Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Disease control and failure patterns of unresectable hepatocellular carcinoma following transarterial radioembolization with yttrium-90 microspheres and with/without sorafenib
Ajalaya Teyateeti, Armeen Mahvash, James Long, Mohamed Abdelsalam, Rony Avritscher, Ahmed Kaseb, Bruno Odisio, Gregory Ravizzini, Devaki Surasi, Achiraya Teyateeti, Homer Macapinlac, Srinivas Cheenu Kappadath
Ajalaya Teyateeti, Gregory Ravizzini, Devaki Surasi, Homer Macapinlac, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Ajalaya Teyateeti, Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Armeen Mahvash, Mohamed Abdelsalam, Rony Avritscher, Bruno Odisio, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
James Long, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Ahmed Kaseb, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Achiraya Teyateeti, Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Srinivas Cheenu Kappadath, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Teyateeti A designed the study, collected, analyzed and interpreted the data and wrote the manuscript; Mahvash A, Abdelsalam M, Avritscher R, Odisio B, Ravizzini G, and Surasi D collected data, provided clinical advice and edited the manuscript; Long J supervised and provided advice for statistical analysis and edited the manuscript; Kaseb A and Macapinlac H edited the manuscript; Teyateeti A contributed to study design, provided clinical advice and made critical revision of the manuscrip; and Kappadath SC contributed to the design of the study, interpretation of the data, made critical revision of the manuscript and supervised the study.
Institutional review board statement: This study was approved by Institutional review board of The University of Texas MD Anderson Cancer Center, No. DR09-0025.
Informed consent statement: A waiver of informed consent was granted by our Institutional Review Board for this retrospective study. Patient data used complied with all institutional data protection and privacy regulations.
Conflict-of-interest statement: All authors have no any conflicts of interest.
Data sharing statement: Authors are open to data sharing, please email queries.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Srinivas Cheenu Kappadath, PhD, Professor, Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, TX 77030, United States. skappadath@mdanderson.org
Received: March 22, 2021
Peer-review started: March 22, 2021
First decision: June 14, 2021
Revised: July 28, 2021
Accepted: December 8, 2021
Article in press: December 8, 2021
Published online: December 21, 2021
ARTICLE HIGHLIGHTS
Research background
Survival outcome of unresectable hepatocellular carcinoma (HCC) patients post yttrium-90 (Y-90) glass microspheres transarterial radioembolization (TARE) with/without sorafenib according to individual’s disease burden might partly be confounded by subsequent treatments. Therefore, a study on tumor response might better represent effectiveness of TARE with/without sorafenib.
Research motivation
Disease control and failure patterns following TARE with/without sorafenib might suggest how to intensify treatment to improve treatment outcome.
Research objectives
This study describes the disease control and failure patterns of unresectable HCC patients who underwent Y-90 microspheres TARE with/without sorafenib according to individuals’ disease burden, i.e., intrahepatic tumor (IHT) and adverse disease features (ADFs), consisting of macrovascular invasion, extrahepatic disease (EHD) and infiltrative/ill-defined HCC.
Research methods
Y-90 microspheres TARE procedures with available pre and post-treatment imaging studies (n = 169) were retrospectively reviewed and categorized into 3 subgroups on the basis of treatment given and individuals’ disease conditions: (1) TARE_alone, referred to TARE only for IHT ≤ 50% without ADFs (n = 63); (2) TARE_sorafenib, referred to TARE with sorafenib for IHT > 50% and/or presence of ADFs (n = 81); and (3) TARE_no_sorafenib, referred to TARE only for patients with contraindication to sorafenib or side effect intolerance (n = 25). Disease control rate (DCR; consisted of complete response, partial response and stable disease) and failure patterns of treated, intrahepatic and extrahepatic sites were assessed using mRECIST.
Research results
The key findings were that TARE_alone for procedures with IHT ≤ 50% and absence of ADFs and TARE_sorafenib for procedures with IHT > 50% and/or presence of ADFs could provide comparable DCR (79% vs 72%) with similar incidence of intrahepatic progression (44.5% vs 38.5%). However, extrahepatic progression was much more common in TARE_sorafenib procedures (13% vs 32%).
Research conclusions
DCR of TARE_alone and TARE_sorafenib procedures were similar (about 70%). Intrahepatic progression was dominant failure pattern for both (about 40%) but extrahepatic progression was far more common in TARE_sorafenib procedures.
Research perspectives
On the basis of findings in the present study, we suggested further investigations on additional treatment to enhance disease control. Disease progression in TARE_alone subgroup usually originated in treated area and mostly limited to intrahepatic area. Thus, local or systemic treatment which potentiates disease control at treated lesion might result in better overall disease control. In TARE_sorafenib subgroup, extrahepatic progression was common and pre-existing EHD could worsen disease control. Study on novel systemic therapy that is more potent than sorafenib might be required to improve treatment outcome in this group of patients.
