Radiation Segmentectomy and Combined ChemoembolizatIon plus Thermoablation Result in Equivalent Histopathologic Tumor Necrosis in Hepatocellular Carcinoma: A Single Institution Analysis of Patients Bridged to Liver Transplant

Sunday, March 30, 2025

3:45 PM – 3:54 PM CT

Location: Music City Center, 207 CD

Presenting Author(s)

Qian Yu, MD (he/him/his)

Resident
University of Chicago, United States

Author/Co-author(s)

DK

Daniel Kwak, MD, PhD

Radiology Resident
University of Chicago, United States
Divya Kumari, MD

Assistant Professor
University of Chicago Hospitals, United States
Mikin V. Patel, MD

Assistant Professor of Radiology
Department of Radiology, University of Chicago, United States
Steven Zangan, MD

Associate Professor
University of Chicago, United States
Rakesh C. Navuluri, MD, FSIR

Associate Professor
University of Chicago, United States
Osman Ahmed, MD, FSIR

Associate Professor of Radiology
University of Chicago, United States
HT

Helen Te, MD

Professor
University of Chicago, United States
Thuong G. Van Ha, MD, FSIR

Professor
The University of Chicago, United States

Purpose:

Radiation segmentectomy using yttrium-90 (RS) and combined transarterial chemoembolization plus thermoablation (TACE-ablate) are both commonly used locoregional treatments for hepatocellular carcinoma (HCC). This study aims to compare the effectiveness of these approaches by evaluating tumor necrosis on liver explants from patients who were bridged to transplant

Materials and Methods:

A retrospective review at a single institution was performed from October 2010 to February 2024, including consecutive patients who underwent either TACE-ablate or RS for treatment-naive HCC lesions up to 5 cm, followed by liver transplantation. All treatments and transplants were performed at the same institution, with no crossover between treatments. TACE and ablation were performed sequentially during the same admission. RS was defined as delivering a target dose of greater than 200 Gy to fewer than two segments, with or without a lobar boost dose. Tumor necrosis was assessed on liver explants, with complete pathologic necrosis (CPN) defined as 100% tumor necrosis.

Results:

A total of 40 tumors from 25 patients were treated by TACE-ablation; 40 tumors from 27 patients underwent RS. The mean segmental dose in the RS group was 284.5 ± 67.1 Gy. Tumor sizes were comparable between the TACE-ablate and RS groups (mean: 2.1 ± 0.9 cm vs. 2.4 ± 0.9 cm), and the mean time from initial treatment to transplant was 362.9 ± 324.4 days vs. 266.2 ± 133.8 days (p=0.0854). No significant difference was observed in the percentage of tumor necrosis between the two groups (mean: 79 ± 29.0% vs. 83.8 ± 29.6%, p=0.441). The rate of CPN was also similar (mean: 45% vs. 60%, p=0.179). For tumors ≤3 cm, the percentage of pathologic necrosis was 78.9 ± 30.9% for TACE-ablate and 87.3 ± 28.2% for RS (p=0.246), and the mean rates of CPN were 51.4% and 72.7%, respectively (p=0.071).

Conclusion: TACE-ablation and RS were equivalent in achieving tumor necrosis among patients bridged to liver transplant, as assessed from liver explants.