Outcomes of Radioembolization in the Treatment of Hepatocellular Carcinoma with Portal Vein Invasion: Resin versus Glass Microspheres

Purpose: To compare outcomes of yttrium-90 radioembolization performed with resin-based (Y-90-resin) and glass-based (Y-90-glass) microspheres in the treatment of hepatocellular carcinoma (HCC) with associated portal vein invasion. Materials and Methods: A single-center retrospeetive review (January 2005-September 2014) identified 90 patients (Y-90-resin, 21; Y-90-glass, 69) with HCC and ipsilateral portal vein thrombosis (PVT), Patients were stratified according to age, sex, ethnicity, Child-Pugh class, Eastern Cooperative Oncology Group status, alpha-fetoprotein > 400 ng/mL, extent of PVT, tumor burden, and sorafenib therapy. Outcome variables included clinical and laboratory toxicifies (Common Terminology Criteria Adverse Events, Version 4.03), imaging response (modified Response Evaluation Criteria in Solid Tumors), time to progression (TTP), and overall survival (OS). Results: Grade 3/4 bilirubin and aspartate aminotransferase toxicities developed at a 2.8-fold (95% confidence interval [CI], 1.3-6.1) and 2.6-fold (95% CI, 1.1-6.1) greater rate in the Y-90-resin group. The disease control rate was 37.5% in the Y-90-resin group and 54.5% in the Y-90-glass group (P = .39). The median (95% CI) TTP was 2.8 (1.9-4.3) months in the Y-90-resin group and 5.9 (4.2-19.1) months in the Y-90-glass group (P = .48). Median (95% CI) survival was 3,7 (2.3-6.0) months in the Y-90-resin group and 9.4 (7.6-45.0) months in the Y-90-glass group (hazard ratio, 2.6; 95% CI, 1.5-4.3, P < .001). Additional multivariate predictors of improved OS included age < 65 years, Eastern Cooperative Oncology Group status < 1, alpha-fetoproteiu <= 400 ng/mL, and unilobar tumor distribution. Conclusions: Imaging response of Y-90 treatment in patients with HCC and PVT was not significantly different between Y-90-glass and Y-90-resin groups. Lower toxicity and improved OS were observed in the Y-90-glass group.