Is radioembolization (⁹⁰Y) better than doxorubicin drug eluting beads (DEBDOX) for hepatocellular carcinoma with portal vein thrombosis? A retrospective analysis

Introduction This study compares radioembolization (⁹⁰Y) versus doxorubicin drug eluting beads (DEBDOX) in the treatment of unresectable hepatocellular carcinoma with portal vein thrombosis. Methods Using our prospectively maintained, multi-center, non-controlled intra-arterial therapy registry, we identified 28 consecutive patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT) treated with DEBDOX and 20 with ⁹⁰Y. Follow-up protocol consisted of a 3-phase CT scan of the liver within 3 months post-treatment. Tumor response rates were measured according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Results There were 65 and 29 treatments in the DEBDOX and ⁹⁰Y groups respectively. Median age of DEBDOX was 59.8 (35-81) and ⁹⁰Y was 66.5 (49-82) years. A defined number of lesions were seen in 78% DEBDOX and 50% ⁹⁰Y patients. Patients were similar in the remaining 8 baseline characteristics including performance status, Child Pugh and extent of PVT. There were fewer overall side effects in the DEBDOX group compared to the ⁹⁰Y group (11% vs 39%; P = 0.03). There was better disease control (mRECIST) in the DEBDOX group compared to the ⁹⁰Y group (67% vs 20%; P = 0.0014). Median survival times were 10 months in DEBDOX and 3 months in the ⁹⁰Y group respectively from first treatment (log-rank, P = 0.037). Conclusion DEBDOX is safe for patients with HCC and PVT and may have lower toxicity than ⁹⁰Y. It may also provide better disease control and survival benefit. Further studies are warranted to validate our observations and to determine if current clinical practice should be altered.