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- W2584547203 abstract "Hyperbilirubinemia is often a contraindication to yttrium-90 radioembolization (Y90) in patients with hepatocellular carcinoma (HCC). We aim to assess if selective Y90 is safe in the setting of solitary HCC and hyperbilirubinemia. With IRB approval, we included all HCC patients from our prospectively acquired Y90 database that had solitary tumors ≤ 5cm and hyperbilirubinemia (total bilirubin ≥ 2mg/dL). Laboratory toxicities (total bilirubin, AST, ALT, and alkaline phosphatase) were evaluated at baseline, 1 month, and 3 months after Y90 according to CTCAE v4. Paired sample Wilcoxon analyses were performed (significance set at P<0.05). Survival was estimated using Kaplan-Meier statistics. Sixty-one patients met inclusion criteria; 58 patients had 1 month and 50 patients had 3 month post-Y90 follow-up data. 2 (3%), 48 (79%), and 11 (18%) were Child-Pugh class A, B, and C, respectively. Segmental and lobar radioembolization were performed on 58 (95%) and 3 (5%) patients, respectively. Median censored survival was 29 months, (95% CI: 27-70.3). Thirty-three (54%) patients received liver transplant after Y90, with median time to transplant of 6.53 months (range: 0.33-34.77). Median total bilirubin (mg/dL) (95%CI) at baseline, 1 month, and 3 months was 2.5 (2.4-2.8), 3.0 (2.8-3.4), and 3.1 (2.7-3.9) (P = 0.003). Median serum alkaline phosphatase (95% CI) at baseline, 1 month, and 3 months was 109 (99-120), 129 (117-141), and 134 (111-153) (P = 0.0001). Baseline and post-treatment AST/ALT demonstrated no statistically significant difference. Per CTCAE v4, grade 1/2/3 toxicities were seen in [0(0%)/45(74%)/16(26%)] and [2(4%)/23(46%)/25(50%)] patients at baseline and 3 months following radioembolization, respectively (P = 0.006). In these patients with baseline hyperbilirubinemia, no grade 4 bilirubin toxicity was seen. In patients with unresectable HCC and liver dysfunction manifested as hyperbilirubinemia, Y90 is tolerated with limited laboratory toxicities. Y90 should be considered as an option in patients with liver dysfunction provided segmental injection can be performed, especially to bridge or downsize to transplant." @default.
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- W2584547203 date "2017-02-01" @default.
- W2584547203 modified "2023-09-23" @default.
- W2584547203 title "Radioembolization for Hepatocellular Carcinoma in Patients with Hyperbilirubinemia" @default.
- W2584547203 doi "https://doi.org/10.1016/j.jvir.2016.12.769" @default.
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