“Radiation embolization as effective as surgery in major liver cancer”


A joint research team has confirmed that the therapeutic effects and side effects of carotid artery radiation embolization in single-modulus liver cancer of five centimeters or more are similar to liver resection surgery.


Professors Lee Jeong-hoon of Seoul National University Hospital (left) and Kim Ji-hye of Bundang Hospital of Seoul National University conducted a study which confirmed that radiation embolization is effective as resection surgery for large liver cancer.


Liver cancer is the seventh most common cancer in Korea. According to the National Cancer Registry, there were 15,605 new cases of liver cancer in 2019, representing 6.1% of the total cancer incidence. The cancer shows a poor survival rate, as the five-year relative survival rate for liver cancer patients is 37.7%, only half of the overall cancer survival rate of 70.7% .


In particular, liver cancer larger than 5 cm has a particularly poor prognosis.


Even after liver resection, the standard treatment, recurrence occurs in about 30% of patients within two years. Also, as liver size decreases after surgery, there is a high risk of liver function deterioration.


Doctors turned to carotid artery chemoembolization as an alternative treatment for patients who could not undergo liver resection due to underlying diseases. However, the treatment has side effects such as high fever and abdominal pain proportional to the size of the cancer.


Therefore, radiation embolization, which has fewer side effects and is more effective than carotid artery chemoembolization, is attracting attention as an alternative treatment for liver resection. Radiation embolization is a method of treating cancer by delivering microbeads loaded with yttrium-90, a radioactive material, to liver cancer through the hepatic artery to generate radiation from inside the tumor.


To confirm the treatment’s effectiveness on large liver cancers larger than 5 cm in size, the team, led by Professors Lee Jeong-hoon of Seoul National University Hospital and Kim Ji-hye of Seoul National University Bundang Hospital , divided large categorized patients with single nodule liver cancer into a radiation embolization group (57 patients) and a liver resection surgery group (500 patients) and monitored the effects of treatment and side effects.


The research team statistically corrected for factors such as age (old age), comorbidity of systemic disease, tumor size, invasion of the left and right lobes of the liver, and vein invasion. door taking into account the unfavorable situation in the radiation embolization group before treatment.


As a result, the team did not confirm any statistical difference between the two groups regarding overall survival and duration of relapses.


At 38.4 months after the first treatment, the mortality rates for the radiation embolization and hepatic resection surgery groups were 21.1 and 20.4%, respectively.


Furthermore, the cumulative recurrence rates for two years after the first treatment were 50 and 58%.


However, there was a difference in the degree of side effects after treatment. The proportion of patients with side effects such as abdominal pain and fever in the radiation embolization group was 43.9% compared to 100% in the liver resection group.


The length of hospitalization was also three days in the radiation embolization group and 12 days in the liver resection group, showing a significant difference.


“Through this study, it is encouraging to find that radiation embolization is a sufficiently effective and safe treatment for large liver cancer compared to liver resection, which is recommended in global medical guidelines,” said the professor Lee.


Professor Kim also said: “The cure for large liver cancer is resection, but given the residual liver function and the possibility of recurrence, surgery is often difficult and liver transplantation is limited.


Radiation embolization may hold hope as an alternative treatment for liver cancer patients who are difficult to operate on, Kim added.


The Journal of Nuclear Medicine published the study in its latest online edition.

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