Carlos Moctezuma-Velazquez1, Aldo J Montano-Loza2, Judith Meza-Junco3, Kelly Burak4, Mang Ma2, Vincent G Bain2, Norman Kneteman5, Phillipe Sarlieve6, Richard J Owen7. 1. Division of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Avenida Vasco de Quiroga No 15, Seccion XVI, Tlalpan, 14080, Mexico City, Mexico. 2. Division of Gastroenterology and Liver Unit, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada. 3. Department of Medical Oncology, Cross Cancer Institute, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada. 4. Liver Unit, University of Calgary, 1403 - 29 St. N.W., Calgary, AB, T2N 2T9, Canada. 5. Division of Transplantation, Department of Surgery, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada. 6. Department of Radiology and Diagnostic Imaging, Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada. 7. Department of Radiology and Diagnostic Imaging, Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112th Street, Edmonton, AB, T6G 2B7, Canada. rowen@ualberta.ca.
Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is the second most common lethal cancer, and there is a need for effective therapies. Selective internal radiation therapy (SIRT) has been increasingly used, but is not supported by guidelines due to a lack of solid evidence. AIMS: Determine the efficacy and safety of SIRT in HCC across the Barcelona Clinic Liver Cancer (BCLC) stages A, B, and C. METHODS: Consecutive patients that received SIRT between 2006 and 2016 at two centers in Canada were evaluated. RESULTS: We analyzed 132 patients, 12 (9%), 62 (47%), and 58 (44%) belonged to BCLC stages A, B, and C; mean age was 61.2 (SD ± 9.2), and 89% were male. Median survival was 12.4 months (95% CI 9.6-16.6), and it was different across the stages: 59.7 (95% CI NA), 12.8 (95% CI 10.2-17.5), and 9.3 months (95% CI 5.9-11.8) in BCLC A, B, and C, respectively (p = 0.009). Independent factors associated with survival were previous HCC treatment (HR 2.01, 95% CI 1.23-3.27, p = 0.005), bi-lobar disease (HR 2.25, 95% CI 1.30-3.89, p = 0.003), ascites (HR 1.77, 95% CI 0.99-3.13, p = 0.05), neutrophil-to-lymphocyte ratio (HR 1.11, 95% CI 1.02-1.20, p = 0.01), Albumin-Bilirubin (ALBI) grade-3 (HR 2.69, 95% CI 1.22-5.92, p = 0.01), tumor thrombus (HR 2.95, 95% CI 1.65-5.24, p < 0.001), and disease control rate (HR 0.62, 95% CI 0.39-0.96, p = 0.03). Forty-four (33%) patients developed severe adverse events, and ALBI-3 was associated with higher risk of these events. CONCLUSIONS: SIRT has the potential to be used across the BCLC stages in cases with preserved liver function. When using it as a rescue treatment, one should consider variables reflecting liver function, HCC extension, and systemic inflammation, which are associated with mortality.
BACKGROUND:Hepatocellular carcinoma (HCC) is the second most common lethal cancer, and there is a need for effective therapies. Selective internal radiation therapy (SIRT) has been increasingly used, but is not supported by guidelines due to a lack of solid evidence. AIMS: Determine the efficacy and safety of SIRT in HCC across the Barcelona Clinic Liver Cancer (BCLC) stages A, B, and C. METHODS: Consecutive patients that received SIRT between 2006 and 2016 at two centers in Canada were evaluated. RESULTS: We analyzed 132 patients, 12 (9%), 62 (47%), and 58 (44%) belonged to BCLC stages A, B, and C; mean age was 61.2 (SD ± 9.2), and 89% were male. Median survival was 12.4 months (95% CI 9.6-16.6), and it was different across the stages: 59.7 (95% CI NA), 12.8 (95% CI 10.2-17.5), and 9.3 months (95% CI 5.9-11.8) in BCLC A, B, and C, respectively (p = 0.009). Independent factors associated with survival were previous HCC treatment (HR 2.01, 95% CI 1.23-3.27, p = 0.005), bi-lobar disease (HR 2.25, 95% CI 1.30-3.89, p = 0.003), ascites (HR 1.77, 95% CI 0.99-3.13, p = 0.05), neutrophil-to-lymphocyte ratio (HR 1.11, 95% CI 1.02-1.20, p = 0.01), Albumin-Bilirubin (ALBI) grade-3 (HR 2.69, 95% CI 1.22-5.92, p = 0.01), tumor thrombus (HR 2.95, 95% CI 1.65-5.24, p < 0.001), and disease control rate (HR 0.62, 95% CI 0.39-0.96, p = 0.03). Forty-four (33%) patients developed severe adverse events, and ALBI-3 was associated with higher risk of these events. CONCLUSIONS: SIRT has the potential to be used across the BCLC stages in cases with preserved liver function. When using it as a rescue treatment, one should consider variables reflecting liver function, HCC extension, and systemic inflammation, which are associated with mortality.
Authors: Robert J Lewandowski; Ahmed Gabr; Nadine Abouchaleh; Rehan Ali; Ali Al Asadi; Ronald A Mora; Laura Kulik; Daniel Ganger; Kush Desai; Bartley Thornburg; Samdeep Mouli; Ryan Hickey; Juan Carlos Caicedo; Michael Abecassis; Ahsun Riaz; Riad Salem Journal: Radiology Date: 2018-04-24 Impact factor: 11.105
Authors: Derek M Biederman; Joseph J Titano; Vivian L Bishay; Raisa J Durrani; Etan Dayan; Nora Tabori; Rahul S Patel; Francis S Nowakowski; Aaron M Fischman; Edward Kim Journal: Radiology Date: 2016-12-07 Impact factor: 11.105
Authors: Philip J Johnson; Sarah Berhane; Chiaki Kagebayashi; Shinji Satomura; Mabel Teng; Helen L Reeves; James O'Beirne; Richard Fox; Anna Skowronska; Daniel Palmer; Winnie Yeo; Frankie Mo; Paul Lai; Mercedes Iñarrairaegui; Stephen L Chan; Bruno Sangro; Rebecca Miksad; Toshifumi Tada; Takashi Kumada; Hidenori Toyoda Journal: J Clin Oncol Date: 2014-12-15 Impact factor: 44.544
Authors: Lindsey A Torre; Rebecca L Siegel; Elizabeth M Ward; Ahmedin Jemal Journal: Cancer Epidemiol Biomarkers Prev Date: 2015-12-14 Impact factor: 4.254
Authors: Michael B Pitton; Roman Kloeckner; Christian Ruckes; Gesine M Wirth; Waltraud Eichhorn; Marcus A Wörns; Arndt Weinmann; Mathias Schreckenberger; Peter R Galle; Gerd Otto; Christoph Dueber Journal: Cardiovasc Intervent Radiol Date: 2014-11-07 Impact factor: 2.740
Authors: Martin C S Wong; Johnny Y Jiang; William B Goggins; Miaoyin Liang; Yuan Fang; Franklin D H Fung; Colette Leung; Harry H X Wang; Grace L H Wong; Vincent W S Wong; Henry L Y Chan Journal: Sci Rep Date: 2017-03-31 Impact factor: 4.379
Authors: Florian Nima Fleckenstein; Maximilian Julius Roesel; Maja Krajewska; Timo Alexander Auer; Federico Collettini; Tazio Maleitzke; Georg Böning; Giovanni Federico Torsello; Uli Fehrenbach; Bernhard Gebauer Journal: Cancers (Basel) Date: 2021-12-24 Impact factor: 6.639