Radioembolization for hepatocellular carcinoma with portal vein thrombosis: Impact of liver function on systemic treatment options at disease progression

Background & Aims: Yttrium-90 (Y-90) radioembolization is a microembolic procedure. Hence, it is commonly used in hepatocellular carcinoma (HCC) patients with portal venous thrombosis (PVT). We analyzed liver function, imaging findings, and treatment options (local/systemic) at disease progression following Y-90 treatment in HCC patients with PVT. Methods: We treated 291 HCC patients with Y-90 radioembolization. From this cohort, we included patients with liver-only disease, PVT and Child-Pugh (CP) score <= 7; this identified 63 patients with HCC and PVT (CP-A:35, CP-B7:27). Liver function, CP status, and imaging findings at progression were determined in order to assess potential candidacy for systemic treatment/clinical trials. Survival, time-to-progression (TTP), and time-to-hepatic decompensation analyses were performed using Kaplan-Meier methodology. Results: Of 35 CP-A and 28 CP-B7 patients, 29 and 15 progressed, respectively. Median survival and TIT were 13.8 and 5.6 months in CP-A and 6.5 and 4.9 months in CP-B7 patients, respectively. Of the 29 CP-A patients who progressed, 45% maintained their CP status at progression (55% decompensated to CP-B). Of the 15 CP-B7 patients who progressed, 20% improved to CP-A, 20% maintained their CP score and 60% decompensated. Conclusions: Knowledge of liver function and CP score of HCC with PVT progressing after Y-90 is critically relevant information, as these patients may be considered for systemic therapy/clinical trials. If a strict CP-A status is mandated, our study demonstrated that 64% of cases exhibited inadequate liver function and were ineligible for systemic therapy/clinical trials. An adjuvant approach using local therapy and systemic agents prior to progression should be investigated. (C) 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.