Yttrium-90 radioembolization for advanced inoperable hepatocellular carcinoma

Background: Advanced inoperable hepatocellular carcinoma (HCC) conferring a grave prognosis may benefit from yttrium-90 (Y-90) radioembolization. Methods: Thirty patients with advanced inoperable HCC including those with any lesion >8 cm in maximal diameter or multiple bi-lobar lesions (totally more than five lesions), or portal vein thrombosis treated with radioembolization were reviewed. Treatment efficacy and safety were evaluated. Univariate and multivariate analyses were performed for identifying potential prognostic factors. Results: After a median follow-up of 18.3 months, the response rate was 30.0%, and the disease control rate was 50.0%. Median overall progression-free survival (PFS) and overall survival (OS) were 3.3 months and 13.2 months, respectively. Longer median PFS was noted in those who had transarterial chemoembolization before radioembolization (7.3 months vs 3.1 months; P=0.021) and duration of alfa-feto protein (AFP) response >= 6 months (11.8 months vs 3.0 months; P < 0.001). Longer median OS was also revealed in those without portal vein thrombosis (17.1 months vs 4.4 months; P= 0.015) and those whose duration of AFP response was >= 6 months (21.2 months vs 8.6 months; P= 0.001). Seventeen patients (56.7%) developed treatment-related complications including five (16.7%) grade 3 events. Multivariate analysis revealed that treatment responders (P= 0.001) and duration of AFP response >= 6 months (P=0.006) were prognostic of PFS, whereas the absence of portal vein invasion (P=0.025), treatment responders (P=0.010), and duration of AFP response >= 6 months (P= 0.001) were prognostic of OS. Conclusion: Y-90 radioembolization is an alternative treatment with a promising outcome for poor-risk advanced inoperable HCC.