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Yttrium-90 radioembolization of unresectable hepatocellular carcinoma – a single center experience

Authors Meyer C, Pieper CC, Ahmadzadehfar H, Lampe NA, Matuschek EME, Maschke TA, Enkirch SJ, Essler M, Spengler U, Schild HH

Received 20 March 2017

Accepted for publication 14 July 2017

Published 26 September 2017 Volume 2017:10 Pages 4773—4785


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 3

Editor who approved publication: Dr Ingrid Espinoza

Carsten Meyer,1,* Claus Christian Pieper,1,* Hojjat Ahmadzadehfar,2 Nina Alexandra Lampe,1 Eva Maria E Matuschek,1 Thomas Adrian Maschke,1 Simon Jonas Enkirch,1 Markus Essler,2 Ulrich Spengler,3 Hans Heinz Schild1

1Department of Radiology, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany, 2Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany, 3Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse, Bonn, Germany

*These authors contributed equally to this work

Purpose: To determine the value of radioembolization (RE) for treatment of unresectable hepatocellular carcinoma (HCC).
Patients and methods: Records of patients undergoing RE for unresectable HCC were retrospectively reviewed. Biochemical and clinical toxicities, imaging response (according to modified Response Evaluation Criteria In Solid Tumors), time-to-progression (TTP) and overall survival (OS) were analyzed. Data were stratified according to clinical and procedural parameters. Univariate and multivariate analyses were performed.
Results: One hundred and fifteen patients (89 male, mean age 69.3 years) underwent 158 REs (119 resin-, 39 glass-based) (Barcelona Clinic Liver Cancer [BCLC]-A: 6.1%, B: 33.9%, C: 60.0%). Median clinical follow-up was 5.9 (0.9–83.5) months. No grade 4 or 5 clinical toxicities were noted. Objective response rate was 35.6%; disease control rate was 76.7%. Median TTP of the treated part of the liver was 4 (0.9–45.4) months. 108/115 patients died during follow-up (median OS 8.4 [0.3–82.8] months after first RE [BCLC-A: 52.8 months, BCLC-B: 12.4 months, BCLC-C: 6.1 months]). On multivariate analysis, baseline Eastern Co-operative Oncology Group status <1, ascites prior to RE and best imaging response were predictors of longer OS. In BCLC-C patients, tumor burden, ascites prior to RE, baseline gamma-glutamyl-transferase and Child–Pugh score were predictive of OS.
Conclusions: RE is safe and effective in carefully selected patients suffering from HCC with a low complication rate. Low baseline Eastern Co-operative Oncology Group status and absence of ascites prior to RE are positive prognostic factors.

Keywords: radioembolization, hepatocellular carcinoma, HCC, locoregional therapy, liver

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