Yttrium-90 microspheres for the treatment of hepatocellular carcinoma

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Gastroenterology. 2004 Nov;127(5 Suppl 2):S194-205.

Yttrium-90 microspheres for the treatment of hepatocellular carcinoma.

Geschwind JF, Salem R, Carr BI, Soulen MC, Thurston KG, Goin KA, Van Buskirk

M, CA, Goin JE.

Unresectable hepatocellular carcinoma is extremely difficult to treat.

TheraSphere consists of yttrium-90 (a pure beta emitter) microspheres, which

are injected into the hepatic arteries. This article reviews the safety and

survival of patients with hepatocellular carcinoma who were treated with

yttrium-90 microspheres. Eighty patients were selected from a database of

108 yttrium-90 microsphere-treated patients and were staged by using

Child-Pugh, Okuda, and Cancer of the Liver Italian Program scoring systems.

Patients were treated with local, regional, and whole-liver approaches.

Survival from first treatment was analyzed with Kaplan-Meier and

regression methods. Adverse events and complications of treatment were coded

by using the Southwest Oncology Group toxicity scoring system. Patients

received liver doses ranging from 47 to 270 Gy. Thirty-two patients (40%)

received more than 1 treatment. Survival correlated with pretreatment Cancer

of the Liver Italian Program scores ( P = .002), as well as with the

individual Cancer of the Liver Italian Program components, Child-Pugh class,

alpha-fetoprotein levels, and percentage of tumor replacement. Patients

classified as Okuda stage I (n = 54) and II (n = 26) had median survival

durations and 1-year survival rates of 628 days and 63%, and 384 days and

51%, respectively ( P = .02). One patient died of liver failure judged as

possibly related to treatment. Thus, in selected patients with

hepatocellular carcinoma, yttrium-90 microsphere treatment is safe and well

tolerated. On the basis of these results, a randomized controlled trial is

warranted comparing yttrium-90 microsphere treatment with transarterial

chemoembolization by using the Cancer of the Liver Italian Program system

for prospective stratified randomization.

PMID: 15508085 [PubMed - in process]