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Radioembolization Versus Chemoembolization (DEBDOX) for the Treatment of Unresectable Hepatocellular Carcinoma: A Propensity Matched Study.

BACKGROUND/AIM
Hepatocellular cancer is a rising dilemma. Patients with unresectable disease may benefit from locoregional therapy. The comparative effectiveness of radioembolization and Doxorubicin-Drug-Eluting-Beads (DEBDOX) has not been established to date. We compared the performance of radioembolization and DEBDOX in the treatment of hepatocellular carcinoma.


PATIENTS AND METHODS
An analysis of our prospectively managed locoregional therapy (LRT) database was performed. Three hundred and fifty-eight patients were treated with LRT for unresectable HCC, out of which 291 were treated with DEBDOX and 67 with Ytrrium-90 ((90)Y). Comparative toxicity, tumor response, progression-free survival (PFS) and overall survival (OS) were assessed. Propensity score matching was used to reduce treatment-selection bias, producing 48 pairs. Comparative analysis was repeated after propensity matching.


RESULTS
Median age was 67 and 65 years for the DEBDOX and (90)Y groups respectively (p=0.2). Overall survival favored the DEBDOX group (DEBDOX: 15-months, (90)Y: 6-months, p<0.0001). PFS also favored the DEBDOX group (DEBDOX: 15-months, (90)Y: 6-months, p<0.0001). All-grade adverse events were similar in both groups, although slightly favoring the DEBDOX group (DEBDOX 10%, (90)Y 15%, p=0.1). After propensity score matching, again longer OS was seen with the DEBDOX group (DEBDOX 13 months, (90)Y 4 months; p=0.0077). There were also similar all-grade adverse events that slightly favored DEBDOX (DEBDOX 14%, (90)Y 20%, p=0.3). Disease control rate was found to be statistically significant, favoring the DEBDOX group (DEBDOX 72%, (90)Y 48%; p=0.02).


CONCLUSION
Our observation suggests that DEBDOX outperforms (90)Y with superior efficacy and survival with a trend towards lower all-grade toxicity.