Resin Versus Glass Microspheres for ⁹⁰Y Transarterial Radioembolization: Comparing Survival in Unresectable Hepatocellular Carcinoma Using Pretreatment Partition Model Dosimetry

Abstract

The aim of this study was to compare survival of patients treated for unresectable hepatocellular carcinoma (uHCC) with 90 Y transarterial radioembolization (TARE) using pretreatment partition model dosimetry (PMD). Methods: We performed a retrospective analysis of prospectively collected data on 77 patients consecutively treated (mean age 6 SD, 66.4 6 12.2 y) for uHCC (36 uninodular, 5 multinodular, 36 diffuse) with 90 Y TARE (41 resin, 36 glass) using pretreatment PMD. Study endpoints were progression-free survival (PFS) and overall survival (OS) assessed by Kaplan-Meier estimates. Several variables including Barcelona Clinic Liver Cancer (BCLC) staging system, tumor size, and serum a-fetoprotein (AFP) level were investigated using Cox proportional hazards regression. Results: The characteristics of 2 groups were comparable with regard to demographic data, comorbidities, Child-Pugh score, BCLC, serum AFP level, and 90 Y global administered activity. The median follow-up time was 7.7 mo (range, 0.4-50.1 mo). Relapse occurred in 44 patients (57%) at a median of 6 mo (range, 0.4-27.9 mo) after 90 Y TARE, and 41 patients (53%) died from tumor progression. Comparison between resin and glass microspheres revealed higher but not statistically significantly PFS and OS rates in the 90 Y resin group than the 90 Y glass group (resin PFS 6.1 mo [95% confidence interval CI, 4.7-7.4] and glass PFS 5 mo [95% CI, 0.9-9.2], P 5 0.53; resin OS 7.7 mo [95% CI, 7.2-8.2] and glass OS 7 mo [95% CI 1.6-12.4], P 5 0.77). No significant survival difference between both types of 90 Y microspheres was observed in any subgroups of patients with early/intermediate or advanced BCLC stages. Among the variables investigated, Cox analyses showed that only in the glass group, the BCLC staging system and the serum AFP level were associated with PFS (P 5 0.04) and OS (P 5 0.04). Tumor size was a prognostic factor without significant influence on PFS and OS after 90 Y TARE. Conclusion: Comparison between resin and glass microspheres revealed no significant survival difference in patients treated for uHCC with 90 Y TARE using pretreatment PMD. Further, larger prospective studies are warranted to confirm these findings.

Contralateral Liver Hypertrophy and Oncological Outcome Following Radioembolization with 90Y-Microspheres: A Systematic Review

“…Despite the need for larger injection volumes and subsequent higher microembolic effects for resin-based spheres due to lower relative activity, no difference has been noted thus far in clinical response [41]. Of note, RE by microspheres does not result in macrovascular embolization; thus, the hypertrophy of the liver is probably induced by radiation effects [14,21,42].…”

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

“…A recent report suggested that the prescribed radiation activity might be significantly lower for resin than for glass microspheres, which may in part result from their different specific activities [31, 32]. However, this difference in activity does not appear to lead to a significant survival difference between the two types of treatment [33]. Postprocedural planar, SPECT, or SPECT/CT imaging with the broad-spectrum bremsstrahlung radiation is done to confirm proper localization of the therapeutic activity in the intended hepatic region.…”

Signature of survival: a 18F-FDG PET based whole-liver radiomic analysis predicts survival after 90Y-TARE for hepatocellular carcinoma

“…The 90 Y-TARE planning and procedure was made as previously described [ 34 ]. Briefly, before 90 Y-TARE, all patients underwent a pretherapy SPECT/CT with intra-arterial administration of 120–180 MBq of 99m Tc-MAA.…”

“…In many of these factors, imaging is essential and therefore plays an important role in the management. Multiple studies have shown a correlation between standardized uptake value (SUV) of HCC on 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) and outcomes following different systemic and locoregional treatments [ 6 – 16 ], including more recently transarterial radioembolization with Yttrium-90 ( 90 Y-TARE) [ 17 – 19 ].…”