70 - Utility of Alpha-Fetoprotein (AFP) monitoring after Y-90 radioembolization of hepatocellular carcinoma in non-AFP producers

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

JK

Joseph Kus, MD

Interventional Radiology Resident
University of Pennsylvania, United States

Author/Co-author(s)

Gregory J. Nadolski, MD

MD
Hospital of the University of PA, United States
SH

Stephen J. Hunt, MD, PhD, FSIR (he/him/his)

Associate Professor
University of Pennsylvania, United States
TG

Terence P.F. P. Gade, MD, PhD

Assistant Professor of Radiology
Department of Radiology, Hospital of the University of Pennsylvania, United States
JM

Jeffrey Mondschein, MD

Associate Professor of Clinical Radiology
University of Pennsylvania, United States
SR

Shilpa Reddy, MD

Assistant Professor of Radiology
University of Pennsylvania, United States
SS

Susan Shamimi-Noori, MD

Program Director
University of Pennsylvania, United States
Michael C. Soulen, MD

Professor
Abramson Cancer Center, University of Pennsylvania, United States
Daniel M. DePietro, MD

Assistant Professor
University of Pennsylvania, United States

Purpose: AFP level monitoring after Y-90 transarterial radioembolization (TARE) of hepatocellular carcinoma (HCC) is a common clinical practice. Post-TARE AFP monitoring may be performed in the subset of HCC patients who do not produce AFP (< 20 ng/mL), but its utility is unclear. This study assesses AFP levels during the 6-month post-TARE period in non-AFP producers and evaluates whether this changed clinical management.  

Materials and Methods: 54 patients (43 male: 11 female, mean age 69.7 ± 9.1 years) with non-AFP producing HCC (AFP < 20 ng/mL pre-TARE) who underwent TARE between 2022 and 2024 were identified using a QA database. Patients had follow-up with AFP level at 1, 3, and 6 months and imaging at 3 and 6 months. Data regarding demographics, tumor characteristics, treatment, AFP level, and outcomes were analyzed.  

Results: 49 patients (90%) were cirrhotic (16 HCV, 30%; 15 EtOH, 28%; 13 NASH, 24%; 5 other, 10%). 94% (n=51) were classified as Child Pugh A and 6% (n=3) were Child Pugh B. The largest lesion in the treated area had a mean size of 3.2 ± 2.4 cm. AFP levels at 1, 3, and 6-month follow-up (FU) are reported in the table for all patients and those with increased or decreased AFP at 1-month FU. Compared to baseline, AFP at 1-month FU demonstrated a median percent change (MPC) of +55% (range -83% to +8742%). In those with increased AFP at 1-month FU, median AFP decreased by 3-month FU, with MPC of -25% (range -68% to +243%) between 1-month and 3-month FU, and decreased further (to near baseline) at 6-month FU. While 83% (n=45) of patients demonstrated increased AFP at 1 month FU, only 9% (n=5) had AFP increase to >20. Increased AFP at 1-month FU triggered restaging imaging in 1 patient (2%) whose AFP rose from 1.9 to 168 (8742%), which demonstrated a partially viable lesion without progression or metastatic disease. Follow up was resumed at the regular interval.

Conclusion: The majority of non-AFP producers demonstrate a transient increase in AFP level 1-month post-TARE, which downtrended to near baseline pre-TARE levels by 6-month FU. This transient increase rarely triggered a change in management, and when it did there was no new or worsening disease identified. These results question the utility of early AFP level monitoring in non-AFP producers post-TARE.  