Clinical outcome of Yttrium-90 selective internal radiation therapy (Y-90 SIRT) in unresectable hepatocellular carcinoma: Experience from a tertiary care center

Background and aim: Whereas Yttrium-90 selective internal radiation therapy (Y-90 SIRT) was shown to improve local tumor control in non-Asian population, the efficacy of this therapy for Asian population in real-world setting remains poorly detailed. We aimed to determine outcomes and identify predictors of response in hepatocellular carcinoma (HCC) patients treated by Y-90 SIRT. Methods: We retrospectively enrolled 52 HCC patients receiving Y-90 SIRT at our tertiary center between 2014 and 2019. Overall survival (OS), progression free survival (PFS), and predictive factors were determined by Kaplan-Meier method and Cox-proportional hazard analysis. Results: Of the 52 patients (81% male, mean age 64.9 years), 71% and 29% were classified as Barcelona Clinic Liver Cancer stage C and B HCC, respectively; 63% had portal vein thrombosis, and 35% had objective tumor response defined by the modified Response Evaluation Criteria in Solid Tumors (mRE-CIST) criteria. OS and PFS were 11.0 and 2.4 months, respectively. Two patients were successfully down-staged and further underwent surgical resection. Multifocal lesion, alpha-fetoprotein (AFP) >= 200 ng/mL, and Eastern Cooperative Oncology Group (ECOG) score >= 1 were significantly associated with poor survival, with adjusted hazard ratio (95% confidence interval) of 7.7 (2.0-29.8), 5.4 (2.0-14.7), and 3.1 (1.0-9.6), respectively (all in P < 0.05). Conclusions Y-90 SIRT is an effective treatment for the local tumor control of HCC without serious adverse events. Single lesion, AFP level and ECOG status were predictors of response.