Liver biopsy is the gold standard for diagnosis; however a combination of clinical, biochemical, ultrasonography, and endoscopic findings is ∼90% accurate. Portal hypertension is a major determinant of the clinical course. In the early asymptomatic stage, termed compensated cirrhosis, esophageal varices may develop in approximately
5% of patients/year and median survival is more than 10 years. Progression of portal hypertension causes transition to the decompensated stage characterized by ascites, variceal IWR-1 supplier hemorrhage, encephalopathy, and jaundice. with a median survival of approximately 2–3 years. Hepatocellular carcinoma may develop during the course of the disease at a rate of approximately 2–3%/year. Major causes of death are liver failure, bleeding, hepatocellular carcinoma, hepatorenal syndrome, and sepsis. The only curative therapy is liver transplantation. “
“Yttrium-90 radioembolization (Y90RE) is a novel approach to radiation therapy for hepatocellular carcinoma (HCC), never tested in phase 2 studies. Fifty-two patients with intermediate (n.17) to advanced (n.35) HCC were prospectively recruited to assess, as the primary endpoint, efficacy of Y90RE on time-to-progression (TTP). Secondary endpoints
were tumor response, safety, and overall survival (OS). All patients were Eastern Cooperative Oncology Group (ECOG) score 0-1, Child-Pugh class A-B7. Y90RE treatments aimed at a lobar delivery of 120 Gy. Retrospective dosimetric correlations were conducted and related to response. Fifty-eight treatments were Napabucasin chemical structure performed on 52 patients. The median follow-up was 36 months. The median TTP was 11 months with no significant difference between portal vein thrombosis (PVT) versus no
PVT (7 versus 13 months). medchemexpress The median OS was 15 months (95% confidence interval [CI], 12-18 months) with a nonsignificant trend in favor of non-PVT versus PVT patients (18 versus 13 months). Five complete responses occurred (9.6%), and the 2 year-progression rate was 62%. Objective response was 40.4%, whereas the disease control rate (78.8%) significantly affected survival (responders versus nonresponders: 18.4% versus 9.1%; P = 0.009). Tumor response significantly correlated with absorbed dose in target lesions (r = 0.60, 95% CI, 0.41-0.74, P < 0.001) and a threshold of 500 Gy predicted response (area under the curve, 0.78). Mortality at 30-90 days was 0%-3.8%. Various grades of reduction in liver function occurred within 6 months in 36.5% of patients, with no differences among stages. On multivariate analysis, tumor response was the sole variable affecting TTP (P < 0.001) and the second affecting survival (after Child-Pugh class). Conclusion: Y90RE is an effective treatment in intermediate to advanced HCC, particularly in the case of PVT. Further prospective evaluations comparing Y90RE with conventional treatments are warranted.