SIR 2024
Interventional Oncology
Jin Woo Choi, MD, PhD
Associate Professor
Seoul National University Hospital, Republic of Korea
Disclosure information not submitted.
Hyo-Cheol Kim, MD
Clinical professor
Seoul National University Hospital, Republic of Korea
Disclosure information not submitted.
Jin Wook Chung, MD, PhD
Professor
Seoul National University Hospital, South Korea
Disclosure information not submitted.
Of the 703 patients who underwent radioembolization for HCC between January 2012 and December 2022 at a single institute, 100 met the Milan criteria (a single tumor ≤ 5 cm or 2-3 tumors ≤ 3 cm). The initial 24 patients underwent R-TARE, which included both a pre-treatment lung shunt scan and a post-treatment Y90 PET-CT scan. From July 2020, S-TARE was prioritized over R-TARE for patients meeting the Milan criteria, given that these patients typically have low lung shunt fractions and the number of patients initially slated for radioembolization rapidly surpassed the capacity for timely lung shunt scans. This study compared complete response rates, time-to-progression (TTP) according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) and localized mRECIST, overall survival (OS), and adverse events, including radiation pneumonitis, after S-TARE and R-TARE using the Chi-square test, Fisher’s exact test, or the log-rank test.
Results:
S-TARE and R-TARE were performed on 38 and 62 patients, respectively. The median tumor size was 3.8 ± 1.0 cm for R-TARE and 3.1 ± 1.0 cm for S-TARE (p = .001). Patients undergoing S-TARE received a significantly higher mean absorbed dose (357 ± 208 Gy) than those undergoing R-TARE (287 ± 144 Gy) (p = 0.018), reflecting the recent trend in ablative dose delivery in radiation segmentectomy. For patients with R-TARE, the lung shunt fraction and estimated lung dose based on the lung shunt scan ranged from 0.7 to 4.4% and 0.2 to 7.7 Gy, respectively. The lung dose measured on the post-treatment Y90 PET-CT scan ranged from 0.1 to 2.7 Gy. Tumor and liver doses on Y90 PET-CT were 709 ± 633 Gy and 194 ± 120 Gy, respectively. No radiation pneumonitis was observed in either group. Complete response rates were similar between R-TARE (92.1%, 35/38) and S-TARE (90.3%, 56/62) (p = .764). No significant differences were found in TTP by mRECIST, TTP by localized mRECIST, or OS between the groups.
Conclusion:
S-TARE was as effective and safe as R-TARE for patients with HCC meeting the Milan criteria.