Radioembolization With Yttrium-90 Microspheres for Intermediate or Advanced Hepatocellular Carcinoma

• Time to progression (TTP) [ Time Frame: At 1, 3, 6, 12 months and every 6 months thereafter ] [ Designated as safety issue: No ]
  

• Tumor Response according to RECIST, WHO, EASL and Choi criteria [ Time Frame: At 3, 6, 12 months and every 6 months thereafter ] [ Designated as safety issue: No ]
  
• Overall survival [ Time Frame: At 1, 3, 6, 12 months and every 6 months thereafter ] [ Designated as safety issue: No ]
  
• Safety: documentation of all adverse events [ Time Frame: At 1, 3, 6, 12 months and every 6 months thereafter ] [ Designated as safety issue: Yes ]
  
• Time-to-symptomatic progression (TTSP) [ Time Frame: At 1, 3, 6, 12 months and every 6 months thereafter ] [ Designated as safety issue: Yes ]
  

Device: Yttrium-90 microspheres (Therasphere MDS Nordion)
Y-90 is incorporated into very tiny glass beads (microspheres: Therasphere MDS Nordion) and is injected into the liver tumor through the hepatic arteries, which are responsible for the feeding of the neoplastic liver tissue. Since the microspheres are unable to pass through the micro-vasculature of the liver parenchyma and tumor they are trapped at those sites and exert a local radio-therapeutic effect.
Other Name: Therasphere, produced by MDS Nordion, Ottawa, Canada

Patients at an intermediate stage (BCLC-B) are currently offered trans-arterial chemoembolisation (TACE) as the standard of care. A recent meta-analysis showed that radioembolization with beta-emitting Yttrium-90-loaded glass microspheres (TheraSphere®) in patients with HCC achieves a median objective response in 79% of cases (range 29-88%) and median survival exceeding 15 months has been reported in patients at intermediate stages who have been treated with TheraSphere®.

In patients with HCC at an advanced stage (BCLC-C) the single treatment that has shown a statistical advantage on overall survival and disease progression is sorafenib, that provides a median survival of 10.7 months. Based on the results reported in literature, the estimated median expected survival of patients with advanced HCC treated by TheraSphere® can be as long as 12 months.

After approval on July 2007 of a treatment protocol of Y-90 for compassionate use by the institutional IRB, at the National Cancer Institute of Milan 40 consecutive patients have been treated with radioembolization with Yttrium-90 microspheres (Theraspheres®) according to the same guidelines of the present prospective phase II protocol. The initial series of 40 patients treated according to a compassionate use of Y-90 has been instrumental for the assessment of the procedure's safety and tolerability. The present study has been targeted to 60 cases including the fist series of 40 "compassionate" patients, due to their adherence to the same inclusion/exclusion criteria of the proposed phase II study.