Transarterial Radioembolization with Yttrium-90 for the Treatment of Hepatocellular Carcinoma

Kallini, Joseph R.; Gabr, Ahmed; Salem, Riad; Lewandowski, Robert J.

doi:10.1007/s12325-016-0324-7

Cited by 135 publications

(106 citation statements)

References 66 publications

(80 reference statements)

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“…A cost-benefit analysis demonstrated that TACE is billed at $17,000 versus $31,000 or $48,000 for unilobar or bilobar TARE, respectively. 8,9 CUrrenT DaTa On Tare are liMiTeD, anD FUrTHer sTUDies are neeDeD TO BeTTer DeFine iTs rOle in THe TreaTMenT OF HCC There are unique circumstances when TARE may be preferred over TACE (e.g., the presence of portal vein thrombosis or the need to induce hypertrophy of unaffected segments prior to surgical resection). 8,10 However, without more robust data, TARE cannot be uniformly endorsed.…”

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confidence: 99%

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

et al. 2016

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Transarterial chemoembolization (TACE) using lipiodol-based regimens, including the administration of an anticancer-in-oil emulsion followed by embolic agents, is widely used in the treatment of hepatocellular carcinoma (HCC). This approach has been supported by meta-analyses of randomized, controlled trials (RCTs) performed more than a decade ago. We performed a systematic review to understand current efficacy and safety data of lipiodol TACE in treatment of HCC. A search of the literature published between January 1, 1980 and June 30, 2013 was performed using MEDLINE and EMBASE databases. All potentially relevant publications were reviewed and articles were selected based on predefined inclusion and exclusion criteria. Of a total of 1,564 articles reviewed, 101 articles, including a total of 10,108 patients treated with lipiodol TACE, were selected for the efficacy analysis. Objective response rate was 52.5% (95% confidence interval [CI]: 43.6-61.5). Overall survival (OS) was 70.3% at 1 year, 51.8% at 2 years, 40.4% at 3 years, and 32.4% at 5 years. Median OS was 19.4 months (95% CI: 16.2-22.6). A total of 217 articles presenting precise description on numbers of adverse events (AEs) were selected for the safety review: In these studies, a total of 21,461 AEs were reported in 15,351 patients. Liver enzyme abnormalities were the most commonly observed AE, followed by the symptoms associated with postembolization syndrome. Overall mortality rate was 0.6% and the most common cause of death was related to acute liver insufficiency. Conclusions: In a systematic literature review, survival figures of HCC patients undergoing lipiodol TACE appear to be in line with those reported in previous RCTs, and no new or unexpected safety concerns were identified. (HEPATOLOGY 2016;64:106-116) SEE EDITORIAL ON PAGE 23H epatocellular carcinoma (HCC) is the thirdleading cause of cancer-related death worldwide. (1) Unlike most solid cancers, future incidence and mortality rates for HCC were projected to largely increase in several regions around the world over the next several years, mostly as a result of the dissemination of hepatitis C virus infection. (2,3) Despite the widespread implementation of surveillance programs of at-risk populations, the majority of patients with HCC are diagnosed late, when curative treatments-including liver transplantation, hepatic resection, and image-guided ablation-cannot be applied. (4) Transarterial chemoembolization (TACE) is widely used in treatment of HCC patients unsuitable for radical therapies. The data collected in the Global Investigation of therapeutic DEcisions in hepatocellular

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confidence: 99%

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

et al. 2016

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“…Automated image analysis may reduce errors from manual analysis (2)(3)(4). Specifically, in abdominal imaging, liver segmentation has multiple direct potential clinical applications, including automated liver volume measurement, which is an important prognostic metric for hepatic surgical procedures (5)(6)(7)(8)(9), and determination of radiation dose in liver tumor radioembolization (10). Other emerging applications include quantification of proton density fat fraction (PDFF) from multiecho MRI examinations to assist in the diagnosis and management of nonalcoholic fatty liver disease (NAFLD) and assessment of liver morphology to assist in the detection of liver cirrhosis (11,12).…”

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confidence: 99%

Automated CT and MRI Liver Segmentation and Biometry Using a Generalized Convolutional Neural Network

