Abstract
Aim
In this study, it was aimed to explore the prognostic factors in patients who received selective internal radiation therapy for hepatocellular cancer.
Materials and methods
A retrospective evaluation was made of 28 (24 male, 4 female, mean age 65.4 ± 6.8 years) hepatocellular cancer patients who received selective internal radiation therapy with Y-90 resin microspheres. Using Cox proportional hazards regression analysis, the relationship between age, gender, MELD score, serum albumin and AFP levels, number of liver lesions, size of the largest lesion, absence of 18F-FDG uptake, maximum standardized uptake value and overall survival times was analyzed.
Results
Treatment was applied to the right lobe in 22 and both in 6 patients. Mean treatment dose was 1.5 ± 0.2 GBq. Number of liver lesions were 1, <5 and multiple in 16, 5 and 7 patients, respectively, and the mean size of the largest lesion was 41.5 mm (min–max 15–160 mm). While 18F-FDG uptake was seen in 24 patients, liver lesions were hypometabolic in 4 patients. Mean SUVmax of liver lesions was calculated as 5.3 ± 0.3. During the mean 17.8 (min–max 2–39) months follow-up period, 19 patients died. Median survival time was computed as 18 ± 5 months (95 % CI 8.1–27.8). Age (p = 0.04), serum AFP level (p = 0.03) and size of the largest lesion (p = 0.02) had a significant negative effect on survival according to the Cox proportional hazards regression analysis.
Conclusion
Age, serum AFP level and the size of the largest liver lesion have a negative significant effect on survival of hepatocellular cancer patients who received selective internal radiation therapy.
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References
Röcken C, Carl-McGrath S. Pathology and pathogenesis of hepatocellular carcinoma. Dig Dis. 2001;19:269–78.
Llovet JM, Fuster J, Bruix J, Barcelona-Clínic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. 2004;10:115–20.
Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinoma in patients with cirrhosis. N Engl J Med. 1996;334:693–9.
Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37:429–42.
Treiber G. Systemic treatment of hepatocellular carcinoma. Dig Dis. 2001;19:311–23.
Aguayo A, Patt YZ. Nonsurgical treatment of hepatocellular carcinoma. Semin Oncol. 2001;28:503–13.
Lau WY, Kennedy AS, Kim YH, et al. Patient selection and activity planning. Int J Radiat Oncol Biol Phys. 2012;82(401Y):407.
Ahmadzadehfar H, Biersack HJ, Ezziddin S. Radioemmbolisation of liver tumors with Yttrium-90 microspheres. Semin Nucl Med. 2010;40:105–21.
Weng Z, Ertle J, Zheng S, Lauenstein T, Mueller S, Bockisch A, Gerken G, Yang D, Schlaak JF. A new model to estimate prognosis in patients with hepatocellular carcinoma after yttrium-90 radioembolization. PLoS ONE. 2013;8(12):e82225.
Salem ME, Jain N, Dyson G, Taylor S, El-Refai SM, Choi M, Shields AF, Critchfield J, Philip PA. Radiographic parameters in predicting outcome of patients with hepatocellular carcinoma treated with yttrium-90 microsphere radioembolization. ISRN Oncol. 2013;15(2013):538376.
Golfieri R, Bilbao JI, Carpanese L, Cianni R, Gasparini D, Ezziddin S, Paprottka PM, Fiore F, Cappelli A, Rodriguez M, Ettorre GM, Saltarelli A, Geatti O, Ahmadzadehfar H, Haug AR, Izzo F, Giampalma E, Sangro B, Pizzi G, Notarianni E, Vit A, Wilhelm K, Jakobs TF, Lastoria S, European Network on Radioembolization with Yttrium-90 Microspheres (ENRY) study collaborators. Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma. J Hepatol. 2013;59(4):753–61. doi:10.1016/j.jhep.2013.05.025.
Faivre S, Zappa M, Vilgrain V, Boucher E, Douillard JY, Lim HY, Kim JS, Im SA, Kang YK, Bouattour M, Dokmak S, Dreyer C, Sablin MP, Serrate C, Cheng AL, Lanzalone S, Lin X, Lechuga MJ, Raymond E. Changes in tumor density in patients with advanced hepatocellular carcinoma treated with sunitinib. Clin Cancer Res. 2011;17(13):4504–12.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.
Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30(1):52–60.
Kim KW, Lee JM, Choi BI. Assessment of the treatment response of HCC. Abdom Imaging. 2011;36(3):300–14.
Sangro B, Salem R, Kennedy A, et al. Radioembolization for hepatocellular carcinoma: a review of the evidence and treatment recommendations. Am J Clin Oncol. 2011;34:422–31.
Seinstra BA, Defreyne L, Lambert B, Lam MG, Verkooijen HM, van Erpecum KJ, van Hoek B, van Erkel AR, Coenraad MJ, Al Younis I, van Vlierberghe H, van den Bosch MA. Transarterial radioembolization versus chemoembolization for the treatment of hepatocellular carcinoma (TRACE): study protocol for a randomized controlled trial. Trials. 2012;13:144.
Giammarile F, Bodei L, Chiesa C, Flux G, Forrer F, Kraeber-Bodere F, Brans B, Lambert B, Konijnenberg M, Borson-Chazot F, Tennvall J, Luster M, The Therapy, Oncology and Dosimetry Committees. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging. 2011;38(7):1393–406.
Kucuk ON, Soydal C, Araz M, Bilgic S, Ibis E. Prognostic importance of 18F-FDG uptake pattern of hepatocellular cancer patients who received SIRT. Clin Nucl Med. 2013;38(7):e283–9.
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Soydal, C., Keskin, O., Kucuk, O.N. et al. Prognostic factors for prediction of survival of hepatocellular cancer patients after selective internal radiation therapy. Ann Nucl Med 29, 426–430 (2015). https://doi.org/10.1007/s12149-015-0962-x
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DOI: https://doi.org/10.1007/s12149-015-0962-x