Survival Outcomes for Yttrium-90 Transarterial Radioembolization With and Without Sorafenib for Unresectable Hepatocellular Carcinoma Patients
Received 4 February 2020
Accepted for publication 21 July 2020
Published 14 September 2020 Volume 2020:7 Pages 117—131
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Dan Duda
Ajalaya Teyateeti,1,2 Armeen Mahvash,3 James P Long,4 Mohamed E Abdelsalam,3 Rony Avritscher,3 Beth Chasen,1 Ahmed O Kaseb,5 Joshua D Kuban,3 Ravi Murthy,3 Bruno C Odisio,3 Achiraya Teyateeti,6 Homer A Macapinlac,1 S Cheenu Kappadath7
1Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 3Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 4Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 5Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 6Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 7Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Correspondence: S Cheenu Kappadath
Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1155 Pressler Street — Unit 1352, Houston, TX 77030, USA
Tel +1 713 745 2835
Purpose: To assess the overall survival (OS) and progression-free survival (PFS) of unresectable hepatocellular carcinoma (HCC) patients undergoing yttrium-90 glass–microsphere transarterial radioembolization (TARE) with and without concurrent sorafenib.
Methods: OS and PFS were analyzed in 55 patients with an intrahepatic tumor (IHT) ≤ 50% without advanced or aggressive disease features (ADFs), which was referred to presence of infiltrative/ill-defined HCC, macrovascular invasion, or extrahepatic disease treated with only TARE (TARE_alone) and in 74 patients with IHT ≤ 50% with ADFs or IHT > 50% treated with TARE and sorafenib (TARE_sorafenib). Prognostic factors for OS and PFS were identified using univariate and multivariate analyses.
Results: Median OS and PFS of TARE_alone patients were 21.6 (95% CI 6.1– 37.1) and 9.1(95% CI 5.2– 13.0) months, respectively, and for TARE_sorafenib patients 12.4 (95% CI 9.1– 15.6) and 5.1 (95% CI 2.6– 7.5) months, respectively. Better OS was associated with serum AFP < 400 (HR 0.27, p=0.02) in TARE_alone, and IHT ≤ 50% (HR 0.39, p=0.004) and AFP < 400 (HR 0.5, p=0.027) in TARE_sorafenib. Unilobar involvement (HR 0.43, p=0.029) and AFP < 400 ng/mL (HR 0.52, p=0.015) correlated with better PFS in TARE_alone and TARE_sorafenib, respectively. Adverse events (AEs) were more frequent in TARE_sorafenib than TARE_alone (92.4 vs 80.3%), but only 9.3% were grade 3 or higher AEs.
Conclusion: TARE_alone provided the most prominent survival benefit in IHT ≤ 50%–without ADF patients who had unilobar HCC and serum AFP < 400 ng/mL. TARE and sorafenib yielded the best outcomes in patients with IHT ≤ 50% and serum AFP < 400 ng/mL, with some additional grade 1– 2 AEs compared to TARE only.
Keywords: 90Y, selective internal radiation therapy, TheraSphere, prognostic factors, adverse events
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