Gerald Antoch MD, Presenter: Nothing to Disclose

Monia Hamami MD, Abstract Co-Author: Nothing to Disclose

Judith Ertle MD, Abstract Co-Author: Nothing to Disclose

Philip Hilgard, Abstract Co-Author: Speakers Bureau, MDS Inc Speakers Bureau, Bayer AG

Andreas Bockisch, Abstract Co-Author: Nothing to Disclose

Michael Forsting MD, Abstract Co-Author: Nothing to Disclose

To assess the efficiacy of intraarterial radioembolization with 90Yttrium in patients with hepatocellular carcinoma (HCC) and large intrahepatic tumor burden.

57 patients with advanced HCC that were no candidates for chemoembolisation were treated with intraarterial radioembolization (Therasphere©, MDS Nordion, Canada). 45 patients were in Child-Pugh stage A and 12 patients in Child-Pugh stage B. Portal vein thrombosis was present in 11 cases (left or right branch in 10 patients, complete PVT in 1 patient). Radioembolization was performed in a lobar fashion from the right or left hepatic artery after protective coil embolization of all gastrointestinal flow. In patients with bilobar disease the right and left liver lobes were treated in separate sessions within a time interval of four weeks. Follow-up CT imaging (response assessment based on RECIST criteria) was performed 30 days, 90 days, and 6 months after the embolization procedure. Alpha fetoprotein was used as a serological marker for follow-up in AFP-positive patients.

In total 77 radioembolization procedures (mean 1.4 treatments per patient) were performed with a mean dose of 115 Gray per liver lobe. 30 days after treatment 86% of patients had stable disease, partial tumor response was documented in 7% of patients, and 7% had progressive disease. At 90 days stable disease, partial response, and progressive disease were found in 72%, 14%, and 14% of patients, respectively. At 6 months 52% of patients had stable disease, 26% had partial tumor response, and 23% had progressive disease. The AFP was found to be a very sensitive indicator of tumor response in AFP-positive patients. The mean AFP-reduction was 64%, 67%, and 69% at 1, 3, and 6 months in responding patients. The overall survival was 98% at 1 month, 96% at 3 months, 81% at 6 months, and 43% at one year.

Patients with HCC and large intrahepatic tumor burden historically have a very poor prognosis. Radioembolization may be an option in this patient population offering promising survival times at 6 months and reasonable survival at one year. Randomized trials evaluating the efficiacy of radioembolisation against and in combination with systemic therapy (Sorafenib) are required.

In patients with locally advanced HCC radioembolisation with 90Yttrium may be an option as a stand-alone therapy or in combination with systemic treatment.

Antoch, G, Hamami, M, Ertle, J, Hilgard, P, Bockisch, A, Forsting, M, Radioembolization of Hepatocellular Carcinoma in Patients with Large Tumor Burden.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/7113296.html