Radiation segmentectomy a potential curative therapy for liver cancer

Last Updated: 2018-04-26

By Megan Brooks

NEW YORK (Reuters Health) - Long-term outcomes with radiation segmentectomy are on par with curative-intent treatments for patients with early-stage hepatocellular carcinoma (HCC), according to a new paper.

"Radiation segmentectomy is a novel technique applicable on an outpatient basis that should now be considered one of the treatment options considered to be potentially curative (the others being ablation, resection, transplantation)," Dr. Riad Salem of Northwestern Memorial Hospital in Chicago told Reuters Health by email. "With such a low toxicity profile, it represents an attractive option for liver-cancer patients and a significant advancement in the field of liver cancer."

Radiation segmentectomy (RS) is a minimally invasive targeted form of radioembolization. Interventional radiologists use cone-beam CT to divide the liver into a number of segments to allow focused delivery of the radioisotope yttrium-90 to the tumor, sparing much of the surrounding healthy tissue. "This technique has now been perfected and many centers are able to offer this approach," Dr. Salem said.

In a paper online April 24 in Radiology, the researchers report long-term outcomes in 70 patients (mean age, 71) with solitary HCC lesions <= 5 cm not amenable to percutaneous ablation who underwent RS between 2003 and 2016. They analyzed the patients' responses to treatment based on European Association for the Study of the Liver (EASL) and the World Health Organization (WHO) criteria.

By EASL criteria, 63 patients (90%) responded including 41 (59%) who had a complete response. By WHO criteria, 50 patients (71%) responded and 11 (16%) had a complete response. Response rates at six months were 86% using EASL criteria and 49% using WHO criteria.

Median time to progression was 2.4 years, with 72% of patients having no target-lesion progression at five years.

Median overall survival was 6.7 years and the probability of survival at one, three and five years was 98%, 66% and 57%, respectively. Overall survival probability at these time points was 100%, 82% and 75% in patients with tumors

This study shows that RS provides response rates, local tumor control, and survival outcomes comparable to radiofrequency ablation, resection and transplantation for selected patients with early-stage HCC and preserved liver function, the authors write.

"RS should be considered curative for the treatment of solitary HCC less than 5 cm," they conclude.

The researchers are continuing to follow the patients in the study. "We want to see these outcomes validated in patients over the longer term," Dr. Salem said in a news release. "We also want to minimize the time from clinic visit to treatment, and fine-tune dosimetry so that we can find the optimal dose that will kill the tumor. In the right patient setting, RS can be considered curative."

SOURCE: https://bit.ly/2HWKBfj

Radiology 2018.