LAUSR

Background Hepatocellular carcinoma (HCC) is the second most common lethal cancer, and there is a need for effective 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 efficacy 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 different 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, respectively ( 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), neutrophil-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 reflecting liver function, HCC extension, and systemic inflammation, which are associated with mortality.