Overall survival and toxicity of Y90 radioembolization for hepatocellular carcinoma patients in Barcelona Clinic Liver Cancer stage C (BCLC-C)

Pulak Goswami, Oladapo R. Adeniran, Shelby K. Frantz, Lea Matsuoka, Liping Du, Ripal T. Gandhi, Zachary S. Collins, Marc R. Matrana, Michael Petroziello, Jayson S. Brower, Daniel Y. Sze, Andrew S. Kennedy, Jafar Golzarian, Eric A. Wang, Daniel B. Brown

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2 Scopus citations


INTRODUCTION: National Comprehensive Cancer Network HCC guidelines recommend Y90 to treat BCLC-C patients only in select cases given the development of systemic regimens. We sought to identify ideal candidates for Y90 by assessing survival and toxicities in this patient group.

MATERIALS AND METHODS: The Radiation-Emitting Selective Internal radiation spheres in Non-resectable tumor registry is a prospective observational study (NCT: 02,685,631). Patients with advanced HCC were stratified into 3 groups based on tumor location, Eastern Cooperative Oncology Group (ECOG) performance status, and liver function. Group 1: liver isolated HCC, ECOG 0 and Child Pugh (CP) A (n = 12, 16%), Group 2: liver isolated HCC, ECOG ≥ 1 or CP B/C (n = 37, 49%), and Group 3: extrahepatic HCC with any ECOG or CP score (n = 26, 35%). Patients in any group could have macrovascular invasion. Overall survival (OS) and progression-free survival (PFS) with 95% confidence intervals (95% CI) were calculated. Grade 3 + toxicities were tracked using Common Terminology Criteria for Adverse Events v5. Cox proportional hazard model was performed to determine factors affecting OS.

RESULTS: Seventy-five BCLC-C patients treated between 2015 and 2019 were reviewed. The groups were similar in age, sex, race, and ethnicity (all p > 0.05). Bilobar disease was least common in Group 1 (p < 0.001). Median OS of the entire cohort was 13.6 (95% CI 7.5-16.1) months. Median OS of Groups 1-3 were 21.8, 13.1 and 11.5 months respectively (p = 0.6). Median PFS for the cohort was 6.3 (4.8-14.7) months. Median PFS for group 1 was not reached. Mean PFS for Group 1 was 17.3 ± 4.8 months. Median PFS for Groups 2 and 3 was 6.8 and 5.9 months (X 2  = 1.5, p = 0.5). Twenty-four Grade 3 or greater toxicities developed, most commonly hyperbilirubinemia (8/75, 11%) and thrombocytopenia (2/75, 3%). The incidence of toxicities between groups was similar (all p > 0.05). Cox Proportional Hazard analysis predicted shorter OS with CP class B/C (X 2  = 6.7, p = 0.01), while macrovascular invasion (X 2  = 0.5, p = 0.5) and ECOG score of ≥ 1 (X 2  = 2.1, p = 0.3) was not associated with OS.

CONCLUSIONS: OS of CPA patients with advanced HCC and performance status of 0 was 21.8 months following Y90. CP A cirrhosis is the best predictor of prolonged OS in advanced (BCLC-C) HCC.

Original languageEnglish (US)
Article number467
JournalBMC Gastroenterology
Issue number1
StatePublished - Dec 2022

Bibliographical note

Funding Information:
Ripal T. Gandhi is a consultant and speaker for Sirtex Medical and serves as a proctor for Sirtex Medical. Zachary S. Collins has received an institutional research grant from Sirtex Medical and serves as a speaker and consultant for Sirtex Medical. Jayson S. Brower is a consultant for Sirtex Medical. Daniel Y. Sze has received institutional research grants from Sirtex Medical and Boston Scientific. He was a consultant and has received support for travel/hotel/meals for meetings with Sirtex Medical and Boston Scientific. Andrew S. Kennedy has received institutional support from Sirtex Medical. Jafar Golzarian is a consultant for Sirtex Medical and Boston Scientific. He has also received institutional grant support from Sirtex Medical. Eric A. Wang is a proctor for Sirtex Medical. Daniel B. Brown has received institutional research support from Sirtex Medical and Guerbet. He has served as a speaker for Cook Medical and a Data Safety Monitor for Bard Medical. The other authors do not have a conflict to report.

Publisher Copyright:
© 2022, The Author(s).


  • Adult
  • Carcinoma, hepatocellular carcinoma
  • Treatment outcome
  • Yttrium radioisotopes/ adverse events
  • Yttrium radioisotopes/ therapeutic use
  • Liver Neoplasms/pathology
  • Carcinoma, Hepatocellular/pathology
  • Humans
  • Progression-Free Survival
  • Proportional Hazards Models
  • Cohort Studies

PubMed: MeSH publication types

  • Observational Study
  • Journal Article


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