The following is a summary of “Resection Postradioembolization in Patients With Single Large Hepatocellular Carcinoma,” published in the November 2023 issue of Surgery by Tzedakis, et al.
For a study, researchers sought to find out how well yttrium-90 transarterial radioembolization (TARE) could help remove a single, big (≥5 cm) hepatocellular cancer that had not been able to be removed before. TARE can shrink cholangiocarcinoma enough to be removed, but its role in how easily HCC can be removed is still unclear. They looked at all patients who had a single big HCC and were treated at the same tertiary center between 2015 and 2020. Patients were either easily removed (upfront surgery) or underwent TARE when necessary. TARE surgery patients were either switched to resection or not (TARE-only).
A propensity score matching study was done to find out more about how TARE affected the short- and long-term results. Of 216 cases, 144 (66.7%) had surgery immediately. Twenty (27.7%) of the 72 TARE cases were switched to excision. TARE surgery patients got a higher mean yttrium-90 dose than the 52 patients who only had TARE (211.89±107.98 Gy vs. 128.57±36.52 Gy, P<0.001). The results after surgery were the same for patients who had direct surgery and those who had TARE surgery.
Overall survival at 1, 3, and 5 years was the same for patients with upfront surgery and those with TARE surgery (83.0%, 60.0%, 47% vs. 94.0%, 86.0%, 55.0%, P=0.43). It was also better for patients with only TARE surgery (61.0%, 16.0%, and 9.0%, P<0.0001). After matching based on propensity scores, patients who had TARE surgery had a significantly higher overall survival rate than patients who had upfront surgery (P=0.021). Still, the rate of disease-free survival was about the same (P=0.29). To sum up, TARE may be a useful downstaging treatment for locally advanced, unresectable single-large HCC that gives similar short- and long-term results to easily resectable tumors.
