scholarly journals ALBI Score Is a Strong Predictor of Toxicity Following SIRT for Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3794
Author(s):  
Céline Lescure ◽  
Florian Estrade ◽  
Maud Pedrono ◽  
Boris Campillo-Gimenez ◽  
Samuel Le Sourd ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Liver Disease ◽  
Strong Predictor ◽  
Multivariable Analysis ◽  
Selective Internal Radiation Therapy ◽  
Internal Radiation ◽  
Liver Functions ◽  
Grade 3

Background: Selective internal radiation therapy (SIRT) is an innovative treatment of hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI) score was designed to better evaluate liver functions in HCC. Methods: We studied, retrospectively, data from patients treated with SIRT for HCC. The primary endpoint was the occurrence of radioembolization-induced liver disease (REILD). The secondary endpoint was overall survival (OS). Results: 222 patients were studied. The ALBI grade 1 patients had significantly less REILD (3.4%) after the first SIRT than ALBI grade 2 or 3 patients (16.8%, p = 0.002). Of the 207 patients with data, 77 (37.2%) had a worsening of ALBI grade after one SIRT. The baseline ALBI grade was significantly associated with OS (p = 0.001), also in the multivariable analysis. The ALBI grade after the first SIRT was significantly associated with OS (p ≤ 0.001), with median OS of 26.4 months (CI 95% 18.2–34.7) for ALBI grade 1 patients (n = 48) versus 17.3 months (CI 95% 12.9–21.8) for ALBI grade 2 patients (n = 123) and 8.1 months (CI 95% 4.1–12.1) for ALBI grade 3 patients (n = 36). Conclusions: The baseline ALBI grade is a strong predictor of REILD. The baseline ALBI score and variations of ALBI are prognostic after SIRT.

scholarly journals Tumor burden and liver function in HCC patient selection for selective internal radiation therapy: SARAH post-hoc study

2020 ◽  
Vol 16 (1) ◽  
pp. 4315-4325 ◽  
Author(s):  
Daniel H Palmer ◽  
Neil S Hawkins ◽  
Valérie Vilgrain ◽  
Helena Pereira ◽  
Gilles Chatellier ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Liver Function ◽  
Tumor Burden ◽  
Selective Internal Radiation Therapy ◽  
Internal Radiation ◽  
Selective Internal Radiation ◽  
Internal Radiation Therapy ◽  
Post Hoc

Aim: To determine whether a liver tumor burden ≤25% and well-preserved liver function (albumin-bilirubin grade 1) are appropriate criteria for identifying patients with unresectable hepatocellular carcinoma who may benefit from selective internal radiation therapy (SIRT) using 90yttrium resin microspheres versus sorafenib. Patients & methods: Post-hoc analysis of patients in the intention-to-treat population of the SARAH trial (SIRT vs sorafenib) with ≤25% tumor burden and albumin-bilirubin grade 1. Primary end point: overall survival. Results: Median overall survival was 21.9 months (95% CI: 15.2–32.5, n = 37) with SIRT and 17.0 months (11.6–20.8, n = 48) with sorafenib (hazard ratios: 0.73; 95% CI: 0.44–1.21; p = 0.22). Conclusion: A combination of good liver function and low tumor burden may be relevant for selection of hepatocellular carcinoma patients for SIRT.

scholarly journals Selective Internal Radiation Therapy Using Yttrium-90 Radioembolization for Hepatocellular Carcinoma

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 81s-81s
Author(s):  
F.K. Hanin ◽  
N.A. Yussof ◽  
J. Sabirin
Keyword(s):  
Colorectal Cancer ◽  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Clinical Response ◽  
Response Rates ◽  
Selective Internal Radiation Therapy ◽  
Internal Radiation ◽  
Metastatic Liver ◽  
Yttrium 90

