Boosted-Dose Yttrium-90 Radiation Segmentectomy or Lobectomy for Hepatocellular Carcinoma Refractory to Prior Transarterial Embolization or Chemoembolization: A Single Institution Retrospective Case Series

Srinivas, Shanmukha; Rose, Steven C.; Jammal, Omar Al; Hsieh, Lee J.; Rockwell, Helena D.; Duncan, David; Minocha, Jeet; Berman, Zachary

doi:10.1007/s00270-023-03388-z

Cited by 4 publications

(11 citation statements)

References 29 publications

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“…Figure 3 is a histogram of the post-therapeutic anaylsis of a patient with a complete response tumor, where we can see three different color curves; each curve represents a specific area with its absorbed activity, such as a tumor, perfused volume, and the whole liver. In our extensive search in PubMed and Medline to identify peer-reviewed 241 clinical studies using the following terms-TheraSphere ® , transarterial radioembolization, SIRT, and SIR-Spheres ® -we found a similar study that has been published recently and they In our extensive search in PubMed and Medline to identify peer-reviewed 241 clinical studies using the following terms-TheraSphere ® , transarterial radioembolization, SIRT, and SIR-Spheres ® -we found a similar study that has been published recently and they evaluated 90Y-SIRT for HCC refractory to prior trans-arterial embolization, or TACE, and they concluded that TARE has a response rate of 85% of patients, which is relatively close to our result [24]. Some antineoplastic agents are known to be potent radiosensitizers and could increase the effect of 90Y-microspheres.…”

Section: Discussionsupporting

confidence: 84%

Efficacy of Selective Internal Radiation Therapy for Hepatocellular Carcinoma Post-Incomplete Response to Chemoembolization

Binzaqr,

Debordeaux,

Blanc

et al. 2023

Pharmaceuticals

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Hepatocellular carcinoma (HCC) is one of the most common neoplasms worldwide and the third most common cause of cancer-related death. Several liver-targeted intra-arterial therapies are available for unresectable HCC, including selective internal radiation therapy (SIRT) and trans-arterial chemoembolization (TACE). Those two are the most used treatment modalities in localized non-operable HCC. TACE is the treatment option for patients with stage B, according to the BCLC staging system. In contrast, SIRT does not have an official role in the treatment algorithm, but recent studies showed promising outcomes in patients treated with SIRT. Although TACE is globally a safe procedure, it might provoke several vascular complications such as spasms, inflammatory constriction, and, in severe cases, occlusion, dissection, or collateralization. Hence, it is acclaimed that those complications could restrain the targeted response of the radio-embolization when we use it as second-line therapy post TACE. In this study, we will assess the efficacity of SIRT using Yttrium 90 Microspheres post incomplete or failure response to TACE. In our retrospective study, we had 23 patients who met the inclusion criteria. Furthermore, those patients have been followed radiologically and biologically. Then, we evaluated the therapeutic effect according to the mRECIST criteria, in addition to the personalized dose analysis. We found 8 patients were treated with TheraSphere®, with a median tumor absorbed dose of 445 Gy, while 15 received SIR-Spheres® treatment with a mean tumor dose of 268 Gy. After radiological analysis, 56.5% of the patients had a complete response, and 17.3% showed partial response, whereas 13% had stable disease and 13% had progressive disease. For patients treated with SIRT after an incomplete response or failure to TACE, we found an objective response rate of 73.8%. Despite the known vascular complications of TACE, SIRT can give a favorable response.

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Section: Discussionsupporting

confidence: 84%

Efficacy of Selective Internal Radiation Therapy for Hepatocellular Carcinoma Post-Incomplete Response to Chemoembolization

Binzaqr,

Debordeaux,

Blanc

et al. 2023

Pharmaceuticals

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“…The goal of this study was to evaluate the outcomes of TARE for the treatment of HCC in patients who had previously been treated with TAE. There is a paucity of published evidence on this topic, and the available literature predominantly describes TARE for HCC in patients previously treated with TACE [10,[12][13][14]. TAE and TACE are comparable intra-arterial locoregional therapies for intermediate-stage HCC not amenable to resection or ablation [19,23].…”

Section: Discussionmentioning

confidence: 99%

“…However, TAE should not be considered curative-intent therapy as disease recurrence is common [9]. Repeat TAE may be used to treat recurrent HCC, but the disease can become refractory to TAE and cease responding, a phenomenon that is well documented with TACE [10,11]. These patients require an alternative treatment.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Y90 Radioembolization for Hepatocellular Carcinoma in Patients Previously Treated with Transarterial Embolization

Zhao,

Son,

Karimi

et al. 2024

Current Oncology

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The aim of this study was to evaluate outcomes of transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) in patients previously treated with transarterial embolization (TAE). In this retrospective study, all HCC patients who received TARE from 1/2012 to 12/2022 for treatment of residual or recurrent disease after TAE were identified. Overall survival (OS) was estimated using the Kaplan–Meier method. Univariate Cox regression was performed to determine significant predictors of OS after TARE. Twenty-one patients (median age 73.4 years, 18 male, 3 female) were included. Median dose to the perfused liver volume was 121 Gy (112–444, range), and 18/21 (85.7%) patients received 112–140 Gy. Median OS from time of HCC diagnosis was 32.9 months (19.4–61.4, 95% CI). Median OS after first TAE was 29.3 months (15.3–58.9, 95% CI). Median OS after first TARE was 10.6 months (6.8–27.0, 95% CI). ECOG performance status of 0 (p = 0.038), index tumor diameter < 4 cm (p = 0.022), and hepatic tumor burden < 25% (p = 0.018) were significant predictors of longer OS after TARE. TARE may provide a survival benefit for appropriately selected patients with HCC who have been previously treated with TAE.

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“…▪ With careful attention to patient selection and dosimetry, Y90-RE can be safe in the setting of prior therapies, 18 including but not limited to surgery, 19 external beam radiation, 20 Y90-RE, 21 22 chemoembolization, 23 and transarterial bland embolization. 23 However, caution is warranted in these clinical situations, for the liver function and/or hepatic reserve can be compromised. As such, the authors recommend considering utilizing personalized dosimetry and limiting treatment to the specific angiosome whenever possible in these circumstances.…”

Section: Dosimetry Fundamentalsmentioning

confidence: 99%

Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips

Villalobos,

Pisanie,

Gandhi

et al. 2024

Semin intervent Radiol

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Boosted-Dose Yttrium-90 Radiation Segmentectomy or Lobectomy for Hepatocellular Carcinoma Refractory to Prior Transarterial Embolization or Chemoembolization: A Single Institution Retrospective Case Series

Cited by 4 publications

References 29 publications

Efficacy of Selective Internal Radiation Therapy for Hepatocellular Carcinoma Post-Incomplete Response to Chemoembolization

Efficacy of Selective Internal Radiation Therapy for Hepatocellular Carcinoma Post-Incomplete Response to Chemoembolization

Outcomes of Y90 Radioembolization for Hepatocellular Carcinoma in Patients Previously Treated with Transarterial Embolization

Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips

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