Introduction

Several studies have demonstrated the efficacy of yttrium-90 radioembolization in the treatment of both primary and secondary hepatic malignancies. There is, however, a paucity of literature comparing the outcomes of patients who, after initial evaluation, proceeded with yttrium-90 radioembolization and those who were managed more conservatively.

Methods

Five-hundred and thirty-seven patients underwent initial evaluation for 90Y radioembolization; of these, 422 patients were suitable for treatment with 90Y radioembolization (Group 1) and the remaining 115 were not (Group 2). The most frequent pathological diagnosis was colorectal cancer (n=287). Patient, pathological and treatment characteristics were compared between the two groups using t-test and chi-square analysis, where appropriate. Survival outcomes were evaluated using the Kaplan-Meier method and compared using the log-rank test.  

Results

The median length of follow-up for all patients after initial evaluation was 11.5 months (range, 2 to 59). Median survival of patients who received 90Y therapy was 10.5 months with a 1- and 3- year survival of 44% and 20%, respectively. Median survival of patients not treated with 90Y radioembolization was 4.0 months with a 1- and 3- year survival of 29% and 15%, respectively. This was statistically significant (p<0.001). In patients with colorectal cancer, median survival in patients treated with and without 90Y radioembolization was 11.4 and 6.7 months, respectively (p=0.003). In patients with non-colorectal cancer, median survival in patients treated with and without 90Y radioembolization was 9.1 months and 2.5 months, respectively (p<0.001).

 Conclusion

These data suggest that 90Y radioembolization is associated with a significantly improved survival in patients’ referred for an initial evaluation. Whilst confounding factors may play a role, offering this treatment may confer the best prognosis.