Intra-arterial treatment with 90Y microspheres for hepatocellular carcinoma: 4 years experience at the Ghent University Hospital

Purpose We report on our experience in terms of eligibility, safety, response and survival for treatment of hepatocellular carcinoma (HCC) with Y-90 microspheres. Secondly, we investigated the urinary excretion of Y-90 following treatment. Methods We retrospectively reviewed all HCC patients referred to our department for Y-90 microsphere treatment. We recorded reasons for not proceeding to actual treatment. In case treatment was performed, we assessed the tolerance (Common Terminology Criteria for Adverse Events v3.0, CTCAE v3.0), the response [modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria] and long-term survival (Kaplan-Meier). The urinary excretion was estimated by 12-h urine collections post-injection for analysis in a gamma counter. Results Forty-three HCC patients were referred for radio-embolization. Fourteen patients were excluded, mainly due to unfavourable Tc-99m-macroaggregated albumin (MAA) distribution. Twenty-nine patients were treated with Y-90 microspheres (TheraSphere, mean activity 2.17 GBq). In four patients severe clinical adverse events were encountered, however only in one case clearly related to the therapy. Twenty patients were assessable by mRECIST: complete response in 15%, partial response in 35%, stable disease in 30% and progression in 20% were observed. A median survival of 12.3 months (95% confidence interval 9.4-15.2) was estimated. Concerning the substudy on urinary excretion, only 0.0025% of the administered activity was excreted in the urine within the first 12 h following TheraSphere. Conclusion Following a strict workup before admitting patients to radioembolization with TheraSphere, we found good clinical tolerance in the vast majority of patients. Radiological response assessment yielded an overall response rate of 50%, when evaluated early following treatment. Urine analysis showed consistently only low activities of Y-90 excreted in the urine.