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A total of 75% to 85% of hepatocellular carcinoma (HCC) cases are associated with underlying cirrhosis. Hepatotoxicity and radiation-induced liver disease (RILD) are known sequelae following Yttrium-90 (Y-90) trans-arterial radioembolization (TARE). The purpose of this study was to evaluate if patients with HCC from underlying cirrhosis have different hepatotoxicity or survival compared to patients with liver metastatic disease, who undergo Y-90 TARE. An institutional review board–approved retrospective single-center review was performed in a series of 52 patients (36 males, 16 females; age 65.3 ± 10.1 years) who underwent Y-90 TARE at a tertiary care academic center. We assessed hepatotoxicity by evaluating pre-treatment and 3-month post-treatment albumin (A), total bilirubin (TB), and albumin-bilirubin (ALBI) score. Changes in pre-treatment versus post-treatment lab values were tested with the Wilcoxon signed rank test. Differences in overall survival (OS) and progression-free survival (PFS) were assessed with the log-rank test. In this cohort, 37 patients had cirrhosis and HCC, and 15 patients had metastatic disease to the liver. Hepatitis C was the risk factor for cirrhosis in 25/37 (68%) patients. Colon cancer was the cause of metastasis in 10/15 (67%) patients. There was no difference in liver function between cirrhotic-HCC patients and patients with metastatic disease who underwent treatment with Y-90 TARE; median OS and PFS were higher in the cirrhotic-HCC group versus the metastatic group following Y-90 TARE (Table 552.1). Y-90 TARE is a safe modality for treating both cirrhotic-HCC and liver metastasis and did not result in hepatotoxicity at 3 months in our cohort, as assessed by A, TB, and ALBI score laboratory values. In this cohort, median OS and PFS were higher for cirrhotic-HCC patients undergoing Y-90 TARE compared to patients with liver metastasis, but that result did not reach statistical significance.
Rao et al. (Wed,) studied this question.