Wang¹,

Mamidipalli²,

Retson³

et al. 2019

Radiology: Artificial Intelligence

105

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To assess feasibility of training a convolutional neural network (CNN) to automate liver segmentation across different imaging modalities and techniques used in clinical practice and to apply this technique to enable automation of liver biometry. Materials and Methods: A two-dimensional U-Net CNN was trained for liver segmentation in two stages by using 330 abdominal MRI and CT examinations. First, the neural network was trained with unenhanced multiecho spoiled gradient-echo images from 300 MRI examinations to yield multiple signal weightings. Then, transfer learning was used to generalize the CNN with additional images from 30 contrast material-enhanced MRI and CT examinations. Performance of the CNN was assessed by using a distinct multiinstitutional dataset curated from multiple sources (498 subjects). Segmentation accuracy was evaluated by computing Dice scores. These segmentations were used to compute liver volume from CT and T1-weighted MRI examinations and to estimate hepatic proton density fat fraction (PDFF) from multiecho T2*-weighted MRI examinations. Quantitative volumetry and PDFF estimates were compared between automated and manual segmentation by using Pearson correlation and Bland-Altman statistics. Results: Dice scores were 0.94 ± 0.06 for CT (n = 230), 0.95 ± 0.03 (n = 100) for T1-weighted MRI, and 0.92 ± 0.05 for T2*weighted MRI (n = 168). Liver volume measured with manual and automated segmentation agreed closely for CT (95% limits of agreement: −298 mL, 180 mL) and T1-weighted MRI (95% limits of agreement: −358 mL, 180 mL). Hepatic PDFF measured by the two segmentations also agreed closely (95% limits of agreement: −0.62%, 0.80%). Conclusion: By using a transfer-learning strategy, this study has demonstrated the feasibility of a CNN to be generalized to perform liver segmentation across different imaging techniques and modalities. With further refinement and validation, CNNs may have broad applicability for multimodal liver volumetry and hepatic tissue characterization.

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“…TARE-Y90 was well tolerated ( Table 2) TARE-Y90 is commonly utilized in adult patients with unresectable primary or secondary liver malignancies, and has been shown to be superior to transarterial chemoembolization in terms of time-toprogression of disease, toxicity profile, and posttreatment quality of life in adults with hepatocellular carcinoma. 15 In the adult population, TARE-Y90 has led to improved survival and has been used for downstaging patients prior to liver transplantation. [16][17][18] It is accepted treatment in the National Comprehensive Cancer Network guidelines for hepatobiliary cancer 19 and neuroendocrine tumors.…”

Section: Diagnoses Are Presented Inmentioning

confidence: 99%

Transarterial radioembolization with yttrium‐90 of unresectable primary hepatic malignancy in children

Aguado

Ristagno

Towbin

et al. 2018

Pediatric Blood & Cancer

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Background Primary malignant liver tumors are rare, accounting for 1% to 2% of all childhood cancers. When chemotherapy fails, transarterial radioembolization with yttrium‐90 (TARE‐Y90) may offer an alternative therapy as a bridge to surgical resection or liver transplant or for palliation. Methods We conducted a retrospective review of 10 pediatric patients with histologically confirmed primary liver malignancy who received treatment with TARE‐Y90. Results The median age at treatment was 5.5 years (range, 2–18 years). Median patient survival from initial diagnosis was 12.5 months (range, 10–28 months), and median patient survival after TARE‐Y90 was 4 months (range, 2–20 months). Retreatment was well tolerated in three of 10 patients, with these patients demonstrating the longest survival times (range, 17–20 months). One patient was transplanted 6 weeks after TARE‐Y90. By RECIST 1.1 criteria of all target lesions, eight of nine patients had stable disease, and one of nine had progressive disease. By mRECIST criteria (requiring postcontrast arterial phase imaging), two of seven patients had a partial response, four of seven had stable disease, and one of seven had progressive disease. Conclusion TARE‐Y90 of unresectable primary liver malignancy is both technically feasible and demonstrates an anticancer effect, and retreatment is well tolerated. TARE‐Y90 could be considered as adjunctive therapy in pediatric patients with unresectable hepatic malignancies and could be used as a bridge to surgical resection or liver transplant. More research is required to determine the efficacy of this treatment in children and to define the clinical scenarios where benefit is likely to be optimized.

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Transarterial Radioembolization with Yttrium-90 for the Treatment of Hepatocellular Carcinoma

Cited by 135 publications

References 66 publications

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data

Automated CT and MRI Liver Segmentation and Biometry Using a Generalized Convolutional Neural Network

Transarterial radioembolization with yttrium‐90 of unresectable primary hepatic malignancy in children

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