Conversion Therapy to Transplant or Surgical Resection in Patients with Unresectable Hepatocellular Carcinoma Treated with Boosted Dose of Yttrium-90 Radiation Segmentectomy

Wednesday, April 2, 2025

10:57 AM – 11:06 AM CT

Location: Music City Center, 209 ABC

Presenting Author(s)

SS

Sam Son, MD (he/him/his)

Research Associate
Memorial Sloan Kettering Cancer Center, United States

Author/Co-author(s)

RG

Ruben Geevarghese, MD

Senior Research Scientist
Memorial Sloan Kettering Cancer Center, United States
Brett Marinelli, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center, United States
KZ

Ken Zhao, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center, United States
Anne Covey, MD

Attending
Memorial Sloan-Kettering Cancer Center, United States
AM

Aaron WP Maxwell, MD

Director of Vascular and Interventional Oncology
Alpert Medical School, Brown University, United States
AW

Alice Wei, MD, MS

Attending
Memorial Sloan Kettering Cancer Center, United States
WJ

William Jarnagin, MD

Chief Attending
Division of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
MD

Michael D'Angelica, MD

Attending
Division of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
Hooman Yarmohammadi, MD

Interventional radiology
Memorial Sloan Kettering Cancer Center, United States

Purpose: The aim of this study was to assess the efficacy of boosted dose yttrium-90 radioembolization (TARE) as a modality for conversion therapy to transplant or surgical resection in patients with unresectable hepatocellular carcinoma (HCC).

Materials and Methods: In this single-center retrospective study, all patients with a diagnosis of HCC who were treated with boosted dose TARE ( >190 Gy) between January 2013 and December 2023 were reviewed. Treatment response and decrease in tumor size were assessed with the RECIST v1.1 and mRECIST criteria. Milan and University of California, San Francisco (UCSF), criteria were used to determine transplant eligibility, and Barcelona Clinic Liver Cancer (BCLC) surgical resection recommendations were used to evaluate tumor resectability.

Results: Thirty-eight patients with primary HCC who were treated with boosted dose TARE were retrospectively analyzed. The majority of the patients were Child–Pugh A (n = 35; 92.1%), BCLC C (n = 17; 44.7%), and ECOG performance status 0 (n = 25; 65.8%). The mean sum of the target lesions was 6.0 cm (standard deviation; SD = 4.0). The objective response rate (ORR) was 31.6% by RECIST and 84.2% by mRECIST. The disease control rate (DCR) was 94.7% by both RECIST and mRECIST. Among patients outside of Milan or UCSF, 13/25 (52.0%, Milan) and 9/19 (47.4%, UCSF) patients were successfully converted to within transplant criteria. Of patients who were initially unresectable, conversion was successful in 7/26 (26.9%) patients.

Conclusion: This study provides further real-world data demonstrating that boosted-dose TARE is an effective modality for conversion of patients with unresectable HCC to transplant or resection.