Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group

Purpose To evaluate sphere concentration delivered to tumor and non-tumor tissue using voxel-based dosimetry as it relates to treatment, pathologic outcomes, and adverse events.Methods A retrospective, single-center analysis of patients (n = 57) with solitary HCC who were treated with Y90 radiation segmentectomy with Y90 glass microsphere infusion (TheraSphere; Boston Scientific, Marlborough, MA, USA) from 2020 to 2022 was performed. Post-treatment dosimetry was evaluated using Mirada DBx Build 1.2.0 Simplicit90Y dosimetry software. Voxel-based dosimetry and MIRD formula were utilized to calculate sphere concentration to tumor and non-tumor tissue. Time to progression (TTP), treatment response, pathologic response, and adverse events were studied.Results Fifty-seven patients with solitary tumors were analyzed with a median tumor diameter of 3.4cm (range 1.2-6.8cm). The median tumor absorbed dose was 692Gy (range, 256-1332Gy) with a median perfused treatment volume of 113mL (range, 33.6-442mL). Median sphere activity (SA) at time of delivery was 1428Bq (range, 412-2589Bq). Using voxel-based dosimetry and the MIRD formula, median tumor sphere concentration was 12,339 spheres/mL (range, 2,689 − 37,649 spheres/mL). Sphere concentration to tumor exhibited a weak, inverse correlation with perfused treatment volume (R2 = 0.25). However, tumor sphere concentration and non-tumor sphere concentration exhibited a direct, positive correlation (R2 = 0.72). Of the 52 tumors with post-treatment imaging, objective response was noted in 50 patients (96%) and complete response in 41 patients (79%). 98% of all treated tumors demonstrated a durable response at 2 years. The median time to progression for all patients was not reached with a 2-year progression rate of 11%. Multivariate analysis demonstrated target dose as the only statistically significant variable associated with TTP (p = 0.033). 14 patients underwent liver transplant. Median tumor necrosis was 99% (range, 80–100%).Conclusion Voxel-based dosimetry following Y90 radioembolization can be utilized to measure sphere concentration into tumor and non-tumoral tissue. Higher SA allows increased tumor absorbed dose with limited sphere/mL tumor capacity.

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“…The importance of individual SA is becoming more integral piece of personalized dosimetry [13,14]. SA ≥ 327Bq…”

Section: Discussionmentioning

confidence: 99%

The Sphere Conundrum: Using Voxel-based Dosimetry to evaluate sphere concentration and tumor dose in Hepatocellular Carcinoma treated with Y-90 Radioembolization

Sandow

Gimenez

Nunez

et al. 2023

Preprint

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“…An ablative dose is delivered into the target segment or lobe. This approach is used to treat localized disease with a curative intent, such as BCLC-0 and BCLC-A HCC patients (100,104,105). Radiation segmentectomy has resulted in high response rates and longer PFS (90,106,107).…”

Section: Radiation Segmentectomy and Lobectomymentioning

confidence: 99%

“…As long as the volume of parenchyma infused is low compared to the total liver volume, this approach is considered safe (107,112,113). The use of cone-beam CT or angio-CT to precisely assess the perfused volume is necessary to allow accurate dosimetry calculations (104,105,114).…”

Section: Radiation Segmentectomy and Lobectomymentioning

confidence: 99%

“…For patients presenting with unilobar disease, with uni-or multi-focal HCCs, for whom resection is often not possible due to small anticipated future liver remnant, radiation lobectomy approach is a reported effective option (100,104,105). The high radiation dose delivered to the lobe may induce hypertrophy of the contralateral lobe, while allowing tumor control or downstaging of the treated lesions (115)(116)(117).…”

Section: Radiation Segmentectomy and Lobectomymentioning

confidence: 99%

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Image-guided percutaneous locoregional therapies for hepatocellular carcinoma

Chevallier¹,

Zhao²,

Marinelli³

et al. 2023

Chin Clin Oncol

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Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the 3 rd leading cause of cancer death worldwide. Treatment options include surgical resection, liver transplantation, imageguided percutaneous locoregional options, external beam radiation therapy (EBRT) and systemic therapies.Treatment choice depends on the stage of the disease and patient's characteristics including performance status and liver function. Barcelona Clinic Liver Cancer (BCLC) staging system, with its recent 2022 update, is one of the most widely endorsed staging system. Locoregional therapies (LRT) are recommended for very early stage (BCLC-0), early stage (BCLC-A), and the two first subgroups of intermediate stage (BCLC-B). Image-guided percutaneous locoregional therapies include ablation, mainly thermal ablation with radiofrequency (RFA), microwave ablations (MWA) and cryoablation, transarterial embolization (TAE, also known as bland embolization), transarterial chemoembolization (TACE), drug-eluding beadstransarterial chemoembolization (DEB-TACE), combination of ablation with embolization, transarterial radioembolization (TARE) also known as selective internal radioembolization therapy, and hepatic artery infusion (HAI). While ablation is recognized as a curative therapy, all intra-arterial therapies are considered non-curative options. There is growing evidence that TARE, through radiation segmentectomy, can be considered a curative intent treatment in appropriate selective patients. In this article, we will review indications, complications, and outcomes of locoregional therapies for HCC.

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“…RL can afford tumor control/downstaging and compensatory hypertrophy of the contralateral lobe potentially allowing subsequent surgical resection. 5 45 78 79…”

Section: Tare For Hepatocellular Carcinomamentioning

confidence: 99%

Transarterial Radioembolization for Hepatic Malignancies in North and South America

Kawakami

Assis

Cohen

et al. 2023

Digestive Disease Interventions

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Transarterial radioembolization (TARE) with yttrium 90 is increasingly utilized for the treatment of hepatic neoplasms, whether primary (particularly hepatocellular carcinoma [HCC]) or metastatic (particularly colorectal). Extensive data and practical experience have led to a better understanding of its most appropriate usage and optimal techniques, particularly regarding dosimetry. Different clinical contexts and technical parameters allow its use with either palliative or curative intent. Improved patient outcomes have led to its inclusion in management guidelines of HCC and colorectal cancer. While available in multiple centers in the United States and Canada, its availability in South America is still very limited. The objective of this article is to review available treatment platforms, indications, techniques, recent advances, and clinical results, as well as briefly explore the disparities in availability throughout the United States.

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Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group

Cited by 48 publications

References 77 publications

The Sphere Conundrum: Using Voxel-based Dosimetry to evaluate sphere concentration and tumor dose in Hepatocellular Carcinoma treated with Y-90 Radioembolization

The Sphere Conundrum: Using Voxel-based Dosimetry to evaluate sphere concentration and tumor dose in Hepatocellular Carcinoma treated with Y-90 Radioembolization

Image-guided percutaneous locoregional therapies for hepatocellular carcinoma

Transarterial Radioembolization for Hepatic Malignancies in North and South America

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