TY - JOUR 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 DO - 10.2967/jnumed.117.199752 SP - jnumed.117.199752 AU - Nadine Abouchaleh AU - Ahmed Gabr AU - Rehan Ali AU - Ali Al Asadi AU - Ronald A Mora AU - Joseph Ralph Kallini AU - Karen Marshall AU - laura Kulik AU - Samdeep Mouli AU - Daniela P Ladner AU - Michael Abecassis AU - Juan C Caicedo AU - Ahsun Riaz AU - Robert J Lewandoski AU - Riad Salem Y1 - 2017/12/01 UR - http://jnm.snmjournals.org/content/early/2017/12/06/jnumed.117.199752.abstract N2 - 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. ER -