Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort
Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%.
With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90.
A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient.
Y90 can be performed in patients with LSF > 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF > 15% should not deter from treatment with Y90.
KeywordsHepatocellular carcinoma (HCC) Lung shunt fraction (LSF) TARE Radioembolization
Study concept and design: Arighno Das, Rehan Ali, Ahmed Gabr, Ronald Mora, Ali Al Asadi, Samdeep Mouli, Robert Lewandowski, Riad Salem, Ahsun Riaz
Acquisition of data: Arighno Das, Rehan Ali, Ahmed Gabr, Ronald Mora, Ali Al Asadi, Samdeep Mouli, Robert Lewandowski, Riad Salem, Ahsun Riaz
Analysis and interpretation of data: Arighno Das, Rehan Ali, Ahmed Gabr, Ronald Mora, Samdeep Mouli, Robert Lewandowski, Riad Salem, Ahsun Riaz
Drafting of the manuscript: Arighno Das, Rehan Ali, Ahmed Gabr, Ronald Mora, Ali Al Asadi, Samdeep Mouli, Robert Lewandowski, Riad Salem, Ahsun Riaz
Critical revision of the manuscript for important intellectual content: all authors
Statistical analysis: Arighno Das, Rehan Ali, Ahmed Gabr, Ronald Mora, Samdeep Mouli, Robert Lewandowski, Riad Salem, Ahsun Riaz
Administrative, technical, or material support: all authors
Study supervision: Arighno Das, Rehan Ali, Ahmed Gabr, Ronald Mora, Samdeep Mouli, Robert Lewandowski, Riad Salem, Ahsun Riaz
Compliance with ethical standards
Conflict of interest
AR, RL, and RS are advisors to BTG. None of the other authors have a conflict of interest.
This retrospective study was approved by our institutional review board and the requirement to obtain informed consent was waived.
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