Efficacy of Ablative Y90 Radioembolization in HCC with Limited Vascular Invasion

Sunday, March 30, 2025

3:09 PM – 3:18 PM CT

Location: Music City Center, 207 CD

Presenting Author(s)

Grace Laidlaw, MD, MS (she/her/hers)

Assistant Professor
University of Washington, United States

Author/Co-author(s)

CH

Charles Hua, MD

Assistant Professor
University of Washington, United States
JJ

James Jeffries, MD

Assistant Professor
University of Washington, United States
AS

Avik Som, MD, PhD

Assistant Professor
University of Washington, United States
Guy Johnson, MD

Associate Professor
University of Washington Medical Center, United States

Purpose: Ablative yttrium-90 (Y90) transarterial radioembolization (TARE) is an effective treatment modality for solitary hepatocellular carcinoma (HCC). However, ablative TARE outcomes in patients with HCC with portal vein tumor thrombus (PVTT) remain incompletely characterized. This retrospective study aimed to assess outcomes in patients undergoing ablative Y90 TARE for treatment of locally advanced HCC with limited vascular invasion (LVI).

Materials and Methods: Patients with Child Pugh A-B7 cirrhosis and HCC with PVTT in a VP1-VP2 distribution undergoing TARE from 2019-2024 at a single institution were retrospectively identified. Patients treated in combination with systemic therapies were excluded. Demographic, clinical, and treatment variables were collected, including age, gender, tumor distribution, PVTT distribution, etiology of cirrhosis, laboratory values, Child-Pugh status, functional status, Y90 treatment dose, and length of follow-up. The primary outcome was local tumor response by mRECIST. Secondary outcomes included adverse events, overall progression, need for additional treatments, and overall survival.

Results: Between 2019-2024, 20 patients (70±8.1 years old, 65% male, 95.0% Child-Pugh A, and 85% ECOG 0) underwent initial treatment with 24 Y90 activities for treatment of HCC with LVI. 55% (n=11) patients had VP1 disease; 45% (n=9) had VP2 disease. Mean tumor dose was 882.8±309.2 Gy. Mean follow-up was 34.1±37.9 months. Local objective response rates were 100%, with 85.0% (n=17) and 15.0% (n=3) demonstrating local complete or partial response, respectively. There were no CTCAE Grade 3 complications; 5% (n=1) of patients developed Grade 1 hypoalbuminemia, and 15.0% (n=3) developed Grade 2 hyperbilirubinemia or ascites. 60% (n=12) of patients developed disease progression outside of the target tumor; 45% of patients (n=9) developed intrahepatic progression, and 15% (n=3) developed extrahepatic progression. 50.0% (n=10) of patients required additional therapies, including catheter-based therapy in 40% (n=8) and systemic therapy in 20% (n=4). 25% (n=5) of patients died during follow-up, with mean time to death 13.5±15.3 months from initial treatment.

Conclusion: Ablative Y90 TARE alone is a safe and effective treatment modality for locally advanced VP1-VP2 HCC , with a high rate of target tumor complete response and limited adverse event profile. Despite high local response rates, separate intrahepatic or extrahepatic progression requiring additional therapies is likely.