Downloaded 21 times
More Related Content
Similar to SIRT-HCC-03-14-KURZ
SIRT-HCC-03-14-KURZ
- 1. Y90 radioembolisation 1 Jens Ricke Radiologyand Nuclear medicine, University of Magdeburg
- 2. SIRT: Y90 Radioembolisation Mikrospheres(20-40 µm) Loaded w/ Yttrium-90 Y-90: beta emitter mean range: 3,9 mm max. range: 11 mm max. energy: 2,27 MeV half life: 64 h
- 4. EASL-EORTC guidelines, JHepatol 2012
- 5. TACE – lessonslearned Llovet, Bruix. Hepatology 2003 • Significant benefit TACE w/ cisplatin or doxorubicin (OR, 0.42; 95% CI, 0.20-0.88) • No benefit with TAE alone (OR, 0.59; 95% CI, 0.29-1.20)
- 6. Selection of patientsfor TACE Llovet Lancet 2002; Lo Hepatology 2002
- 7. Journal of Hepatology(2012) 56, 1330–1335 •Strictly BCLC B •no PVT (even segmental!) •Performance status 0 •Multinodular •Selective treatment only •But all nodules treated •No of nodules must be small (?)
- 8. Prognostische Faktoren fürTACE Hu JVIR 2011 •n=362 Patienten, konventionelle TACE •Multivariate Analyse, Overall survival
- 9. EASL-EORTC guidelines, JHepatol 2012
- 11.
- 13.
- 14.
- 15.
- 16. •TTP > inY90 (p=0.046) •Response > in Y90 (n.s.) •Advantages for Y90 in subgroup analyses: – TTP in BCLC B (only univariate) – Survival in T3 and BCLC C (only univariate) Y90 in elderly, PVT, large or „diffuse“ tumors Y90 RE vs. TACE* *Salem et al. Gastroenterology 2011
- 17. Radioembolisation bei Pfortaderthrombose VorSIRT 10w post SIRT
- 18. Y90 in theperspective of the SHARP trial Sangro Hepatology 2011
- 19. SIRVENIB and SARAH •Y90radioembolization vs. Sorafenib – Asia-Pacific and France •Endpoint: Survival, time-to-progression •Will show that Y90 has superior responses in BCLC C – Cross-over – Imaging endpoint unfavourable for Sorafenib
- 21.
- 22. Systemic therapy afterY90 radioembolization •Very good survival with PVT and Child Pugh A – Not with Child Pugh B of 7 points •With tumor progression also worsening of CP-status •Very limited therapeutic window for Sorafenib Memon et al J Hepatol 2013
- 23. SORAMIC - structure Diagnosis HCCStaging Ablation therapy Therapy w/ palliative intentionPrimovist MR vs. CT Therapeutic decision Primovist MR vs. CT Therapeutic decision RFA & Sorafenib vs. RFA & Placebo: time-to-recurrence RFA & Sorafenib vs. RFA & Placebo: time-to-recurrence SIRT & Sorafenib vs. Sorafenib Overall survival SIRT & Sorafenib vs. Sorafenib Overall survival
- 24. Active sites &candidates in 2013/14 SORAMIC
- 25. SORAMIC: Interim onSafety* •Y90 and Sorafenib vs. Sorafenib alone •Sequential treatment right/left liver – Interval 4-6 weeks •Start Sorafenib 200 bid day 3 •Increase to 400 bid day 10 •Interim safety after 40 patients * presented at the EASL 2013
- 26. Treatment characteristics * presentedat the EASL 2013
- 27. Results * presented atthe EASL 2013
- 28. Take home III:HCC •Role of Y90 radioembolisation to be determined – Large tumors, diffuse disease – Portal vein infiltration •Sorafenib and TACE simultaneously not recommended •Combination of Y90 and Sorafenib is safe – Data on efficacy 2015
- 29.