Skip to main content
Top
Published in: Annals of Nuclear Medicine 5/2015

01-06-2015 | Original Article

Prognostic factors for prediction of survival of hepatocellular cancer patients after selective internal radiation therapy

Authors: Cigdem Soydal, Onur Keskin, Ozlem N. Kucuk, Elgin Ozkan, Sadik Bilgic, Ramazan Idilman, Metin K. Kir

Published in: Annals of Nuclear Medicine | Issue 5/2015

Login to get access

Abstract

Aim

In this study, it was aimed to explore the prognostic factors in patients who received selective internal radiation therapy for hepatocellular cancer.

Materials and methods

A retrospective evaluation was made of 28 (24 male, 4 female, mean age 65.4 ± 6.8 years) hepatocellular cancer patients who received selective internal radiation therapy with Y-90 resin microspheres. Using Cox proportional hazards regression analysis, the relationship between age, gender, MELD score, serum albumin and AFP levels, number of liver lesions, size of the largest lesion, absence of 18F-FDG uptake, maximum standardized uptake value and overall survival times was analyzed.

Results

Treatment was applied to the right lobe in 22 and both in 6 patients. Mean treatment dose was 1.5 ± 0.2 GBq. Number of liver lesions were 1, <5 and multiple in 16, 5 and 7 patients, respectively, and the mean size of the largest lesion was 41.5 mm (min–max 15–160 mm). While 18F-FDG uptake was seen in 24 patients, liver lesions were hypometabolic in 4 patients. Mean SUVmax of liver lesions was calculated as 5.3 ± 0.3. During the mean 17.8 (min–max 2–39) months follow-up period, 19 patients died. Median survival time was computed as 18 ± 5 months (95 % CI 8.1–27.8). Age (p = 0.04), serum AFP level (p = 0.03) and size of the largest lesion (p = 0.02) had a significant negative effect on survival according to the Cox proportional hazards regression analysis.

