Radioembolization Versus Chemoembolization (DEBDOX) for the Treatment of Unresectable Hepatocellular Carcinoma: A Propensity Matched Study

BACKGROUND/AIM: Hepatocellular cancer is a rising dilemma. Patients with unresectable disease may benefit from locoregional therapy. The comparative effectiveness of radioembolization and Doxorubicin-Drug-Eluting-Beads (DEBDOX) has not been established to date. We compared the performance of radioembolization and DEBDOX in the treatment of hepatocellular carcinoma.

PATIENTS AND METHODS: An analysis of our prospectively managed locoregional therapy (LRT) database was performed. Three hundred and fifty-eight patients were treated with LRT for unresectable HCC, out of which 291 were treated with DEBDOX and 67 with Ytrrium-90 ((90)Y). Comparative toxicity, tumor response, progression-free survival (PFS) and overall survival (OS) were assessed. Propensity score matching was used to reduce treatment-selection bias, producing 48 pairs. Comparative analysis was repeated after propensity matching.

RESULTS: Median age was 67 and 65 years for the DEBDOX and (90)Y groups respectively (p=0.2). Overall survival favored the DEBDOX group (DEBDOX: 15-months, (90)Y: 6-months, p<0.0001). PFS also favored the DEBDOX group (DEBDOX: 15-months, (90)Y: 6-months, p<0.0001). All-grade adverse events were similar in both groups, although slightly favoring the DEBDOX group (DEBDOX 10%, (90)Y 15%, p=0.1). After propensity score matching, again longer OS was seen with the DEBDOX group (DEBDOX 13 months, (90)Y 4 months; p=0.0077). There were also similar all-grade adverse events that slightly favored DEBDOX (DEBDOX 14%, (90)Y 20%, p=0.3). Disease control rate was found to be statistically significant, favoring the DEBDOX group (DEBDOX 72%, (90)Y 48%; p=0.02).

CONCLUSION: Our observation suggests that DEBDOX outperforms (90)Y with superior efficacy and survival with a trend towards lower all-grade toxicity.