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SIR 2025

Interventional Oncology

Scientific Session

Session: Interventional Oncology - Y90 3

Radiation Segmentectomy for Oligometastatic and Oligoprogressive Hepatic Metastases: Single Institutional Outcomes over 10 Years

Wednesday, April 2, 2025
11:24 AM – 11:33 AM CT
Location: Music City Center, 209 ABC
Purpose: To evaluate patient outcomes and safety after radiation segmentectomy (RS) in patients with oligometastatic and oligoprogressive hepatic metastases. 

Materials and Methods: IRB-approved, single center, retrospective study of 41 adult patients (51% male) with mean age of 64 (±12.5) years who underwent a total of 44 RS for hepatic metastatic disease between 1/2014 and 12/2023. Past medical and oncological history, intraprocedural details, pre- and post-procedure labs, and hepatic-specific progression-free and overall survival were collected. Adverse events within 30 days were graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5. Progression-free survival (PFS) was determined using RECIST, mRECIST, and/or PERCIST criteria and evaluated using Kaplan Meier survival curves.

Results: Colorectal carcinoma was the most common primary malignancy (17/41, 41.5%). Prior to the index RS, 14 (34.1%) patients had prior liver-directed or ablative therapies and 9 (22.0%) had surgical resection in addition to chemotherapy. Median largest tumor dimension was 4.5 (IQR: 2.5) cm. TheraSphere (Boston Scientific, Marlborough, MA) was the predominant microsphere utilized for RS (43/44, 97.7%). Median radiation dose to target segment was 153.5 (IQR: 95.0) Gray. Arterial access complications occurred in two procedures (2/88, 2.3%), one required placement of a covered endograft in the external iliac artery. Post-embolization syndrome (PES) developed after 33 (75.0%) of RS procedures, one required overnight admission. Fatigue persisted after one week in 5 (11.4%) cases. Laboratory toxicities in the first month occurred after 23 (52.3%) RS, majority of which were grade 1-2 toxicities (19/23, 82.6%). No non-target complications were seen. One (2.3%) patient developed a post-RS right-sided pleural effusion that may have been reactive or secondary to known heart failure.  Complete response of the target hepatic lesion(s) occurred in 14 (14/38, 36.8%), p</span>artial response in 7 (15.9%), and stable disease in 2 (4.5%) patients.  Mean PFS was 19.7 (95% CI: 14.5-25.0) months. Three patients (3/41, 7.3%) did not receive follow-up imaging due to transitioning to hospice care; three patients with progression of the target hepatic lesion(s) underwent a second RS within the study period. Overall mean survival from index RS was 21.2 (95% CI: 15.5-26.9) months.

Conclusion: In this heavily pre-treated population, radiation segmentectomy resulted in high rates of local tumor control with relatively low rates of clinically significant post-procedure complications, PES, and toxicities.