Conclusion

Age, serum AFP level and the size of the largest liver lesion have a negative significant effect on survival of hepatocellular cancer patients who received selective internal radiation therapy.
Literature
1.
go back to reference Röcken C, Carl-McGrath S. Pathology and pathogenesis of hepatocellular carcinoma. Dig Dis. 2001;19:269–78.PubMedCrossRef Röcken C, Carl-McGrath S. Pathology and pathogenesis of hepatocellular carcinoma. Dig Dis. 2001;19:269–78.PubMedCrossRef
2.
go back to reference Llovet JM, Fuster J, Bruix J, Barcelona-Clínic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. 2004;10:115–20.CrossRef Llovet JM, Fuster J, Bruix J, Barcelona-Clínic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. 2004;10:115–20.CrossRef
3.
go back to reference Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinoma in patients with cirrhosis. N Engl J Med. 1996;334:693–9.PubMedCrossRef Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinoma in patients with cirrhosis. N Engl J Med. 1996;334:693–9.PubMedCrossRef
4.
go back to reference Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37:429–42.PubMedCrossRef Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37:429–42.PubMedCrossRef
6.
go back to reference Aguayo A, Patt YZ. Nonsurgical treatment of hepatocellular carcinoma. Semin Oncol. 2001;28:503–13.PubMedCrossRef Aguayo A, Patt YZ. Nonsurgical treatment of hepatocellular carcinoma. Semin Oncol. 2001;28:503–13.PubMedCrossRef
7.
go back to reference Lau WY, Kennedy AS, Kim YH, et al. Patient selection and activity planning. Int J Radiat Oncol Biol Phys. 2012;82(401Y):407. Lau WY, Kennedy AS, Kim YH, et al. Patient selection and activity planning. Int J Radiat Oncol Biol Phys. 2012;82(401Y):407.
8.
go back to reference Ahmadzadehfar H, Biersack HJ, Ezziddin S. Radioemmbolisation of liver tumors with Yttrium-90 microspheres. Semin Nucl Med. 2010;40:105–21.PubMedCrossRef Ahmadzadehfar H, Biersack HJ, Ezziddin S. Radioemmbolisation of liver tumors with Yttrium-90 microspheres. Semin Nucl Med. 2010;40:105–21.PubMedCrossRef
9.
go back to reference Weng Z, Ertle J, Zheng S, Lauenstein T, Mueller S, Bockisch A, Gerken G, Yang D, Schlaak JF. A new model to estimate prognosis in patients with hepatocellular carcinoma after yttrium-90 radioembolization. PLoS ONE. 2013;8(12):e82225.PubMedCentralPubMedCrossRef Weng Z, Ertle J, Zheng S, Lauenstein T, Mueller S, Bockisch A, Gerken G, Yang D, Schlaak JF. A new model to estimate prognosis in patients with hepatocellular carcinoma after yttrium-90 radioembolization. PLoS ONE. 2013;8(12):e82225.PubMedCentralPubMedCrossRef
10.
go back to reference Salem ME, Jain N, Dyson G, Taylor S, El-Refai SM, Choi M, Shields AF, Critchfield J, Philip PA. Radiographic parameters in predicting outcome of patients with hepatocellular carcinoma treated with yttrium-90 microsphere radioembolization. ISRN Oncol. 2013;15(2013):538376. Salem ME, Jain N, Dyson G, Taylor S, El-Refai SM, Choi M, Shields AF, Critchfield J, Philip PA. Radiographic parameters in predicting outcome of patients with hepatocellular carcinoma treated with yttrium-90 microsphere radioembolization. ISRN Oncol. 2013;15(2013):538376.
11.
go back to reference Golfieri R, Bilbao JI, Carpanese L, Cianni R, Gasparini D, Ezziddin S, Paprottka PM, Fiore F, Cappelli A, Rodriguez M, Ettorre GM, Saltarelli A, Geatti O, Ahmadzadehfar H, Haug AR, Izzo F, Giampalma E, Sangro B, Pizzi G, Notarianni E, Vit A, Wilhelm K, Jakobs TF, Lastoria S, European Network on Radioembolization with Yttrium-90 Microspheres (ENRY) study collaborators. Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma. J Hepatol. 2013;59(4):753–61. doi:10.1016/j.jhep.2013.05.025.PubMedCrossRef Golfieri R, Bilbao JI, Carpanese L, Cianni R, Gasparini D, Ezziddin S, Paprottka PM, Fiore F, Cappelli A, Rodriguez M, Ettorre GM, Saltarelli A, Geatti O, Ahmadzadehfar H, Haug AR, Izzo F, Giampalma E, Sangro B, Pizzi G, Notarianni E, Vit A, Wilhelm K, Jakobs TF, Lastoria S, European Network on Radioembolization with Yttrium-90 Microspheres (ENRY) study collaborators. Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma. J Hepatol. 2013;59(4):753–61. doi:10.​1016/​j.​jhep.​2013.​05.​025.PubMedCrossRef
12.
go back to reference Faivre S, Zappa M, Vilgrain V, Boucher E, Douillard JY, Lim HY, Kim JS, Im SA, Kang YK, Bouattour M, Dokmak S, Dreyer C, Sablin MP, Serrate C, Cheng AL, Lanzalone S, Lin X, Lechuga MJ, Raymond E. Changes in tumor density in patients with advanced hepatocellular carcinoma treated with sunitinib. Clin Cancer Res. 2011;17(13):4504–12.PubMedCrossRef Faivre S, Zappa M, Vilgrain V, Boucher E, Douillard JY, Lim HY, Kim JS, Im SA, Kang YK, Bouattour M, Dokmak S, Dreyer C, Sablin MP, Serrate C, Cheng AL, Lanzalone S, Lin X, Lechuga MJ, Raymond E. Changes in tumor density in patients with advanced hepatocellular carcinoma treated with sunitinib. Clin Cancer Res. 2011;17(13):4504–12.PubMedCrossRef
13.
go back to reference Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.PubMedCrossRef Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.PubMedCrossRef
14.
go back to reference Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30(1):52–60.PubMedCrossRef Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30(1):52–60.PubMedCrossRef
15.
go back to reference Kim KW, Lee JM, Choi BI. Assessment of the treatment response of HCC. Abdom Imaging. 2011;36(3):300–14.PubMedCrossRef Kim KW, Lee JM, Choi BI. Assessment of the treatment response of HCC. Abdom Imaging. 2011;36(3):300–14.PubMedCrossRef
16.
go back to reference Sangro B, Salem R, Kennedy A, et al. Radioembolization for hepatocellular carcinoma: a review of the evidence and treatment recommendations. Am J Clin Oncol. 2011;34:422–31.PubMedCrossRef Sangro B, Salem R, Kennedy A, et al. Radioembolization for hepatocellular carcinoma: a review of the evidence and treatment recommendations. Am J Clin Oncol. 2011;34:422–31.PubMedCrossRef
17.
go back to reference Seinstra BA, Defreyne L, Lambert B, Lam MG, Verkooijen HM, van Erpecum KJ, van Hoek B, van Erkel AR, Coenraad MJ, Al Younis I, van Vlierberghe H, van den Bosch MA. Transarterial radioembolization versus chemoembolization for the treatment of hepatocellular carcinoma (TRACE): study protocol for a randomized controlled trial. Trials. 2012;13:144. Seinstra BA, Defreyne L, Lambert B, Lam MG, Verkooijen HM, van Erpecum KJ, van Hoek B, van Erkel AR, Coenraad MJ, Al Younis I, van Vlierberghe H, van den Bosch MA. Transarterial radioembolization versus chemoembolization for the treatment of hepatocellular carcinoma (TRACE): study protocol for a randomized controlled trial. Trials. 2012;13:144.
18.
go back to reference Giammarile F, Bodei L, Chiesa C, Flux G, Forrer F, Kraeber-Bodere F, Brans B, Lambert B, Konijnenberg M, Borson-Chazot F, Tennvall J, Luster M, The Therapy, Oncology and Dosimetry Committees. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging. 2011;38(7):1393–406.PubMedCrossRef Giammarile F, Bodei L, Chiesa C, Flux G, Forrer F, Kraeber-Bodere F, Brans B, Lambert B, Konijnenberg M, Borson-Chazot F, Tennvall J, Luster M, The Therapy, Oncology and Dosimetry Committees. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging. 2011;38(7):1393–406.PubMedCrossRef
19.
go back to reference Kucuk ON, Soydal C, Araz M, Bilgic S, Ibis E. Prognostic importance of 18F-FDG uptake pattern of hepatocellular cancer patients who received SIRT. Clin Nucl Med. 2013;38(7):e283–9.PubMedCrossRef Kucuk ON, Soydal C, Araz M, Bilgic S, Ibis E. Prognostic importance of 18F-FDG uptake pattern of hepatocellular cancer patients who received SIRT. Clin Nucl Med. 2013;38(7):e283–9.PubMedCrossRef
Metadata
Title
Prognostic factors for prediction of survival of hepatocellular cancer patients after selective internal radiation therapy
Authors
Cigdem Soydal
Onur Keskin
Ozlem N. Kucuk
Elgin Ozkan
Sadik Bilgic
Ramazan Idilman
Metin K. Kir
Publication date
01-06-2015
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 5/2015
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-015-0962-x

Other articles of this Issue 5/2015

Annals of Nuclear Medicine 5/2015 Go to the issue