Yttrium-90 Radioembolization for the Treatment of Solitary, Unresectable HCC: The LEGACY Study

Overview

Journal Hepatology

Specialty Gastroenterology

Date 2021 Mar 19

PMID 33739462

Citations 155

Authors

Riad Salem

Guy E Johnson

Edward Kim

Ahsun Riaz

Vivian Bishay

Eveline Boucher

Kirk Fowers

Robert Lewandowski

Siddharth A Padia

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Locoregional therapies, including yttrium-90 radioembolization, play an important role in the treatment of unresectable HCC. The aim of the LEGACY (Local radioEmbolization using Glass Microspheres for the Assessment of Tumor Control with Y-90) study was to evaluate objective response rate (ORR) and duration of response (DoR) in patients with solitary unresectable HCC treated with yttrium-90 glass microspheres.

Approach And Results: LEGACY is a multicenter, single-arm, retrospective study conducted at three sites that included all eligible, consecutive patients with HCC treated with radioembolization between 2014 and 2017. Eligibility criteria included solitary HCC ≤ 8 cm, Child-Pugh A cirrhosis, and Eastern Cooperative Oncology Group performance status 0-1. Primary endpoints were ORR and DoR based on modified Response Evaluation Criteria in Solid Tumors in the treated area (localized), as evaluated by blinded, independent, central review. Radioembolization was performed with intent of ablative-level dosimetry in a selective fashion when possible. Overall survival was evaluated using Kaplan-Meier and multivariate Cox proportional hazards. Among the 162 patients included, 60.5% were Eastern Cooperative Oncology Group 0, and the median tumor size was 2.7 cm (range: 1-8) according to blinded, independent, central review. Radioembolization served as neoadjuvant therapy for transplantation or resection in 21.0% (34 of 162) and 6.8% (11 of 162) of patients, respectively, and as primary treatment for all others. Median follow-up time was 29.9 months by reverse Kaplan-Meier. ORR (best response) was 88.3% (CI: 82.4-92.4), with 62.2% (CI: 54.1-69.8) exhibiting a DoR ≥ 6 months. Three-year overall survival was 86.6% for all patients and 92.8% for those neoadjuvant patients with resected or transplanted liver.

Conclusions: In this multicenter study of radioembolization, clinical meaningful response rates and prolonged DoR were observed in the treatment of unresectable, solitary HCC ≤ 8 cm.

Citing Articles

Commentary on "Hepatocellular Carcinoma with Vascular Invasion Treated with Resin Yttrium-90 Transarterial Radioembolization Using Single Compartment Dosimetry".

Sajan A, Garcia-Reyes K, Young S, Berman Z, Sandow T, Raja J Cardiovasc Intervent Radiol. 2025; .

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Achieving Complete Pathologic Necrosis in Hepatocellular Carcinoma Treated with Radiation Segmentectomy before Liver Transplantation: A Comprehensive Glass Microsphere Analysis.

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Long-term outcomes of Yttrium-90 transarterial radioembolization for patients with hepatocellular carcinoma.

Muglia R, De Giorgio M, Marra P, Carbone F, Dulcetta L, Prussia C Eur J Nucl Med Mol Imaging. 2025; .

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Managing Complex Hepatocellular Carcinoma Subtypes: Diffuse Infiltrative, Large Tumours, and Tumour Rupture-The Challenges and Strategies.

Choudhury A, Roy A, Mukund A, Sharma D, Heo S, Choi W J Clin Exp Hepatol. 2025; 15(3):102505.

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Effect of Narrow-Margin Hepatectomy Combined with Intraoperative Radiotherapy on Long-Term Prognosis of Patients with Centrally Located Hepatocellular Carcinoma: A Propensity Score Matching Analysis.

Tao C, Liu L, Hu N, Wang H, Zhang K, Liu Y J Hepatocell Carcinoma. 2025; 12:261-274.

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