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Reuters Health Information (2010-02-01): Chemoembolization, yttrium give similar results against advanced liver cancer


Chemoembolization, yttrium give similar results against advanced liver cancer

Last Updated: 2010-02-01 20:09:46 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In patients with unresectable hepatocellular carcinoma (HCC) confined to the liver, repeated cisplatin-based chemoembolization and a single dose of intrahepatic arterial yttrium 90 (90Y) microspheres produce equivalent median survival times, U.S. researchers conclude in a report published online on January 11 in the journal Cancer.

Their findings, however, are based on a retrospective comparison of two non-simultaneous cohorts.

The median survival in the single-center study was 11.5 months for patients treated with 90Y and 8.5 months for those in the chemoembolization cohort. Although this difference is statistically significant, further analysis revealed a selection bias. Patients treated with 90Y had somewhat "milder" disease, a fact that essentially canceled out the apparent advantage.

The study compared outcomes in 691 patients who received cisplatin-based chemoembolization between 1992 and 2000 and 99 patients treated with 90Y microspheres between 2000 and 2005.

Chemoembolization was repeated every eight to 12 weeks as possible, while internal hepatic irradiation with 90Y was scheduled once, with a second dose given only for progressive disease.

Complete tumor response rates were similar and low (3%-5%) in both groups.

Although temporary tiredness and lack of appetite were the main adverse effects following chemoembolization, the report noted that the need for multiple treatments was a major inconvenience for patients.

When comparing the clinical outcomes of these two treatments, "the risk and inconvenience" of repeated inpatient chemoembolizations need to be weighed against the advantage of "limited treatments in an outpatient setting for 90Y," the authors write.

Based on this and on the very similar results of the two treatments, the investigators conclude that "in a risk-benefit analysis between the 2 treatment options, 90Y offers a superior option for palliative care."

In email to Reuters Health, lead author Dr. Brian I. Carr of Thomas Jefferson University, Philadelphia, commented, "There are increasingly effective treatment choices for patients with unresectable HCC....the era of therapeutic nihilism is at last lifting."

Cancer 2010.

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