Transarterial Radioembolization for Unresectable Hepatocellular Carcinoma: Real-Life Efficacy and Safety Analysis of Korean Patients

Abstract

Simple Summary While guidelines endorse locoregional intra-arterial therapies for intermediate-stage hepatocellular carcinoma (HCC) and systemic chemotherapies for advanced-stage HCC, there is emerging literature on transarterial radioembolization (TARE) with 90Y radioembolization. Our present study included a large number of patients from two major hospitals in Korea that may represent real-life efficacy data of unresectable HCCs. This study comprised 24% of Barcelona Clinic Liver Cancer (BCLC) A, 42% of BCLC B and 34% of BCLC C staged HCCs, which may represent real-life efficacy data across BCLC stages. The best overall tumor response, median overall survival and progression-free survival were comparable or even better than previous studies, especially for the intermediate-stage. Furthermore, the toxicities were durable, patients recovered without complication and none experienced adverse effects from the irradiation of non-target tissues. Transarterial radioembolization (TARE) has become widely used in the treatment of HCC, one of the most common causes of cancer mortality worldwide. Here we investigated the long-term clinical outcomes of patients with hepatocellular carcinoma (HCC) treated with TARE in a multi-medical center in Korea. A total of 149 patients treated with TARE from 2008-2014 were recruited. The pre-treatment HCC stage was classified according to the BCLC stage, of which C and D were defined as advanced HCC. Advanced HCC stage and Child-Turcotte-Pugh (CTP) score A were identified in 62 (42%) and 134 (90%) patients, respectively. Portal vein thrombosis (PVT) was identified in 58 patients (38.9%). The median time to progression (TTP) was 14 months, and the median overall survival (OS) and progression-free survival (PFS) were 18.6 and 8.9 months, respectively. The overall tumor response was 47%, and the disease control rate was 78%. OS and PFS differed significantly according to the presence of liver cirrhosis, extrahepatic metastasis, tumor response and curative treatment after TARE (all, p < 0.05). Multiple tumors and major PVT were other independent factors related to OS, while the des-gamma carboxy protein level predicted PFS (all, p < 0.05). Tumor size was an independent predictor of tumor response. TTP, OS and PFS all differed among BCLC stages. The serious adverse effect after TARE was clinically not significant. Therefore, TARE is safe and effective in treating early to advanced HCCs.