SIR 2024
Interventional Oncology
Ava Zamani, BA
Medical Student
Univeristy of Queensland-Ochsner Clinical School
Financial relationships: Full list of relationships is listed on the CME information page.
Kelley Nunez, PhD
Disclosure information not submitted.
Tyler Sandow, MD
Interventional Radiologist
Ochsner Health
Financial relationships: Full list of relationships is listed on the CME information page.
Ari Cohen, MD
Medical Director of Multi-Organ Transplant Institute
Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA, 70121
Disclosure information not submitted.
Paul Thevenot, PhD
Associate Professor
Ochsner Clinic Foundation
Disclosure information not submitted.
The Barcelona Clinic Liver Cancer (BCLC) Staging and Treatment Algorithm recommends transarterial chemoembolization (TACE) and radio/microwave ablation (MWA) for non-resectable, early- to intermediate-stage (BCLC A-B) hepatocellular carcinoma (HCC). 90Yittrium (90Y) radioembolization is recommended as a secondary treatment pathway. As clinical data has become available, some centers have begun utilizing 90Y as a primary treatment option for BCLC A-B. This study uses retrospective data from multiple centers within a single health system to compare liver-directed therapy (LDT) outcomes among TACE, MWA, and 90Y after subgrouping based on primary target tumor diameter ≤ or > 3 cm.
Materials and Methods: Retrospective, single system, multi-center study included treatment naïve, non-resectable HCC with BCLC A-B and ECOG 0-1 with underlying cirrhosis Child-Pugh (CP) A5 – B9 that received liver-directed therapy (LDT) as a definitive treatment approach (n = 445, 2016-2023). LDT approaches included MWA, doxorubicin-eluting embolic TACE (DEE-TACE), and 90Y. Objective response (OR) was calculated after the first treatment cycle. Target time to retreatment (tTTR) and time to BCLC-C progression (TTP) were compared among treatment approaches.
Results: Subgrouping based on target tumor diameter yielded the cohorts: ≤ 3cm – TACE (n = 94), MWA (n = 78), 90Y (n = 87) and > 3cm – TACE (n = 54), 90Y (n = 132). In the ≤ 3cm cohort, the OR was similar among treatment modalities (P = 0.053) – TACE (58/91), MWA (58/72), 90Y (65/82). Median tTTR (P < 0.001) was shorter for TACE (4 months) compared to MWA (43 months) or 90Y (31 months) and resulted in a higher 1 year retreatment frequency [TACE (68%), MWA (24%), 90Y (34%)]. However, TTP were similar (P = 0.194) with 2 year progression rates of – TACE (33%), MWA (19%), and 90Y (22%). In the > 3cm cohort, there was a similar OR between treatments (P = 0.720) - TACE (33/51), 90Y (85/122). However, there was a significance difference in tTTR (P < 0.001) with TACE having a shorter median tTTR – TACE (2 months), 90Y (8 months). At 1 year after treatment, nearly all patients receiving TACE required retreatment to the target tumor – TACE (92%), 90Y (60%), however TTP were similar (P = 0.633) with 2 year progression rates – TACE (48%), 90Y (54%).
Conclusion: In this single system retrospective analysis, MWA and 90Y provided a more durable treatment response compared to TACE for HCC ≤ 3 cm. For HCC > 3cm, 90Y also yielded a more durable treatment response compared to TACE.