Radiographic Parameters in Predicting Outcome of Patients with Hepatocellular Carcinoma Treated with Yttrium-90 Microsphere Radioembolization

Abstract

Background. In patients with hepatocellular carcinoma, selection criteria for transarterial hepatic selective internal radiotherapy are imprecise. Additionally, radiographic parameters to predict outcome of transarterial hepatic selective internal radiotherapy have not been fully characterized. Patients and methods. Computed tomography (CT) scans of 23 patients with unresectable primary hepatocellular carcinoma before and after transarterial hepatic selective internal radiotherapy with yttrium-90 microspheres were retrospectively reviewed. Selected radiographic parameters were evaluated and correlated with progression-free survival and overall survival. Response to treatment was assessed with Response RECIST 1.1 and Morphology, Attenuation, Size, and Structure (MASS) criteria. Results. On the post-SIRT CT, 68% of tumors demonstrated decreased size (median decrease of 0.8 cm, P = 0.3); 64% had decreased attenuation (median decrease 5.7 HU, P = 0.06), and 48% demonstrated increased tumor necrosis (P < 0.001). RECIST-defined partial response was seen in 10% patients, stable disease in 80%, and 10% had disease progression. Median progression-free survival was 3.9 months (range, 3.3 to 7.3), and median overall survival was 11.2 months (7.1 to 31.1). Pretreatment lower hepatopulmonary shunt fraction, central hypervascularity, and well-defined tumor margins were associated with improved progression-free survival. Conclusion. In patients with unresectable hepatocellular carcinoma, pretreatment CT parameters may predict favorable response to SIRT and improve patient selection.

90Y Radioembolization Lung Shunt Fraction in Primary and Metastatic Liver Cancer as a Biomarker for Survival

“…8,9 In a study of 23 HCC patients treated with 90 Y, multivariate analysis demonstrated an association between prolonged progression-free survival and low LSF. 10 Considering the functional role of angiogenesis in metastasis, it is possible that LSF may be associated with the risk of metastatic spread of cancer cells from established primary and secondary liver tumors. Although previous studies have described the correlation between high LSF and more aggressive tumor characteristics, evaluation of LSF and its correlation with overall survival (OS) from 90 Y radioembolization have not been examined in detail.…”

Liver Decompensation as Late Complication in HCC Patients with Long-Term Response following Selective Internal Radiation Therapy

“…This is particularly difficult in patients treated with SIRT since the radiation-induced changes in liver parenchyma impede objective response evaluation according to tumor size or contrast-enhancement. Furthermore, the radiological tumor response after SIRT can be delayed, or due to tumor necrosis and edema, show initial pseudo progression followed by stable or responsive disease afterwards [25].…”

Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review

“…The imaging evaluation consists of triphasic liver CT or MRI to evaluate variant vascular anatomy and to assess the extent and location of the hepatic tumor and its hypervascularity ( 7 14 ). CT scans may identify several characteristics of primary HCC that are associated with a favorable response to Y90-SIRT such as well-defined tumor margins, central hypervascularity pattern, and hepatopulmonary fraction ( 17 ).…”

“…Tumor response assessment following Y90-SIRT can be performed with conventional cross-sectional imaging such as CT and MRI ( 9 17 ). There is a lack of standardization of functional imaging in HCC and response assessment based on anatomical methods is considered as the standard ( 26 27 ).…”