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SIR 2025

Interventional Oncology

Traditional Poster

Session: Traditional Poster Presentations

54 - Procedural Predictors of Complete Pathologic Necrosis after Yttrium-90 Trans-Arterial Radioembolization for Hepatocellular Carcinoma

Monday, March 31, 2025
12:10 PM – 1:10 PM CT
Location: Music City Center, Expo Poster Area
Purpose: Achieving complete pathologic necrosis (CPN) has been associated with improved oncologic outcomes. Yittrium-90 (Y-90) radioembolization has demonstrated promising results in achieving CPN. However, several technical considerations, such as the optimal dose or quantity of microspheres per injection, remain unclear.

Materials and Methods: Retrospective review of individuals who underwent Y-90 radioembolization for HCC prior to liver transplantation at a large volume academic medical center (2014-2023). Relevant clinical and demographic data were extracted from electronic medical records, including alpha-fetoprotein (AFP), Child-Pugh (CP) score, lesion size, injection location, microsphere number, dose delivered, and pathologic outcome. Univariate and multivariate analyses were conducted to assess associations between these variables and the extent of pathologic necrosis, employing binary classification for each predictor variable.

Results: Overall, 104 lesions in 77 patients treated with Y-90 radioembolization using a single vessel injection were included. Overall – mean lesion size was 2.340 cm, median vial ordered was 6.5 GBq, median particle number was 2.6x10^6, and mean dose measured by cone-beam CT (CBCT) was 557.57 Gy. Lesions achieving CPN had smaller lesion size (2.23cm vs. 2.98 cm, p=0.042), greater proportion of selective injection (89.9% vs. 64.7%, p=0.019), and fewer number of microspheres (2.82x10^6 vs. 4.07x10^6, p=0.039). Multivariate analysis yielded lesion size < 3 cm (Odds Ratio (OR) 5.472 95% CI [1.544, 19.400], p=0.008) and dose measured by CBCT > 400Gy (OR 4.246 [1.060, 17.001], p=0.041) as independent predictors for achieving CPN.

Conclusion: Higher doses ( >400Gy) to the treated segment and smaller tumor size (< 3 cm) were predictors of CPN. The number of microspheres used was not predictive of CPN.