Long-term Clinical Outcomes of Yttrium-90 Transarterial Radioembolization for Hepatocellular Carcinoma: A 5-Year Institutional Experience

Mina S Makary; Jordan Bozer; Eric D Miller; Dayssy A Diaz; Ali Rikabi

doi:10.1016/j.acra.2023.07.007

Long-term Clinical Outcomes of Yttrium-90 Transarterial Radioembolization for Hepatocellular Carcinoma: A 5-Year Institutional Experience

Acad Radiol. 2023 Aug 1:S1076-6332(23)00357-4. doi: 10.1016/j.acra.2023.07.007. Online ahead of print.

Authors

Mina S Makary¹, Jordan Bozer², Eric D Miller³, Dayssy A Diaz³, Ali Rikabi²

Affiliations

¹ Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th Floor, Columbus, OH 43210 (M.S.M., J.B., A.R.). Electronic address: Mina.Makary@OSUMC.edu.
² Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, 4th Floor, Columbus, OH 43210 (M.S.M., J.B., A.R.).
³ Department of Radiation Oncology, The Ohio State University Medical Center, Columbus, Ohio (E.D.M., D.A.D.).

PMID: 37537129
DOI: 10.1016/j.acra.2023.07.007

Abstract

Rationale and objectives: To examine the clinical outcomes of yttrium-90 (Y90) transarterial radioembolization (TARE) for primary hepatocellular carcinoma (HCC) through the evaluation of a 5-year institutional experience.

Materials and methods: This retrospective study evaluated 88 consecutive patients with primary HCC receiving Y90 TARE treatment at an academic medical center from 2017 to 2021. Disease distribution was bilobar in 60.2% of patients with an average lesion diameter of 5.0 ± 3.4 cm and Barcelona Clinic Liver Cancer stage B or C in 77% of the participants. Clinical outcomes were elucidated by examination of complications, liver function tests, biochemical response, and radiographic response. Objective response ratio (ORR) and progression-free survival (PFS) were also calculated.

Results: The mean administered Y90 radiation dose was 127.8 ± 20.2 Gy. No significant complications or LFT elevations occurred post-therapy. Of the 73.9% of patients with α-fetoprotein-producing tumors, 67.8% experienced a complete or partial biochemical response 1 month post-treatment. The ORR was 83.3% on 6-month imaging and PFS was 9.6 ± 8.5 months. Functional outcomes (Eastern Cooperative Oncology Group) were maintained or improved in 79.6% and 76.1% of patients by 6 months and 1 year post-treatment, respectively. The mean survival was 14.7 ± 12.1 months. At 6 months post-treatment, 77.3% of patients were downstaged to or maintained Milan criteria, which was sustained for 74.4% and 70.0% of patients 1 year and 2 years after treatment, respectively.

Conclusion: Y90-TARE is a safe and effective therapy for primary HCC. Enduring outcomes further act as a realistic bridge to liver transplantation, with a majority of patients maintaining Milan criteria and preserving their functional status long term.

Keywords: Hepatocellular carcinoma; Locoregional therapy; Radioembolization; Y-90 therapy.