SIR 2024
Interventional Oncology
Leah Bowen, MD, PhD
Resident
Saint Joseph Hospital General Surgery Residency
Financial relationships: Full list of relationships is listed on the CME information page.
Katherine Marchak, MD (she/her/hers)
Interventional Radiologist
University of Colorado Health System
Disclosure information not submitted.
Jonathan Lindquist, MD
Interim Vice Chair, Quality & Patient Safety and Clinical Operations
University of Colorado Department of Radiology
Financial relationships: Full list of relationships is listed on the CME information page.
Premal Trivedi, MD, MS
Associate Professor, Interventional Radiology
University of Colorado Anschutz Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Leigh Casadaban, MD, MS
Assistant Professor
University of Colorado
Financial relationships: Full list of relationships is listed on the CME information page.
To evaluate outcomes of Yttrium-90 radioembolization (RE) for large hepatocellular carcinoma (HCC) or cholangiocarcinoma at a single center.
Materials and methods:
Patients receiving RE at a single center from 2019 to 2021 were retrospectively reviewed. Inclusion criteria included HCC or intrahepatic cholangiocarcinoma greater than >8cm in largest dimension without extrahepatic disease and tumor sparing at least one lobe or both the lateral and posterior segments. Radiation dosimetry was calculated using a single compartment model. Patients with multiple treatment administrations and/or treatment modalities were included. Tumor response was determined according to mRECIST criteria. Overall survival and progression-free survival were calculated with reference to the date of first radioembolization to the target tumor. Adverse events were assessed using CTCAE v5.0. Patients were followed for at least 1 year post RE.
Results:
15 patients (10 males, 5 females) met inclusion criteria. Median age was 68 years. All patients were Child-Pugh Class A except one Class B7 patient. All patients were outside Milan Criteria with performance status 0-2, and therefore were BCLC Class C. All patients had HCC except one patient with cholangiocarcinoma. Median tumor size was 9.6 cm (range 8.1-12.4 cm). 7/15 (47%) had portal vein invasion. 6 patients required subsequent RE or transarterial chemoembolization (TACE). Median perfused liver dose was 242 Gy (range 110-523) given to a median perfused volume of 800cc (range 339-1413cc). Accounting for boost doses, the median index tumor dose was 400 Gy (range 130-1650 Gy). Time to best response occurred on average 2.5 months after treatment with objective response (OR) rate 11/15 (73%). In 8/15 (53%) patients with perfused liver absorbed dose >200 Gy, OR was achieved in 7/8 (88%). This included 4 with complete response and 3 with partial response. 4 of these 8 (50%) went on to hepatectomy. In 7/15 (47%) who received < 200 Gy to the perfused liver, 4/7 (57%) achieved OR. Only grade 1 and 2 adverse events occurred. Median overall survival was 14.4 months and median progression-free survival (PFS) was 5.5 months. Adjuvant or neoadjuvant systemic therapy correlated with increased PFS (median = 11.7 months) compared to patients who did not receive systemic therapy (median = 5.1 months).
Conclusion:
RE of HCC or cholangiocarcinoma >8 cm is safe and effective in selected patients. A perfused liver dose >200 Gy can achieve high response rates with no major adverse events and can bridge to hepatectomy. The addition of systemic therapy may also improve PFS.