Survival and pattern of tumor progression with yttrium-90 microsphere radioembolization in predominantly hepatitis B Asian patients with hepatocellular carcinoma Andrew Yu-Keat KhorYing TohJohn Carson AllenDavid Chee-Eng Ng • Yung-Hsiang KaoGuili ZhuSu-Pin ChooRichard Hoau-Gong Lo • Kiang-Hiong TayJin-Yao TeoBrian Kim-Poh GohMark Christiaan Burgmans • Farah Gillian IraniAnthony Soon-Whatt GohPierce Kah-Hoe Chow

Purpose Intra-arterial yttrium-90 ( 90 Y) microsphere radioembolization (RE) is an emerging treatment option with good outcomes reported predominantly in hepatitis C Western populations with hepatocellular carcinoma (HCC). We report outcomes in predominantly hepatitis B Asian patients treated with 90 Y-RE focusing on overall survival (OS), time to progression (TTP), tumor response, pattern of tumor recurrence and adverse events. Prognostic factors for survival were also identified. Methods A retrospective cohort study was conducted in a single tertiary institution. All non-trial patients treated with 90 Y-RE at our institution from 1 January 2008 to 30 June 2012 were included. Results Data from 103 consecutive patients were analyzed. The majority of patients were Child-Pugh class A (59.2 %) and Barcelona Clinic Liver Cancer (BCLC) stage C (68.9 %). Median OS was 14.4 months (95 % CI 11.0‐22.2), which varied by disease stage: Child-Pugh A, 21.7 months; ChildPugh B, 7.1 months; BCLC B, 23.8 months; BCLC C, 11.8 months. Response and disease control rates by RECIST 1.1 were 21.2 and 59.6 %, respectively, while disease control for index lesions treated with 90 Y-RE was 100 %. Development of new intrahepatic lesions was the main reason for eventual disease progression. Median overall TTP was 5.3 months (95 % CI 4.1‐10.0). Pretreatment vascular invasion, low serum albumin and elevated total bilirubin levels predicted poorer survival. Conclusions Survival outcomes in hepatitis B Asian patients treated with 90 Y-RE for HCC are comparable to hepatitis C Western populations. While disease control for lesions treated with 90 Y-RE is excellent, the development of