Efficacy and Safety of Transarterial Radioembolization in Elderly Patients with Hepatocellular Carcinoma: A Single-Center Experience

Overview

Journal Turk J Gastroenterol

Publisher Aves

Specialty Gastroenterology

Date 2024 Aug 11

PMID 39128104

Authors

Umit Karaogullarindan

Yuksel Gumurdulu

Oguz Uskudar

Emre Odabas

Hasan Selim Guler

Cansu Geckalan

Burcu Arslan Benli

Anil Delik

Asena Ayca Ozdemir

Sedef Kuran

Affiliations

Soon will be listed here.

Abstract

Background/aims: Hepatocellular carcinoma is a major cause of mortality and morbidity in both cirrhotic and non-cirrhotic patients, and most patients are suitable for locoregional and/or systemic therapy at the time of diagnosis. In this study, we aimed to determine the efficacy and safety of transarterial radioembolization in elderly patients.

Materials And Methods: Patients diagnosed with hepatocellular carcinoma between 2013 and 2022 were screened retrospectively. The patients were divided into 2 groups: the elderly (age >70 years) and the young (age <70 years). Transarterial radioembolization response was evaluated according to the Response Evaluation Criteria in Solid Tumors.

Results: Ninety patients were included in the young group, and 56 patients were in the elderly group. It was observed that male dominance was less in the elderly group (P > .05). Hepatitis B was the most common cause in both groups. There were no significant differences between groups with regard to morphological features of tumors [tumor focality (single; 62.2% and 60.7%, respectively) and maximal tumor diameter (6.9 and 6.55 cm, respectively)], transarterial radioembolization responses (51.1% and 39.3%, respectively), survival (9 and 8.5 months), and both early and late side effects (P > .05). Age was not found to be an effective factor in transarterial radioembolization response (P > .05).

Conclusion: No differences in the safety and efficacy of transarterial radioembolization were observed between the groups. In addition, it was observed that age was not a predictive factor for adverse events. In elderly patients in the frail group, it should be considered that age alone should not be seen as a limitation in the transarterial radioembolization decision.

References

Ricke J, Klumpen H, Amthauer H, Bargellini I, Bartenstein P, De Toni E . Impact of combined selective internal radiation therapy and sorafenib on survival in advanced hepatocellular carcinoma. J Hepatol. 2019; 71(6):1164-1174. DOI: 10.1016/j.jhep.2019.08.006. View

Oken M, Creech R, Tormey D, Horton J, Davis T, McFadden E . Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5(6):649-55. View

Mirici-Cappa F, Gramenzi A, Santi V, Zambruni A, Di Micoli A, Frigerio M . Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: a 20-year multicentre experience. Gut. 2010; 59(3):387-96. DOI: 10.1136/gut.2009.194217. View

Yi S, Choi J, Yi J, Lee Y, Han K . Risk factors for hepatocellular carcinoma by age, sex, and liver disorder status: A prospective cohort study in Korea. Cancer. 2018; 124(13):2748-2757. DOI: 10.1002/cncr.31406. View

Vilgrain V, Pereira H, Assenat E, Guiu B, Ilonca A, Pageaux G . Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet Oncol. 2017; 18(12):1624-1636. DOI: 10.1016/S1470-2045(17)30683-6. View

Chow P, Gandhi M, Tan S, Khin M, Khasbazar A, Ong J . SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma. J Clin Oncol. 2018; 36(19):1913-1921. DOI: 10.1200/JCO.2017.76.0892. View

Facciorusso A, Serviddio G, Muscatiello N . Transarterial radioembolization vs chemoembolization for hepatocarcinoma patients: A systematic review and meta-analysis. World J Hepatol. 2016; 8(18):770-8. PMC: 4921799. DOI: 10.4254/wjh.v8.i18.770. View

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

Mazzaferro V, Sposito C, Bhoori S, Romito R, Chiesa C, Morosi C . Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: a phase 2 study. Hepatology. 2012; 57(5):1826-37. DOI: 10.1002/hep.26014. View

10.

Carr B, Kondragunta V, Buch S, Branch R . Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma: a two-cohort study. Cancer. 2010; 116(5):1305-14. PMC: 2829376. DOI: 10.1002/cncr.24884. View

11.

Sangro B, Carpanese L, Cianni R, Golfieri R, Gasparini D, Ezziddin S . Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: a European evaluation. Hepatology. 2011; 54(3):868-78. DOI: 10.1002/hep.24451. View

12.

Zou J, Zhu W, Meng H, Luo P, Zhang J . Efficacy and safety of selective internal radiotherapy versus sorafenib for intermediate-locally advanced hepatocellular carcinoma: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2019; 13(3):271-279. DOI: 10.1080/17474124.2019.1570135. View

13.

Kennedy A, Ball D, Cohen S, Cohn M, Coldwell D, Drooz A . Safety and Efficacy of Radioembolization in Elderly (≥ 70 Years) and Younger Patients With Unresectable Liver-Dominant Colorectal Cancer. Clin Colorectal Cancer. 2015; 15(2):141-151.e6. DOI: 10.1016/j.clcc.2015.09.001. View

14.

Hilgard P, Hamami M, El Fouly A, Scherag A, Muller S, Ertle J . Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology. 2010; 52(5):1741-9. DOI: 10.1002/hep.23944. View

15.

. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018; 69(1):182-236. DOI: 10.1016/j.jhep.2018.03.019. View

16.

Tohme S, Sukato D, Nace G, Zajko A, Amesur N, Orons P . Survival and tolerability of liver radioembolization: a comparison of elderly and younger patients with metastatic colorectal cancer. HPB (Oxford). 2014; 16(12):1110-6. PMC: 4253335. DOI: 10.1111/hpb.12307. View

17.

Karaogullarindan U, Gumurdulu Y, Uskudar O, Odabas E, Guler H, Delik A . Prognostic factors of elderly patients with hepatocellular carcinoma: should we be more courageous in treatment?. Eur J Gastroenterol Hepatol. 2022; 34(9):956-960. DOI: 10.1097/MEG.0000000000002396. View

18.

Lee S, Choi H, Jeong S, Lee K, Chung J, Park Y . Hepatocellular carcinoma in older adults: clinical features, treatments, and survival. J Am Geriatr Soc. 2011; 59(2):241-50. DOI: 10.1111/j.1532-5415.2010.03273.x. View

19.

Sieghart W, Hucke F, Peck-Radosavljevic M . Transarterial chemoembolization: modalities, indication, and patient selection. J Hepatol. 2015; 62(5):1187-95. DOI: 10.1016/j.jhep.2015.02.010. View

20.

Heimbach J, Kulik L, Finn R, Sirlin C, Abecassis M, Roberts L . AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2017; 67(1):358-380. DOI: 10.1002/hep.29086. View