Selective internal radiation therapy for unresectable HCC: The SIRT downstaging study

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Oncology

Background:

• Selective internal radiation therapy (SIRT) is a recommended downstaging (DS) strategy for unresectable hepatocellular carcinoma (HCC) <8 cm.
• This study reports on the experience with SIRT for unresectable HCC in a tertiary care setting.

Purpose of the Study:

• To evaluate the effectiveness of SIRT as a downstaging strategy for unresectable HCC.
• To assess the rates of achieving downstaging and subsequent curative treatment after SIRT.
• To identify factors associated with successful downstaging.

Main Methods:

• Retrospective observational study of 127 consecutive patients undergoing SIRT between October 2013 and June 2020.
• Downstaging (DS) was defined as achieving eligibility for curative treatment 6 months post-SIRT.
• Patient demographics, HCC characteristics, treatment outcomes, and survival data were analyzed.

Main Results:

• 39% of patients (50/127) achieved DS 6 months post-SIRT.
• 23% of all patients (29/127) underwent curative treatment (13% transplant, 8.5% resection, 0.8% RFA).
• Median overall survival was 51 months for patients with DS vs. 10 months without (p < 0.001).
• Factors associated with DS included younger age, lower baseline alpha-fetoprotein, specific HCC distribution, and better ALBI grade.

Conclusions:

• SIRT is an effective treatment for unresectable HCC, achieving downstaging in 39% of cases.
• A significant proportion of patients downstaged by SIRT subsequently received curative treatment.
• SIRT offers a viable option for improving outcomes in unresectable HCC.