INTRODUCTION: National Comprehensive Cancer Network HCC guidelines recommend Y90 to treat BCLC-C patients only in select cases given the development of systemic regimens. We sought to identify ideal candidates for Y90 by assessing survival and toxicities in this patient group.MATERIALS AND METHODS: The Radiation-Emitting Selective Internal radiation spheres in Non-resectable tumor registry is a prospective observational study (NCT: 02,685,631). Patients with advanced HCC were stratified into 3 groups based on tumor location, Eastern Cooperative Oncology Group (ECOG) performance status, and liver function. Group 1: liver isolated HCC, ECOG 0 and Child Pugh (CP) A (n=12, 16%), Group 2: liver isolated HCC, ECOG=1 or CP B/C (n=37, 49%), and Group 3: extrahepatic HCC with any ECOG or CP score (n=26, 35%). Patients in any group could have macrovascular invasion. Overall survival (OS) and progression-free survival (PFS) with 95% confidence intervals (95% CI) were calculated. Grade 3+toxicities were tracked using Common Terminology Criteria for Adverse Events v5. Cox proportional hazard model was performed to determine factors affecting OS.RESULTS: Seventy-five BCLC-C patients treated between 2015 and 2019 were reviewed. The groups were similar in age, sex, race, and ethnicity (all p>0.05). Bilobar disease was least common in Group 1 (p<0.001). Median OS of the entire cohort was 13.6 (95% CI 7.5-16.1) months. Median OS of Groups 1-3 were 21.8, 13.1 and 11.5months respectively (p=0.6). Median PFS for the cohort was 6.3 (4.8-14.7) months. Median PFS for group 1 was not reached. Mean PFS for Group 1 was 17.3±4.8months. Median PFS for Groups 2 and 3 was 6.8 and 5.9months (X2=1.5, p=0.5). Twenty-four Grade 3 or greater toxicities developed, most commonly hyperbilirubinemia (8/75, 11%) and thrombocytopenia (2/75, 3%). The incidence of toxicities between groups was similar (all p>0.05). Cox Proportional Hazard analysis predicted shorter OS with CP class B/C (X2=6.7, p=0.01), while macrovascular invasion (X2=0.5, p=0.5) and ECOG score of=1 (X2=2.1, p=0.3) was not associated with OS.CONCLUSIONS: OS of CPA patients with advanced HCC and performance status of 0 was 21.8months following Y90. CP A cirrhosis is the best predictor of prolonged OS in advanced (BCLC-C) HCC.
View details for DOI 10.1186/s12876-022-02528-y
View details for PubMedID 36396989