Pathologic Response of Hepatocellular Carcinoma Treated with Yttrium-90 Glass Microsphere Radiation Segmentectomy Prior to Liver Transplantation: A Validation Study

Toskich, Beau B.; Vidal, Lucas Lauar Cortizo; Olson, Matthew T.; Lewis, Jason T.; LeGout, Jordan D.; Sella, David M.; Montazeri, Seyed Ali; Devcic, Zlatko; Lewis, Armand F.; Frey, G; Ritchie, Charles; Paz‐Fumagalli, Ricardo; Croome, Kristopher P.; Patel, Tushar

doi:10.1016/j.jvir.2020.12.019

Cited by 48 publications

(45 citation statements)

References 16 publications

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“…Administering high doses of radiation to expendable volumes of liver, also known as radiation segmentectomy (two Couinaud segments or less) and lobectomy, has improved both the safety and efficacy of radioembolization. Radiopathologic Oncotarget 2 www.oncotarget.com analyses have supported improved pathologic necrosis rates when ablative doses are prescribed, of which 190 Gray (Gy) has shown to represent a minimal efficacy threshold [6,7]. Whether a similar dose relationship is present with cholangiocarcinoma remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Safety and initial efficacy of ablative radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma

et al. 2021

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Purpose: To investigate safety, response, and survival after ablative glass microsphere 90 Y radioembolization for unresectable intrahepatic cholangiocarcinoma. Materials and Methods: A retrospective review of 37 radioembolizations in 28 patients treated with single compartment dose of ≥190 Gy encompassing >75% of the largest tumor was performed. Tumors were assessed for stage, morphology, and arterial supply. Response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST), freedom from progression (FFP), progression-free survival (PFS), overall survival (OS), biochemical hepatic function, performance status, and adverse events were investigated.Results: The median highest dose per patient was 256.8 Gy (195.7-807.8). Objective response at 3 months was 94.1% (complete 44.1% and partial 50%). Median OS was not reached and the 30-month OS rate was 59%, with a median follow-up of 13.4 months (5.4-39.4). FFP in the radiated field and overall FFP at 30 months were 67% and 40%, respectively. Favorable arterial supply was associated with improved OS (p = 0.018). Unfavorable arterial supply was associated with worse OS [HR 5.7 (95% CI 1.1-28.9, p = 0.034)], and PFS [HR 5.9 (95% CI 1.9-18.4, p = 0.002)]. Patients with mass-forming tumors had a survival benefit (p = 0.002).Laboratory values and performance status did not significantly change 3 months after radioembolization. Grade 3 and 4 adverse events occurred in 2 (7.1%) patients. Conclusions: Radioembolization of unresectable intrahepatic cholangiocarcinomawith ablative intent has a high response rate, promising survival, and is well tolerated.

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Section: Introductionmentioning

confidence: 99%

Safety and initial efficacy of ablative radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma

et al. 2021

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“…Recent data have emerged in support of moving the ablative radioembolization dose nadir from >190 Gy to >400 Gy MIRD in light of increased pathologic necrosis. 11 , 27 Approximately half of the cohort in this study received a dose above 400 Gy MIRD. In this subset, a %LT threshold of 25% was significantly associated with class increase in baseline CP-B patients (vs 14.5% with a MIRD ≥190 Gy), which could be related to insufficient sample size and should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Biochemical Safety of Ablative Yttrium-90 Radioembolization for Hepatocellular Carcinoma as a Function of Percent Liver Treated

