Ryan D Hirsch1,2, Chris Mills3, Rohit Sawhney4,5, Siddharth Sood6, Virginia Bird6, Gauri Mishra7, Anouk Dev7, William Kemp8,9, John Lubel8,9, Stuart K Roberts8,9, Paul Gow3, Amanda J Nicoll4,5,6. 1. Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia. ryandavidhirsch@gmail.com. 2. Gastroenterology, Eastern Health, 3W Box Hill Hospital, 8 Arnold St, Box Hill, VIC, 3128, Australia. ryandavidhirsch@gmail.com. 3. Gastroenterology, Austin Health, Heidelberg, Victoria, Australia. 4. Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia. 5. Gastroenterology, Eastern Health, 3W Box Hill Hospital, 8 Arnold St, Box Hill, VIC, 3128, Australia. 6. Gastroenterology and Hepatology, Melbourne Health, Parkville, Victoria, Australia. 7. Gastroenterology, Monash Health, Clayton, Victoria, Australia. 8. Gastroenterology, Alfred Health, Melbourne, Victoria, Australia. 9. Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is responsible for 1% of deaths worldwide, and the incidence continues to increase. Despite surveillance programs, 70% of HCC patients are not suitable for curative options at diagnosis, and therefore, non-curative treatments are essential to modern clinical practice. There are many novel treatments, though their roles are not well defined. This study aimed to contrast Selective Internal Radiation Therapy (SIRT) and Drug Eluting Bead Transarterial Chemoembolisation (DEB-TACE) to further define their roles. METHODS: This was a retrospective multicentre cohort study. Factors included for analysis were type of HCC treatment, number of lesions, lesion size, multiple disease severity scores, cirrhosis and vascular invasion. The primary endpoint was transplant-free survival. RESULTS: Transplant-free survival was similar between the two cohorts (p = 0.654), despite a variation in median lesion size, SIRT: 54.5 mm, DEB-TACE: 34 mm (p ≤ 0.001). A univariate Cox proportional hazard model utilising treatment modality as the covariate showed no significant difference in survival (DEB-TACE HR 1.4 (95%CI 0.85-2.15 p = 0.207). The size of the largest lesion was the best predictor of 3-year survival (p = 0.035). Lesion size was inversely associated with survival (HR 1.01 (95%CI 1-1.02, p = 0.025)) on multivariate analysis. CONCLUSION: This study is the first to catalogue the experience of using SIRT in HCC in a real-world Australian population. It has demonstrated no difference in survival outcomes between DEB-TACE and SIRT. Further, it has shown SIRT to be a reasonable alternative to DEB-TACE especially in larger lesions and has demonstrated that DEB-TACE has a role in select patients with advanced disease.
BACKGROUND: Hepatocellular carcinoma (HCC) is responsible for 1% of deaths worldwide, and the incidence continues to increase. Despite surveillance programs, 70% of HCC patients are not suitable for curative options at diagnosis, and therefore, non-curative treatments are essential to modern clinical practice. There are many novel treatments, though their roles are not well defined. This study aimed to contrast Selective Internal Radiation Therapy (SIRT) and Drug Eluting Bead Transarterial Chemoembolisation (DEB-TACE) to further define their roles. METHODS: This was a retrospective multicentre cohort study. Factors included for analysis were type of HCC treatment, number of lesions, lesion size, multiple disease severity scores, cirrhosis and vascular invasion. The primary endpoint was transplant-free survival. RESULTS: Transplant-free survival was similar between the two cohorts (p = 0.654), despite a variation in median lesion size, SIRT: 54.5 mm, DEB-TACE: 34 mm (p ≤ 0.001). A univariate Cox proportional hazard model utilising treatment modality as the covariate showed no significant difference in survival (DEB-TACE HR 1.4 (95%CI 0.85-2.15 p = 0.207). The size of the largest lesion was the best predictor of 3-year survival (p = 0.035). Lesion size was inversely associated with survival (HR 1.01 (95%CI 1-1.02, p = 0.025)) on multivariate analysis. CONCLUSION: This study is the first to catalogue the experience of using SIRT in HCC in a real-world Australian population. It has demonstrated no difference in survival outcomes between DEB-TACE and SIRT. Further, it has shown SIRT to be a reasonable alternative to DEB-TACE especially in larger lesions and has demonstrated that DEB-TACE has a role in select patients with advanced disease.
Authors: Munveer Singh Bhangoo; Diraj R Karnani; Paul N Hein; Huan Giap; Harry Knowles; Chris Issa; Steve Steuterman; Paul Pockros; Catherine Frenette Journal: J Gastrointest Oncol Date: 2015-10
Authors: F Abdul Rahman; J Naidu; C S Ngiu; Y Yaakob; Z Mohamed; H Othman; R Jarmin; M H Elias; N Abdul Hamid; N Mohd Mokhtar; Ra Raja Ali Journal: Asian Pac J Cancer Prev Date: 2016
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