ISRA May 2022

Transarterial Radioembolization Using Yttrium-90 as a Treatment Option for Hepatocellular Carcinoma Patients – Our experience

Samuel Francis 1 Amit Talmon 2 Daniel Raskin 2 Uri Rimon 2 Gil Golan 2
1Ben-Gurion University of the Negev, Medical School for International Health, Israel
2Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel

Purpose: Transarterial radioembolization (TARE) with Yttrium-90 (Y90) is a recognized treatment option for hepatocellular carcinoma (HCC) and has been shown to be effective in prolonging survival. Our goal was to assess the effectiveness of treatment at our institution.

Methods: This retrospective study included patients who underwent TARE for HCC at Sheba Medical Center between the years 2017-21. Patients were selected for treatment by the center’s multidisciplinary liver tumor board.

After selection, patients underwent a routine paradigm consisting of pretreatment with low dose radionuclide angiography (99mTcMAA), followed by single positron emission computer tomography (SPECT-CT) to assess pulmonary, gastric, and other shunting. Dosimetry was gauged based on tumor volume and radioembolization was performed with Y90 glass microspheres.

Treatment response was assessed by magnetic resonance imaging (MRI) four months post-treatment.

Patients were followed up for 40 months for mortality and response to treatment. Partial response was considered as reduction of at least 30% in the sum of target lesion diameters. Complete response was considered as the disappearance of any intratumoral arterial enhancement in all target lesions. Kaplan-Meier analysis was used to calculate survival time.

Results: Twenty-eight patients, average age 72 (range 40-86, 15 males), were included in the study. Two patients underwent pretreatment assessment and were found unfit for TARE treatment.

Median post-treatment survival time was 2 months (95% CI: 13.5-18.9), with cumulative 1, 2, and 3-year survival rates being 79%, 40%, and 26%, respectively. Twenty-five patients presented for follow up, of which 11 (36.7%) showed partial response and 7 (23.3%) showed complete response.

Conclusions: The results showed survival benefit comparable to recent studies at other institutions and support TARE as a good treatment option for select HCC patients.