Vol.:(0123456789) 1 3 Digestive Diseases and Sciences https://doi.org/10.1007/s10620-020-06245-y ORIGINAL ARTICLE Selective Internal Radiation Therapy for Hepatocellular Carcinoma Across the Barcelona Clinic Liver Cancer Stages Carlos Moctezuma‑Velazquez 1  · Aldo J. Montano‑Loza 2  · Judith Meza‑Junco 3  · Kelly Burak 4  · Mang Ma 2  · Vincent G. Bain 2  · Norman Kneteman 6  · Phillipe Sarlieve 5  · Richard J. Owen 5 Received: 6 September 2019 / Accepted: 29 March 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Background Hepatocellular carcinoma (HCC) is the second most common lethal cancer, and there is a need for efective therapies. Selective internal radiation therapy (SIRT) has been increasingly used, but is not supported by guidelines due to a lack of solid evidence. Aims Determine the efcacy and safety of SIRT in HCC across the Barcelona Clinic Liver Cancer (BCLC) stages A, B, and C. Methods Consecutive patients that received SIRT between 2006 and 2016 at two centers in Canada were evaluated. Results We analyzed 132 patients, 12 (9%), 62 (47%), and 58 (44%) belonged to BCLC stages A, B, and C; mean age was 61.2 (SD ± 9.2), and 89% were male. Median survival was 12.4 months (95% CI 9.6–16.6), and it was diferent across the stages: 59.7 (95% CI NA), 12.8 (95% CI 10.2–17.5), and 9.3 months (95% CI 5.9–11.8) in BCLC A, B, and C, respec- tively (p = 0.009). Independent factors associated with survival were previous HCC treatment (HR 2.01, 95% CI 1.23–3.27, p = 0.005), bi-lobar disease (HR 2.25, 95% CI 1.30–3.89, p = 0.003), ascites (HR 1.77, 95% CI 0.99–3.13, p = 0.05), neu- trophil-to-lymphocyte ratio (HR 1.11, 95% CI 1.02–1.20, p = 0.01), Albumin–Bilirubin (ALBI) grade-3 (HR 2.69, 95% CI 1.22–5.92, p = 0.01), tumor thrombus (HR 2.95, 95% CI 1.65–5.24, p < 0.001), and disease control rate (HR 0.62, 95% CI 0.39–0.96, p = 0.03). Forty-four (33%) patients developed severe adverse events, and ALBI-3 was associated with higher risk of these events. Conclusions SIRT has the potential to be used across the BCLC stages in cases with preserved liver function. When using it as a rescue treatment, one should consider variables refecting liver function, HCC extension, and systemic infammation, which are associated with mortality. Keywords Carcinoma hepatocellular · Liver cirrhosis · Embolization · Therapeutic · Radiotherapy Abbreviations ALBI Albumin–Bilirubin grade BCLC Barcelona Clinic Liver Cancer HCC Hepatocellular carcinoma SIRT Selective internal radiation therapy SBRT Stereotactic body radiation therapy EASL European Association for the Study of the Liver OS Overall survival mRECIST Modifed response evaluation criteria in solid tumors AE Adverse event SAE Severe adverse event ORR Objective response rate DCR Disease control rate TACE Transarterial chemoembolization TTP Time to progression TTV Total tumor volume ECOG Eastern Cooperative Oncology Group NA Not available Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-020-06245-y) contains supplementary material, which is available to authorized users. * Richard J. Owen rowen@ualberta.ca Extended author information available on the last page of the article