Radioembolization for unresectable Hepatocellular carcinoma (HCC): analysis in elderly patients

Purpose: To assess the effects of advanced age on the tolerance and clinical outcomes following radioembolization (RE). Materials and Methods: The European Network on RE with yttrium-90 (90Y) resin microspheres (ENRY) study group conducted a retrospective analysis among 128 elderly (70 years) and 197 younger (<70 years) patients with unresectable HCC who received RE consecutively between 09/2003 and 12/2009. Results: Elderly and younger cohorts had a mean age (range) of 74 (70–87) and 58 (22–69.8) years, respectively. Patients in the elderly and younger cohorts had similar: baseline total bilirubin >1.5 mg/dL (13.3% vs. 19.5%), Child-Pugh class A (85.2% vs. 80.7%), underlying cirrhosis (81.3% vs. 76.6%) and ECOG performance status 0–1 (89.8% vs. 86.2%), respectively. Many had advanced BCLC stage C disease (56.3% vs. 56.3%) invading both lobes (51.2% vs. 54.3%); although elderly patients appeared more likely to receive segmental treatment (10.9% vs. 5.1%; p=0.054). Median overall survival [95% CI] did not deteriorate with advancing age (14.5 [10.6–16.8] vs. 12.8 [10.8–17.9] months in the elderly and younger patients; p=0.942) and did not differ between the elderly and younger cohorts with advancing BCLC stage disease: early A (23.7 [15.1–38.1] vs. 27.4 (19.4–46.8] months), intermediate stage B (16.9 [10.6–not reached] vs. 18.4 [12.8–22.8] months) or advanced stage C (10.3 [7.4–13.1] vs. 9.7 [7.5–11.7] months), respectively. RE was equally well tolerated in both cohorts. Severe increases in total bilirubin (grade ³3) at 3 months from baseline were observed in 4.3% and 6.9% of older and younger cohorts, respectively.