducted using Cox-proportion harzards. A subanalysis for patients with high alpha-fetoprotein (AFP) (>100 ng/dl) was conducted. Results: Between 2003 and 2017, 185 patients with PVT related to HCC had Y90. Seventy-four patients (40%) were CP-A, 51 (28%) were CP-B7 and 60 (32%) were ≥CP-B8. Median OS for CP-A patients was 13.3 months (95%CI: 8.7-15.7). CP-B7 patients had a median OS of 6.9 months (95%CI: 5.3-10.1). CP-≥B8 patients had a median OS of 3.9 months (95%CI: 2.9-5.0). On multivariate analysis, baseline bilirubin, ascites, and AFP were more significant prognosticators. Out of 123 patients with high AFP (>100 ng/dl), 12 patients restored normal AFP levels (<13 ng/dl) and exhibited median OS of 23.9 months (CI: 20.1-124.1). Conclusion: Y90 radioembolization can serve as a safe and effective treatment for advanced stage HCC patients with tumor PVT. OS outcomes are affected by baseline liver function, tumor size and AFP level.