Background: Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver that accounts for an important health problem worldwide. It is the sixth most common cancer worldwide with an incidence of 626,000 new patients a year, and the third most common cause of cancer related death. Secondary or metastatic liver are more common than primary tumor. The most common sites of primary tumor are breast, lung, and colorectal cancer with the majority of secondary liver cancers are metastases from colorectal cancer. Several locoregional catheter-based therapies options are available such as transarterial chemoembolism (TACE), drug eluting bead chemo-embolism and 90Y radioembolization for treatment of choice for unresectable HCC. Aim: To assess the effectiveness, safety and cost-effectiveness of selective internal radiation therapy (SIRT) using 90Y microspheres for the treatment of hepatocellular carcinoma. Methods: Electronic databases searched through the Ovid interface using MEDLINE (R) In-Process and Other Non-Indexed Citations and Ovid MEDLINE (R) 1946 to present. Additional articles were identified from reviewing the references of retrieved articles. Last search was conducted on 25th February 2016. Results: Seventeen articles related to SIRT using 90Y microspheres for HCC were included in this report in term of safety and effectiveness. For primary HCC, limited fair level of retrievable evidence to demonstrate that yttrium-90 radioembolization increased clinical response rates, improve survival and downstaging tumor for resection or transplant in unresectable primary HCC. For liver metastatic disease in colorectal cancer, limited fair level of retrievable evidence to demonstrate improvement in clinical response rates, longer median time to liver progression and overall survival when used in combination with first, second or third line chemotherapy as well as salvage treatment of chemotherapy refractory disease. For liver metastasis in neuroendocrine tumor, limited low level of retrievable evidence to suggest the use of 90Y radioembolization improved clinical response rates and median overall survival. Sufficient fair level of retrievable to suggest that 90Y radioembolization is a safe and well-tolerated procedure with some radioembolization specific complications. No retrievable evidence on cost-effectiveness. Conclusion: SIRT using 90Y microspheres may be used for unresectable primary hepatocellular carcinoma (HCC) and liver metastasis from colorectal cancer (mCRC). Strict criteria should be applied for patient selection and treatment shall be delivered through multidisciplinary team approach. However, SIRT is not recommended for unresectable metastatic liver disease of neuroendocrine tumor (mNET).

SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma

2018 ◽  
Vol 36 (19) ◽  
pp. 1913-1921 ◽  
Author(s):  
Pierce K.H. Chow ◽  
Mihir Gandhi ◽  
Say-Beng Tan ◽  
Maung Win Khin ◽  
Ariunaa Khasbazar ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Locally Advanced ◽  
Asia Pacific ◽  
Selective Internal Radiation Therapy ◽  
Internal Radiation ◽  
Advanced Hcc ◽  
Selective Internal Radiation ◽  
Internal Radiation Therapy ◽  
Sorafenib Group ◽  
Grade 3

Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 (90Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0%, respectively, failed to receive assigned therapy without significant cross-over to either group. Median OS was 8.8 and 10.0 months with RE and sorafenib, respectively (hazard ratio, 1.1; 95% CI, 0.9 to 1.4; P = .36). A total of 1,468 treatment-emergent adverse events (AEs) were reported (RE, 437; sorafenib, 1,031). Significantly fewer patients in the RE than sorafenib group had grade ≥ 3 AEs (36 of 130 [27.7%]) v 82 of 162 [50.6%]; P < .001). The most common grade ≥ 3 AEs were ascites (five of 130 [3.8%] v four of 162 [2.5%] patients), abdominal pain (three [2.3%] v two [1.2%] patients), anemia (zero v four [2.5%] patients), and radiation hepatitis (two [1.5%] v zero [0%] patients). Fewer patients in the RE group (27 of 130 [20.8%]) than in the sorafenib group (57 of 162 [35.2%]) had serious AEs. Conclusion In patients with locally advanced HCC, OS did not differ significantly between RE and sorafenib. The improved toxicity profile of RE may inform treatment choice in selected patients.

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