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Selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC): Informing clinical practice for multidisciplinary teams in England

Lookup NU author(s): Professor Helen ReevesORCiD, Professor Derek Manas, Dr Peter Littler

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Abstract

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.Objective: Hepatocellular carcinoma (HCC) deaths are rising alarmingly. Many patients are unsuitable for available therapies. Poor response rates further hamper outcomes for those that are. Selective internal radiation therapy (SIRT) offers hope, although which patients benefit over standard approaches remains unclear. Design/method: As a quality/service improvement, we audited consecutive patients treated with SIRT (2015-2020) by the Newcastle upon Tyne Hospitals National Health Service Foundation Trust HCC multidisciplinary team. Indications, Barcelona clinic liver cancer (BCLC) stage, treatment response, subsequent therapies and survival at 30 September 2021 were assessed Results: Fifty-one patients received SIRT. Thirty-day mortality was zero. Three months partial response, stable disease and progressive disease on imaging were 50%, 22% and 28%, respectively. Overall median survival was 21 months. There were four subgroups: (1) BCLC-B: HCC>7 cm too large for transarterial chemoembolisation (TACE) alone (n=21); (2) BCLC-B: HCC progressed post TACE (n=7); (3) BCLC-C: HCC with any combination of large tumour burden, branch portal vein thrombosis, non-hepatitis C virus aetiology (n=16); (4) BCLC-C: sorafenib inappropriate (n=7). In group 1, 5/21 (23.8%) of patients were downstaged to resection, 33% received subsequent medical therapies and median survival was >40 months. In BCLC-B patients treated second line (group 2), median survival was 14.2 months. In BCLC-C, median survival was 20.2 months for group 3 and 4.2 months for group 4. Conclusion: SIRT outcomes for advanced HCC, often bridging patients with adverse predictive factors to subsequent surgery or medical therapies, were encouraging. A role after TACE or for BCLC-C patients requires further assessment.


Publication metadata

Author(s): Reeves HL, Reicher J, Priona G, Manas DM, Littler P

Publication type: Article

Publication status: Published

Journal: Frontline Gastroenterology

Year: 2022

Pages: epub ahead of print

Online publication date: 30/06/2022

Acceptance date: 01/06/2022

ISSN (print): 2041-4137

ISSN (electronic): 2041-4145

Publisher: BMJ Publishing Group

URL: http://dx.doi.org/10.1136/flgastro-2022-102137

DOI: 10.1136/flgastro-2022-102137


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