Hepatocellular carcinoma radiation segmentectomy treatment intensification prior to liver transplantation increases rates of complete pathologic necrosis: an explant analysis of 75 tumors

Montazeri, Seyed Ali; Garza-Ramos, Cynthia De la; Lewis, Armand F.; Lewis, Jason T.; LeGout, Jordan D.; Sella, David M.; Paz‐Fumagalli, Ricardo; Devcic, Zlatko; Ritchie, Charles; Frey, Gregory; Vidal, Lucas Lauar Cortizo; Croome, Kristopher P.; McKinney, J. Mark; Harnois, Denise M.; Krishnan, Sunil; Patel, Tushar; Toskich, Beau B.

doi:10.1007/s00259-022-05776-y

Cited by 28 publications

(24 citation statements)

References 12 publications

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“…The patient outcomes within this cohort add to the growing literature supporting radiation segmentectomy with glass microspheres for the treatment of early-stage HCC in patients with solitary tumors. The localized objective response rate of 96% aligns with other reported outcomes in literature [1,12,13]. Comparably, durable treatment response greater than 2 years was achieved in 98% of treated lesions, and only 11% of patients demonstrated progression at 2 years.…”

Section: Discussionsupporting

confidence: 88%

“…Similarly, the results of this study highlight the importance of SA on imaging and pathologic treatment response, as it relates to limited space within the tumor to concentrate microspheres and deliver an ablative dose. In this study, the desired dose was delivered in all cases, which is similar to other publications involving the use of glass microspheres [1,3,5,12,13]. Based on Fig.…”

Section: Discussionmentioning

confidence: 65%

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

Section: Discussionmentioning

confidence: 99%

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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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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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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 65%

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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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“…Numerous studies have demonstrated the safety of this approach and increasingly higher rates of complete pathologic necrosis with higher doses in various tumor types. [116][117][118] Whereas the vast literature is on HCC, outcomes of this strategy for cholangiocarcinoma will be forthcoming.…”

Section: Transarterial Embolotherapies For Unresectable Liverconfined...mentioning

confidence: 99%

“…An increasingly popular modification of radioembolization treatments is the use of extra‐high doses confined to small volumes of tumor‐bearing liver, termed the radiation segmentectomy approach, wherein doses as high as 400‐800 Gy to the targeted tumor are delivered. Numerous studies have demonstrated the safety of this approach and increasingly higher rates of complete pathologic necrosis with higher doses in various tumor types 116–118 . Whereas the vast literature is on HCC, outcomes of this strategy for cholangiocarcinoma will be forthcoming.…”

Section: Locoregional Therapies For Liver‐confined Unresectable Iccmentioning

confidence: 99%

Advances in the treatment of intrahepatic cholangiocarcinoma: An overview of the current and future therapeutic landscape for clinicians

Moris

Palta

Kim

et al. 2022

CA A Cancer J Clinicians

194

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Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor and remains a fatal malignancy in the majority of patients. Approximately 20%-30% of patients are eligible for resection, which is considered the only potentially curative treatment; and, after resection, a median survival of 53 months has been reported when sequenced with adjuvant capecitabine. For the 70%-80% of patients who present with locally unresectable or distant metastatic disease, systemic therapy may delay progression, but survival remains limited to approximately 1 year. For the past decade, doublet chemotherapy with gemcitabine and cisplatin has been considered the most effective first-line regimen, but results from the recent use of triplet regimens and even immunotherapy may shift the paradigm.More effective treatment strategies, including those that combine systemic therapy with locoregional therapies like radioembolization or hepatic artery infusion, have also been developed. Molecular therapies, including those that target fibroblast growth factor receptor and isocitrate dehydrogenase, have recently received US Food and Drug Administration approval for a defined role as second-line treatment for up to 40% of patients harboring these actionable genomic alterations, and whether they should be considered in the first-line setting is under investigation. Furthermore, as the oncology field seeks to expand indications for immunotherapy, recent data demonstrated that combining durvalumab with standard cytotoxic therapy improved survival in patients with ICC. This review focuses on the current and future strategies for ICC treatment, including a summary of the primary literature for each treatment modality and an algorithm that can be used to drive a personalized and multidisciplinary approach for patients with this challenging malignancy.

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Spatial density and tumor dosimetry are important in radiation segmentectomy with 90Y glass microspheres

Chiesa

Mazzaglia

Maccauro

2022

Eur J Nucl Med Mol Imaging

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Hepatocellular carcinoma radiation segmentectomy treatment intensification prior to liver transplantation increases rates of complete pathologic necrosis: an explant analysis of 75 tumors

Cited by 28 publications

References 12 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

Advances in the treatment of intrahepatic cholangiocarcinoma: An overview of the current and future therapeutic landscape for clinicians

Spatial density and tumor dosimetry are important in radiation segmentectomy with 90Y glass microspheres

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