Purpose: To determine overall survival (OS), progression-free survival (PFS), and toxicity in patients with hepatocellular carcinoma (HCC) in a multicenter, real-world data registry using transarterial radioembolization (TARE) with resin microspheres. Materials and Methods: A total of 448 patients with HCC were treated at 36 centers between 2015 and 2019. Treatment history, baseline laboratory and imaging, and treatment goal were assessed. OS and PFS were stratified using Barcelona Clinic Liver Cancer (BCLC) and Child-Pugh (CP) classifications. Kaplan-Meier analyses compared OS and PFS with 95% confidence intervals. Transplants were tracked. Toxicities were assessed using Common Terminology Criteria for Adverse Events v5. Cox proportional hazard of baseline demographics assessed factors affecting survival. Results: Prior chemoembolization and systemic therapy were used in 107 (26%) and 68 (16%) patients, respectively. Using the BCLC staging system, 66 patients (19%) were BCLC A and 202, 51, and 26 were BCLC B, C, and D, respectively. Median OS for patients with BCLC A disease was not achieved at 30 months. Median OS for patients with BCLC B, C, and D disease were 19.5, 13.6, and 11.5 months, respectively (P =.0006). Median PFS for patients with BCLC A, B, C, and D were 19.8, 10.0, 6.3, and 5.9 months, respectively (P =.003). Twenty patients underwent transplantation, representing 14 of 43 (33%) and 6 of 28 (21%) patients who underwent bridging and downstaging therapy, respectively. Common Grade 3 toxicities were encephalopathy (11/448, 2.5%), hyperbilirubinemia (10/448, 2.2%), and ascites (9/448, 2.0%). Factors predicting longer survival included CP A (χ2 = 4.2, P =.04) and BCLC A (χ2 = 5.2, P =.02). Conclusions: In a frequently pretreated patient cohort with disease burden in 81% beyond the Milan criteria, TARE with resin microspheres provided OS comparable to other studies in this multicenter registry.
Bibliographical noteFunding Information:
K.V. receives research support from Sirtex Medical, Siemens, and Merit. He also has produced educational material for Terumo. E.W. receives research support from Terumo and Sirtex Medical. R.G. is a consultant for Sirtex Medical, ABK Biomedical, and Boston Scientific. Z.C. receives research support from Sirtex Medical. J.B. is a consultant for Sirtex Medical, Merit Medical, and Boston Scientific. D.Y.S. received equity from BlackSwan Vascular, Confluent Medical, Proteus Digital Health, RadiAction Medical, and TriSalus Life Sciences, is a consultant for Argon, Artio Medical, Astra-Zeneca, Bayer, BlackSwan Vascular, Boston Scientific, Bristol-Myers Squibb, Eisai, FluidX, W. L. Gore, Guerbet, Koli, Replimune, Sirtex, Terumo, TriSalus, and Varian, and receives research support from Boston Scientific, Merit Medical, and Sirtex. D.B.B. receives research support from Sirtex Medical and Guerbet and serves as a consultant for Becton-Dickinson. None of the other authors have identified a conflict of interest.
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