Researchers found that a higher dosage of radioembolization treatment using yttrium (Y)-90 microspheres than previously recommended may benefit patients with hepatocellular carcinoma, according to a recent study published by Chen et al in Liver Cancer. The findings could be practice-changing.
Background
The overall prognosis of hepatocellular carcinoma is poor, with a 5-year survival rate of less than 20%. Late diagnosis and poorly efficacious therapy, especially in the later stages of hepatocellular carcinoma could contribute to these poor outcomes.
Because treatment for locally advanced hepatocellular carcinoma often varies greatly, so do clinical outcomes. The disease can present with vascular invasion, which is frequently treated with radioembolization using Y-90 microspheres. Y-90 is a minimally invasive therapy that delivers high doses of radiation via the bloodstream to tumor cells in the blood or tumors in the liver—first gaining popularity as a treatment option for hepatocellular carcinoma in the 2000s. Previous studies have suggested that delivery of 120 Gy to hepatocellular carcinoma should confer disease control. However, the relationship between Y-90 dosage and clinical outcomes in patients with hepatocellular carcinoma and its optimal dosage for the disease’s treatment has not been determined.
Study Methods and Results
In the recent study, the researchers examined the outcomes of 413 patients with locally advanced hepatocellular carcinoma following treatment with Y-90 microspheres between January 2008 and May 2019. The patients were divided into two groups on the basis of their tumor’s absorbed dose of Y-90 therapy: those who received ≥ 150 Gy and those that did not. The ≥ 150 Gy dosage was based on the mean dosage of the patient cohort, which was 154.7 ± 80.4 Gy.
The researchers found that the patients who received the elevated dose of ≥ 150 Gy of Y-90 therapy experienced improved overall survival outcomes, living nearly 15 months longer compared with those who didn’t receive the elevated dose.
Additionally, 17% (n = 70) of the patients whose tumor burden was successfully regressed or downstaged by Y-90 therapy subsequently underwent conversion therapy with surgical resection, thermal ablation, or liver transplantation. These patients lived four times as long as those who did not receive conversion therapy.
Conclusions
“Y-90 [therapy] has been a valuable option for treating [hepatic] cancer that cannot be surgically removed, but the radiation dose must be adequate without causing harm to patients. Now that we know a higher dose can potentially help achieve better outcomes, it can guide treatment planning and discussions between patients and their [physicians],” highlighted lead study author Chen Kaina, MD, MRCP, MMed, an associate consultant in the Department of Gastroenterology & Hepatology at Singapore General Hospital.
“[Hepatic] cancer remains a lethal disease that is of higher prevalence in Asia. End-to-end research is key to understanding its molecular underpinnings, enhancing diagnosis and improving treatment so that patients have better outcomes. This study is one of the many we are conducting on [hepatic] cancer. We hope that our combined efforts studying the disease will move the needle and take [hepatic] cancer from lethal to treatable,” underscored senior study author Pierce Chow, MBBS, FRCS, MMed, FAMS, PhD, Professor and a senior consultant surgeon in the Division of Surgery and Surgical Oncology at Singapore General Hospital and the National Cancer Centre Singapore.
The researchers have launched a multinational trial exploring the benefits of combining Y-90 therapy with immunotherapy in patients with hepatocellular carcinoma.
Disclosure: For full disclosures of the study authors, visit karger.com.
