90Yttrium Selective Internal Radiation Therapy in Unresectable or Otherwise High-Risk Hepatocellular Carcinoma: Single-Centre Experience

Objectives: We reviewed prognostic factors and clinical outcomes of selective internal radiation therapy (SIRT) with 90Yttrium (90Y) microsphere using transarterial embolisation in unresectable hepatocellular carcinoma (HCC).Methods: All cases of hepatocellular carcinoma patients who underwent 90Y SIRT at Princess Margaret Hospital between July 2017 and September 2021 were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), and prognostic factors, as well as tumour response according to modified Response Evaluation Criteria in Solid Tumors criteria and safety, were evaluated.Results: Thirty HCC patients were treated with 90Y SIRT , of whom 26 (87%) were male. The median age of patients was 66.5 years (range, 40-93). Fifty-seven percent were chronic hepatitis B carriers and the majority (93%) had Child-Pugh class A liver disease. Patients had portal vein thrombosis, or tumour size >8 cm. After a median follow-up of 14.6 months, the objective response rate was 26.9% and the local control rate was 76.9%, including three complete responses, four partial responses and 13 cases of stable disease. The median PFS was 6.3 months and the 1-year PFS was 40.2%. Median OS was not yet reached and the 1-year OS was 57.5%. In multivariable analysis, alpha-fetoprotein level was a significant prognostic factor for OS (p = 0.045) and PFS (p = 0.011). Most side-effects were grades 1-2 only.Conclusion: 90Y SIRT via transarterial embolisation is an effective and safe treatment for intermediate-to advanced -stage HCC patients which provides satisfactory local control with minimal toxicity. Longer survival was observed in patients with alpha-fetoprotein level <400 mu g/L at baseline.