50 - Optimizing Yttrium-90 Radioembolization in Complex Liver Tumors: Impact of Dose Escalation and Selective Flow Diversion on Tumor Control and Progression-Free Survival

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

Hunter Colson

Medical Student
University of Kentucky College of Medicine, United States

Author/Co-author(s)

Andrew Shabila, MD

Assistant Professor of Radiology. Assistant Program Director
University of Kentucky, United States
HA

Haseeb Ahmad, BS

Medical Student
University of Kentucky, United States
EE

Elias El-haddad, MD

Fellow, Division of Vascular and Interventional Radiology
UK Healthcare - Department of Radiology, United States
LA

Luis F. Acosta, MD

Assistant Professor of Radiology
University of Kentucky, United States
Gaby E. Gabriel, MD, FSIR

Program Director, Interventional Radiology Residency
University of Kentucky Department of Radiology, United States
Driss Raissi, MD, FSIR, MBA

Chief, Division of Vascular and Interventional Radiology
University of Kentucky, United States

Purpose: This study aims to evaluate the impact of Yttrium-90 (Y-90) dose escalation, selective flow diversion, and tumor location on treatment response and progression-free survival (PFS) in patients with hepatocellular carcinoma (HCC) and metastatic liver tumors. It investigates how tailored dosing and flow manipulation techniques improve tumor control and reduce recurrence in complex anatomical cases.

Materials and Methods: A retrospective analysis was performed on patients treated with Y-90 radioembolization across various liver segments (e.g., Segments 7, 8, right hepatic lobe). Data on Y-90 dose (mCi/Gray), flow diversion or redistribution, prior interventions (TACE, MWA), and tumor response (complete, partial, progressive) were analyzed. PFS and time to progression were calculated using mRECIST criteria, and the correlation between segmental location, dosing strategies, and tumor control was examined.

Results: Patients receiving higher Y-90 doses (≥100 mCi) and flow diversion exhibited significantly improved outcomes, with 60% achieving complete responses and extended PFS. Tumors in Segments 7 and 8 required dual flow diversion due to complex vascular anatomy. Flow redistribution improved PFS compared to treatments without diversion, while lower doses ( < 80 mCi) or absence of flow diversion led to partial responses and earlier progression. Prior treatments influenced microsphere distribution, sometimes necessitating repeat treatments. Importantly, no significant cases of radiation-induced liver disease (RILD) were reported, supporting the safety of higher-dose strategies with flow diversion.

Conclusion: Higher Y-90 doses combined with selective flow diversion play a critical role for achieving complete tumor responses and prolonged PFS, particularly in patients with complex hepatic vasculature. This strategy is especially effective in treating large or poorly perfused liver tumors. Future treatment protocols should emphasize individualized dosing and flow diversion based on tumor characteristics and prior treatment history to optimize patient outcomes in Y-90 radioembolization.