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.
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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
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AR, RL, and RS are advisors to BTG. None of the other authors have a conflict of interest.
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This retrospective study was approved by our institutional review board and the requirement to obtain informed consent was waived.
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This article is part of the Topical Collection on Oncology – Digestive tract
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Das, A., Riaz, A., Gabr, A. et al. Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort. Eur J Nucl Med Mol Imaging 47, 807–815 (2020). https://doi.org/10.1007/s00259-019-04517-y
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DOI: https://doi.org/10.1007/s00259-019-04517-y