New study determines higher dosage for radioembolisation to treat liver cancer, improves survival rates by almost 15 months and facilitates curative treatment

Singapore, 10 October 2024 – A study led by clinician-scientists and researchers from the National Cancer Centre Singapore (NCCS) and Singapore General Hospital (SGH) has determined the benefits of using a higher dosage of radioembolisation treatment using yttrium-90 (Y-90) microspheres, than previously recommended, for liver cancer. Patients who received this elevated dose had significantly better outcomes than those who did not. The study results, which are potentially practice changing, were published in the journal Liver Cancer in September 2024.

Primary liver cancer, or hepatocellular carcinoma (HCC), is the third leading cause of cancer-related death and the sixth most common cancer, worldwide. Overall prognosis of HCC poor, with less than 20% of patients surviving five years past diagnosis. One of the reasons for poor outcomes is late diagnosis and poorly efficacious therapy especially in late states of HCC.

Treatment for locally advanced HCC, varies greatly and as a result, so do clinical outcomes. HCC can present with vascular invasion which is when tumour cells have invaded blood vessels. HCC with vascular invasion is frequently treated with radioembolisation using (Y-90) microspheres. Y-90 is a minimally invasive treatment, that first gained popularity as a treatment option for HCC in the 2000s. Y-90 delivers high doses of radiation via the bloodstream to tumour cells in the blood or tumours in the liver. However, the relationship between Y-90 dosage and clinical outcomes in HCC patients and its optimal dosage for HCC treatment has not been determined till now.

Determining optimal dosage for a promising liver cancer treatment

To address this gap in knowledge, a team of clinicians and scientists studied the outcomes of 413 locally advanced HCC patients treated with Y-90 therapy between January 2008 and May 2019 at SGH and NCCS. This is the largest single-institution unresectable HCC cohort treated with Y-90 (resin) therapy study to date.

Patients were divided into two groups based on the tumour absorbed dose of Y-90: those who received ≥ 150 Gy and those that did not. The unit Gray (Gy) denotes the amount of radiation a unit volume of tumour has received. The ≥ 150 Gy dosage was based on the mean dosage of the patient cohort, which was 154.7+/- 80.4. Earlier studies have suggested that delivery of 120 Gy to HCC should confer disease control.

The team found that patients who received ≥150 Gy of Y-90 therapy had significantly better overall survival outcomes, living almost 15 months longer than those who did not. In addition, 17% of the study cohort or 70 patients whose tumour burden was successfully regressed or downstaged by Y-90 subsequently underwent curative treatments, such as surgical resection, thermal ablation or liver transplantation. This process of downstaging tumours so that the patient has the opportunity to receive curative treatment is also known as conversion therapy. The patients who underwent conversion therapy after Y-90 showed remarkably prolonged survival outcomes, living 4 times as long compared to those who did not receive curative treatments.

What findings mean for liver cancer patients

“Y-90 has been a valuable option for treating liver cancer that cannot be surgically removed but the radiation dose must be adequate without causing harm to patients. Now that we know a higher dose can potentially help achieve better outcomes, it can guide treatment planning and discussions between patients and their doctors,” said Dr Chen Kaina, first author of the study and Associate Consultant in the Department of Gastroenterology & Hepatology, SGH.

“Liver cancer remains a lethal disease that is of higher prevalence in Asia. End-to-end research is key to understanding its molecular underpinnings, enhancing diagnosis and improving treatment so that patients have better outcomes. This study is one of the many we are conducting on liver cancer. We hope that our combined efforts studying the disease will move the needle and take liver cancer from lethal to treatable,” said Professor Pierce Chow, senior author of the study and Senior Consultant Surgeon, Division of Surgery and Surgical Oncology, SGH and NCCS.

As a next step the team has launched a country multi-national trial that combines Y90 with immunotherapy for HCC.

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About the National Cancer Centre Singapore

The National Cancer Centre Singapore (NCCS) is a leading national and regional tertiary cancer centre with specialists who are experts in treating cancer. In addition to offering holistic and multidisciplinary oncology care, our clinicians and scientists collaborate with local and international partners to conduct robust, cutting-edge clinical and translational research. To achieve its vision of being a global leading cancer centre, NCCS offers world-class care and shares its depth of experience and expertise by training local and overseas medical professionals.

To meet growing healthcare needs, the new NCCS building opened in 2023 with increased capacity and expanded facilities dedicated to cancer care, rehabilitation, research and education. To give patients the best treatment outcomes, advanced and innovative treatment such as proton therapy is offered at the new Goh Cheng Liang Proton Therapy Centre at NCCS.

In 2024, NCCS celebrates its silver anniversary, celebrating 25 years of advancing cancer care from breakthroughs to healing.

About Singapore General Hospital

Singapore General Hospital, established in 1821, is the largest tertiary hospital in Singapore and ranked among the world’s best. It provides the most comprehensive patient-centred care with over 50 clinical specialties on its campus. As an Academic Medical Centre, it takes pride in training healthcare professionals and conducting cutting edge research to meet evolving needs of the nation as well as the region. Driven by a strong sense of purpose, SGH is committed to give of its best to heal and bring hope, as it has for over 200 years.

For more information, please visit www.sgh.com.sg.