Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma

Laura E. Moreno-Luna, Ju Dong Yang, William Sanchez, Ricardo Paz-Fumagalli, Denise Harnois, Teresa A. Mettler, Denise N. Gansen, Piet C. De Groen, Konstantinos N Lazaridis, K. V. Narayanan Menon, Nicholas F La Russo, Steven Robert Alberts, Gregory James Gores, Chad J. Fleming, Seth W. Slettedahl, William S. Harmsen, Terry M Therneau, Gregory A. Wiseman, James C. Andrews, Lewis Rowland Roberts

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Purpose: Intermediate-stage hepatocellular carcinoma (HCC) is usually treated with locoregional therapy using transarterial chemoembolization (TACE). Transarterial radioembolization (TARE) using β-emitting yttrium-90 integral to the glass matrix of the microspheres is an alternative to TACE. This retrospective case-control study compared the outcomes and safety of TARE versus TACE in patients with unresectable HCC. Materials and Methods: Patients with unresectable HCC without portal vein thrombosis treated with TARE between 2005 and 2008 (n = 61) were retrospectively frequency-matched by age, sex, and liver dysfunction with TACE-treated patients (n = 55) in the Mayo Clinic Hepatobiliary Neoplasia Registry. Imaging studies were reviewed, and clinical and safety outcomes were abstracted from the medical records. Results: Complete tumor response was more common after TARE (12 %) than after TACE (4 %) (p = 0.17). When complete response was combined with partial response and stable disease, there was no difference between TARE and TACE. Median survival did not differ between the two groups (15.0 months for TARE and 14.4 months for TACE; p = 0.47). Two-year survival rates were 30 % for TARE and 24 % for TACE. TARE patients received fewer treatments (p < 0.001). Fifty-nine (97 %) TARE patients received outpatient treatment. In contrast, 53 (98 %) TACE patients were hospitalized for ≥1 day (p < 0.001). Compared with TACE, TARE was more likely to induce fatigue (p = 0.003) but less likely to cause fever (p = 0.02). Conclusion: There was no significant difference in efficacy between TARE and TACE. TARE patients reported more fatigue but had less fever than TACE patients. Treatment with TARE required less hospitalization than treatment with TACE. These findings require confirmation in randomized trials.

Original languageEnglish (US)
Pages (from-to)714-723
Number of pages10
JournalCardioVascular and Interventional Radiology
Volume36
Issue number3
DOIs
StatePublished - Jun 2013

Fingerprint

Hepatocellular Carcinoma
Safety
Fatigue
Fever
Therapeutics
Yttrium
Portal Vein
Microspheres
Medical Records
Glass
Registries
Case-Control Studies
Liver Diseases
Neoplasms
Hospitalization
Thrombosis
Outpatients
Survival Rate
Survival

Keywords

  • Chemoembolization
  • Efficacy
  • Hepatocellular carcinoma
  • Radioembolization
  • Safety
  • Yttrium-90

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma. / Moreno-Luna, Laura E.; Yang, Ju Dong; Sanchez, William; Paz-Fumagalli, Ricardo; Harnois, Denise; Mettler, Teresa A.; Gansen, Denise N.; De Groen, Piet C.; Lazaridis, Konstantinos N; Narayanan Menon, K. V.; La Russo, Nicholas F; Alberts, Steven Robert; Gores, Gregory James; Fleming, Chad J.; Slettedahl, Seth W.; Harmsen, William S.; Therneau, Terry M; Wiseman, Gregory A.; Andrews, James C.; Roberts, Lewis Rowland.

In: CardioVascular and Interventional Radiology, Vol. 36, No. 3, 06.2013, p. 714-723.

Research output: Contribution to journalArticle

Moreno-Luna, LE, Yang, JD, Sanchez, W, Paz-Fumagalli, R, Harnois, D, Mettler, TA, Gansen, DN, De Groen, PC, Lazaridis, KN, Narayanan Menon, KV, La Russo, NF, Alberts, SR, Gores, GJ, Fleming, CJ, Slettedahl, SW, Harmsen, WS, Therneau, TM, Wiseman, GA, Andrews, JC & Roberts, LR 2013, 'Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma', CardioVascular and Interventional Radiology, vol. 36, no. 3, pp. 714-723. https://doi.org/10.1007/s00270-012-0481-2
Moreno-Luna, Laura E. ; Yang, Ju Dong ; Sanchez, William ; Paz-Fumagalli, Ricardo ; Harnois, Denise ; Mettler, Teresa A. ; Gansen, Denise N. ; De Groen, Piet C. ; Lazaridis, Konstantinos N ; Narayanan Menon, K. V. ; La Russo, Nicholas F ; Alberts, Steven Robert ; Gores, Gregory James ; Fleming, Chad J. ; Slettedahl, Seth W. ; Harmsen, William S. ; Therneau, Terry M ; Wiseman, Gregory A. ; Andrews, James C. ; Roberts, Lewis Rowland. / Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma. In: CardioVascular and Interventional Radiology. 2013 ; Vol. 36, No. 3. pp. 714-723.
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T1 - Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma

AU - Moreno-Luna, Laura E.

AU - Yang, Ju Dong

AU - Sanchez, William

AU - Paz-Fumagalli, Ricardo

AU - Harnois, Denise

AU - Mettler, Teresa A.

AU - Gansen, Denise N.

AU - De Groen, Piet C.

AU - Lazaridis, Konstantinos N

AU - Narayanan Menon, K. V.

AU - La Russo, Nicholas F

AU - Alberts, Steven Robert

AU - Gores, Gregory James

AU - Fleming, Chad J.

AU - Slettedahl, Seth W.

AU - Harmsen, William S.

AU - Therneau, Terry M

AU - Wiseman, Gregory A.

AU - Andrews, James C.

AU - Roberts, Lewis Rowland

PY - 2013/6

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N2 - Purpose: Intermediate-stage hepatocellular carcinoma (HCC) is usually treated with locoregional therapy using transarterial chemoembolization (TACE). Transarterial radioembolization (TARE) using β-emitting yttrium-90 integral to the glass matrix of the microspheres is an alternative to TACE. This retrospective case-control study compared the outcomes and safety of TARE versus TACE in patients with unresectable HCC. Materials and Methods: Patients with unresectable HCC without portal vein thrombosis treated with TARE between 2005 and 2008 (n = 61) were retrospectively frequency-matched by age, sex, and liver dysfunction with TACE-treated patients (n = 55) in the Mayo Clinic Hepatobiliary Neoplasia Registry. Imaging studies were reviewed, and clinical and safety outcomes were abstracted from the medical records. Results: Complete tumor response was more common after TARE (12 %) than after TACE (4 %) (p = 0.17). When complete response was combined with partial response and stable disease, there was no difference between TARE and TACE. Median survival did not differ between the two groups (15.0 months for TARE and 14.4 months for TACE; p = 0.47). Two-year survival rates were 30 % for TARE and 24 % for TACE. TARE patients received fewer treatments (p < 0.001). Fifty-nine (97 %) TARE patients received outpatient treatment. In contrast, 53 (98 %) TACE patients were hospitalized for ≥1 day (p < 0.001). Compared with TACE, TARE was more likely to induce fatigue (p = 0.003) but less likely to cause fever (p = 0.02). Conclusion: There was no significant difference in efficacy between TARE and TACE. TARE patients reported more fatigue but had less fever than TACE patients. Treatment with TARE required less hospitalization than treatment with TACE. These findings require confirmation in randomized trials.

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