Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis

Abstract

The aim of this study was to evaluate the efficacy and the safety of Y90 radioembolization (Y90-RE) in patients with unresectable hepatocellular carcinoma (HCC) analysing our results and correlating them with independent prognostic factors for overall survival (OS) and for complications. Forty-three patients with advanced inoperable HCC including those with multiple bilobar lesions or portal vein thrombosis (PVT) treated with Y90-RE were reviewed. Treatment efficacy and safety were evaluated. Survival was calculated by the Kaplan-Meier method. Univariate analyses were performed for identifying potential prognostic factors. Radiologic response was evaluated with the modified Response Evaluation Criteria in Solid Tumours (mRECIST) criteria. Clinical toxicities were prospectively recorded. Median overall progression-free survival and OS were 27.7 and 16.8 months, respectively. Longer median OS was revealed in those without PVT (p = 0.0241) and those whose pre-treatment haemoglobin values was higher (p = 0.0471). According with mRECIST criteria, we observed a disease control rate of 69.2 and 61.9% at 3- and 6-month follow-up, respectively. Complications developed in 28 patients (65.1%), among which grade 2-3 events were reported in 17 patients. We noted that activity administered dose presented a correlation with intra-procedural toxicity (p = 0.039259) while common hepatic artery use as release site was associated with a most frequent presentation of remote adverse events. Y90-RE is an alternative treatment with a promising outcome for poor-risk advanced inoperable HCC. PVT and pre-treatment haemoglobin values can be predictors of efficacy. Activity administered dose and arterial release site can be predictors of safety.

Predicting hyperprogressive disease in patients with advanced hepatocellular carcinoma treated with anti-programmed cell death 1 therapy

“…The haemoglobin level was negatively associated with an increased risk of HPD. Floridi et al also suggested that higher pre-treatment haemoglobin values corresponded to a longer median OS in patients with HCC [21]. In contrast, PVTT was positively associated with an increased risk of HPD, which is consistent with the results of previous studies [22].…”

Radioembolization lung shunt estimation based on a 90Y pretreatment procedure: A phantom study

“…The total initial activity of the phantom, 1586 MBq, was comparable to a clinically used treatment dosage of 90 Y resin microspheres (SIR-Spheres â , Sirtex, Sydney, Australia). 20,21 The phantom was imaged multiple times during decay, down to a final total activity of 25 MBq, which is well below the estimated safety threshold of about 100 MBq for a 90 Y pretreatment procedure.…”

SPECT/CT image‐based dosimetry for Yttrium‐90 radionuclide therapy: Application to treatment response

“…Despite positive results from published studies,6, 7 the reported doses assume that the activity distribution within the treatment volume is uniform. Quantitative patient‐specific 90 Y dosimetry has been studied using bremsstrahlung single photon emission computed tomography (SPECT)/computed tomography (CT) 8, 9, 10, 11 and positron emission tomography (PET)/CT 12, 13, 14, 15, 16.…”