Ramos¹,

Overfield²,

Montazeri³

et al. 2021

JHC

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Purpose Transarterial radioembolization can serve as an ablative therapy for early-stage hepatocellular carcinoma (HCC). Given the volumetric variability of liver segments, this study aimed to characterize the safety of ablative radioembolization by determining percent liver treated (%LT) thresholds associated with biochemical toxicity. Patients and Methods Patients with HCC receiving a single ablative radioembolization treatment using glass microspheres from 2017 through 2020 were reviewed. %LT was calculated as treatment angiosome volume divided by whole liver volume. Biochemical toxicities were defined as increases in Albumin-Bilirubin (ALBI) grade or Child-Pugh (CP) class compared to baseline and albumin or bilirubin adverse events (AEs) per the Common Terminology Criteria for Adverse Events. Receiver operating characteristic curves and multivariate logistic regression analyses were performed to assess the impact of %LT on toxicities. Results Of 141 patients analyzed, 53% (n=75) were ALBI 1, 45% (n=64) ALBI 2, 79% (n=111) CP-A, and 21% (n=30) CP-B. A %LT ≥14.5% was associated with grade/class increases in ALBI 2 ( p ≤0.01) and CP-B patients ( p =0.026). In multivariate analysis, a %LT ≥14.5% was an independent predictor of increases in the ALBI 2 and CP-B groups ( p <0.01). No significant %LT threshold was found for ALBI 1 and CP-A patients. No grade 3/4 albumin or bilirubin AEs were reported, while grade 2 AEs were related to an initial whole liver volume <1.3 L ( p ≤0.01). Conclusion Patients with ALBI 2 and CP-B liver function are less likely to have an increase in their respective grade/class when treating <14.5% of the liver using glass microspheres. ALBI 1 and CP-A patients showed no definitive %LT threshold for biochemical toxicity within the range of this study.

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“…The unique physical features of carbon ions including their Bragg peak characteristics, narrow lateral penumbra, and steep dose gradients may serve as ideal attributes for HCC treatment wherein sparing even a low dose bath to the uninvolved liver could be advantageous when there is underlying liver dysfunction. 15 Similar conformality achieved with ablative TARE or “radiation segmentectomy” has demonstrated increased pathologic necrosis rates, 17–19 providing further justification for employing CIRT as a means to achieve conformality, high radiation doses to the tumor, and efficient sparing of the uninvolved liver. Hypothesizing that an increased tumor dose will translate into improved LC and, in turn, improved OS, one could conjecture that CIRT tumor control is superior to that of the photon and PBT.…”

Section: The Relevance Of Physical Properties Of Cirt In the Treatment Of Hccmentioning

confidence: 97%

“… 35 A multitude of photon and radioembolization trials demonstrated that LC was enhanced with the escalation of dose delivered to tumor and a similar correlation between RILD and mean radiation dose to “normal” liver. 17–19 , 26 , 36–38 …”

Section: Advantages Of Cirt In the Management Of Hccmentioning

confidence: 99%

Carbon Ion Radiotherapy in the Management of Hepatocellular Carcinoma

Abousaida

Seneviratne

Hoppe

et al. 2021

JHC

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Localized hepatocellular carcinoma (HCC) that is unresectable and non-transplantable can be treated by several liver-directed therapies. External beam radiation therapy (EBRT) is an increasingly accepted and widely utilized treatment modality in this setting. Accelerated charged particles such as proton beam therapy (PBT) and carbon ion radiation therapy (CIRT) offer technological advancements over conventional photon radiotherapy. In this review, we summarize the distinct advantages of CIRT use for HCC treatment, focusing on physical and biological attributes, and outline dosimetric and treatment planning caveats. Based on these considerations, we posit that HCC may be among the best indications for use of CIRT, as it allows for maximizing tumoricidal doses to the target volume while minimizing the dose to the organs at risk.

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Pathologic Response of Hepatocellular Carcinoma Treated with Yttrium-90 Glass Microsphere Radiation Segmentectomy Prior to Liver Transplantation: A Validation Study

Cited by 48 publications

References 16 publications

Safety and initial efficacy of ablative radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma

Safety and initial efficacy of ablative radioembolization for the treatment of unresectable intrahepatic cholangiocarcinoma

Biochemical Safety of Ablative Yttrium-90 Radioembolization for Hepatocellular Carcinoma as a Function of Percent Liver Treated

Carbon Ion Radiotherapy in the Management of Hepatocellular Carcinoma

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