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Low 1-Year Survival Observed With Radioactive Spheres in Advanced Hepatocellular Carcinoma: Presented at SIR

By Ed Susman

WASHINGTON, DC -- March 25, 2008 -- The use of radioactive beads for embolisation and radiation of hepatocellular carcinoma does not appear to appreciably extend survival in patients with advanced disease, researchers said here at the Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting.

"While a response to selective internal radiation therapy can be seen in some patients with advanced hepatocellular carcinoma, overall survival is poor at 1 year," said Darryl A. Zuckerman, MD, Associate Professor of Clinical Radiology, University of Cincinnati, Cincinnati, Ohio.

In his series of 30 patients treated with selective internal radiation therapy utilising Yttrium-90 microscopic radioactive glass beads, the 1-year survival was about 24% -- similar to the rate seen in other studies with a similar patient population.

"The role of selective internal radiation therapy in these patients may be as part of a multimodality approach in which other therapies are considered in combination or as a bridge to liver transplantation in a small subset of patients," Dr. Zuckerman said in his poster presentation on March 18.

"Ultimately a randomised, controlled trial may be required to determine the clinical value of using selective internal radiation therapy in stage III and stage IV patients," he said.

In their study, Dr. Zuckerman and colleagues enrolled 30 consecutive patients with stage III or stage 4 disease who were expected to have 3 months or more of life, an Eastern Cooperative Oncology Group performance status less than 3, relatively good kidney function, and hepatic blood vessels that were able to handle selective catheterisation.

Patients had a mean age of 61.5 years, but ranged from 20 to 86 years. Ten of the patients had disease progression after receiving prior interventions. Fourteen of the patients had infiltrative tumours; 11 had multicentric tumours and 5 had solitary masses.

The beads delivered a mean of 118.5 Gy to the tumours. In most of the patients the procedure produced little response, although in tumours that showed some necrosis at baseline, use of selective internal radiation therapy did produce complete responses in 2 patients and partial responses in 15 patients.

However, 1-month survival after treatment was 96.9%, 3-month survival was 77.5%, 6-month survival was 59.9%, 9-month survival was 43.5%, 1-year survival was 24.2%, and 18-month survival was 16.1%, Dr. Zuckerman reported.

Five of the patients in the study developed grade 3/4 liver toxicity and 1 patient developed a gastric ulcer believed to be related to treatment. The ulcer was treated conservatively and resolved.


[Presentation title: Effectiveness of Selected Internal Radiation Therapy in Advanced Hepatocellular Carcinoma: Single Center Experience. Abstract 361]

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