SIR 2024
Interventional Oncology
Muhamad Serhal, MD
Postdoctoral Research Fellow
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Pouya Entezari, MD
Clinical Research Associate
Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago IL
Disclosure information not submitted.
Ahsun Riaz, MD
Associate Professor, Interventional Radiology
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Laura Kulik, MD
Professor
Department of Medicine, Division of Hepatology, Northwestern University
Disclosure information not submitted.
Aparna Kalyan, MD
Disclosure information not submitted.
Andrew C. Gordon, MD, PhD (he/him/his)
Integrated Interventional Radiology Resident
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
Riad Salem, MD, FSIR, MBA
Professor
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Robert Lewandowski, MD, FSIR
Professor
Northwestern University
Financial relationships: Full list of relationships is listed on the CME information page.
With IRB approval, a retrospective chart review including all HCC patients with baseline total bilirubin (TBili) >2 mg/dL treated with selective TARE between 6/2006-3/2021 was performed. Baseline demographic data, including serum bilirubin and albumin levels as well as ALBI grade, was compared to 1-, 3-, and 6-month post-treatment values. Toxicities were evaluated using CTCAE V5 criteria. Paired sample Wilcoxon analyses (significance, P ≤ 0.05) were used to compare baseline and follow-up values. Overall survival (OS) rates were estimated using Kaplan-Meier statistics from date of TARE, censoring to date of last follow-up or transplant.
Results: 129 patients (median age 63.8 years, 68% male) met the inclusion criteria; 82% were Child-Pugh (CP) B, 15% CP C, and 3% CP A. While median TBili at 1 and 3 months was significantly higher than baseline (P = 0.008 and 0.001, respectively), there was no significant difference at 6 months (P = 0.070). Grade 3/4 TBili toxicities were seen in 1 (1%) patient after 1 month, 2 (2%) after 3 months, and 7 (5%) after 6 months. The median albumin at 1 and 3 months was significantly improved compared to baseline (P = 0.010 and 0.050, respectively), but there was no significant difference at 6 months (P = 0.800). Grade 3 albumin toxicity was present in 4 (3%) patients at baseline, 5 (4%) after 1 month, 1 (1%) after 3 months, and 3 (2%) after 6 months. There were no grade 4 albumin toxicities. There was no significant change in ALBI grade at any of the timepoints. Of the 75 patients treated with intent of bridging to liver transplantation, 70% (52 patients) successfully underwent transplant. The median time to transplant after TARE was 5.0 months (range 0.2:34.0 months). The median censored OS was 35.1 months (95% CI 27.9:42.2).
Conclusion:
This study confirms the safety of selective TARE for patients with HCC and baseline hyperbilirubinemia. This treatment option is of particular interest in bridging patients to liver transplant.