Abstract:
BACKGROUND & AIMS:Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. METHODS:We collected data from 463 patients who were treated with transarterial locoregional therapies (chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed. RESULTS:Abdominal pain and increased transaminase activity were more frequent following chemoembolization (P < .05). There was a trend that patients treated with radioembolization had a higher response rate than with chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42). CONCLUSIONS:Patients with HCC treated by chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.
journal_name
Gastroenterologyjournal_title
Gastroenterologyauthors
Salem R,Lewandowski RJ,Kulik L,Wang E,Riaz A,Ryu RK,Sato KT,Gupta R,Nikolaidis P,Miller FH,Yaghmai V,Ibrahim SM,Senthilnathan S,Baker T,Gates VL,Atassi B,Newman S,Memon K,Chen R,Vogelzang RL,Nemcek AA,Resnick SAdoi
10.1053/j.gastro.2010.10.049subject
Has Abstractpub_date
2011-02-01 00:00:00pages
497-507.e2issue
2eissn
0016-5085issn
1528-0012pii
S0016-5085(10)01587-8journal_volume
140pub_type
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