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Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort

  • Arighno Das
  • Ahsun Riaz
  • Ahmed Gabr
  • Rehan Ali
  • Ronald Mora
  • Ali Al Asadi
  • Samdeep Mouli
  • Robert J. Lewandowski
  • Riad SalemEmail author
Original Article
Part of the following topical collections:
  1. Oncology – Digestive tract

Abstract

Background

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%.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Hepatocellular carcinoma (HCC) Lung shunt fraction (LSF) TARE Radioembolization 

Notes

Author contributions

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.

Ethical approval

This retrospective study was approved by our institutional review board and the requirement to obtain informed consent was waived.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, Section of Interventional RadiologyNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of Surgery, Division of Transplant SurgeryNorthwestern UniversityChicagoUSA
  3. 3.Department of Medicine, Division of OncologyNorthwestern UniversityChicagoUSA

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