Yttrium-90 transarterial radioembolization (Y-90 TARE) improved survival rates compared to transarterial hepatic embolization (TAE) without Y-90 in patients with large liver tumors, according to a recent study.
The finding is from a retrospective assessment of the two minimally invasive procedures in patients with tumors larger than 7 cm. This research found that patients who underwent Y-90 TARE rather than TAE lived more than eight months longer, noted lead author Sam Son, MD, of Memorial Sloan Kettering Cancer Center in New York City, and colleagues.
“Many therapeutic modalities including surgical, locoregional, and systemic therapies are available for the treatment of unresectable [hepatocellular carcinoma] larger than 7 cm, but the optimal treatment approach remains uncertain,” the group wrote. The study was published March 13 in the Journal of Vascular and Interventional Radiology.
Despite efforts to improve surveillance for hepatocellular carcinoma (HCC), more than half of patients are diagnosed at an advanced stage with large tumors that are difficult to remove surgically without permanently damaging the liver, the authors explained.
Conversely, Y-90 TARE and transarterial hepatic embolization (TAE), a similar procedure but that does not employ radioactive Y-90 to destroy the tumors, have proven effective in patients with tumors between 5 cm to 7 cm, yet the optimal treatment approach for patients with liver tumors larger than 7 cm in diameter remains to be determined, the authors noted.
Hence, the group reviewed outcomes among 66 patients who underwent either Y-90 TARE or TAE at their center between January 2013 and December 2023. The group looked at side effects from the treatments, patient responses, and their progression-free and overall survival. The mean tumor size of patients who underwent TAE (n = 44) was 10.4 cm and the mean tumor size for patients who underwent Y-90 TARE (n = 22) was 10.7 cm.
According to the analysis, both procedures resulted in comparable adverse event rates, with grade 1 (mild) adverse events reported in 22 (50%) of the patients who underwent TAE and in six patients (27%) who underwent Y-90 TARE.
Two patients in the TARE group were hospitalized overnight for monitoring of post-procedural nausea and abdominal pain, while all patients in the TAE group were hospitalized for at least one day and 47.7% of them stayed more than two days.
In addition, compared with the TAE group, Y-90 TARE was associated with better control of disease progression, with patients who underwent the procedure experiencing locoregional progression-free survival of 21.6 months compared with 4.6 months, the group reported. Patients who underwent Y-90 TARE also experienced longer overall survival rates of 23.6 months compared with 15.2 months with TAE.
“These outcomes for patients receiving TARE represent an improvement when contrasted with those reported after TACE in patients with large and huge HCC,” the group wrote.
In terms of limitation of the study, the authors noted its retrospective design and suggested prospective studies are necessary to confirm the results.
“TAE and TARE are both safe transarterial treatment modalities for HCC > 7 cm ... [but] TARE may offer the additional benefits of no hospital stay, durable tumor control, and potentially improved clinical outcomes," they concluded.
The full study can be found here.
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