3:27 PM Abstract No. 84 Radiation segmentectomy vs. conventional Y-90 selective internal radiation therapy: a comparison of survival in patients treated for hepatocellular carcinoma with portal vein thrombosis

Abstract

To compare the survival of patients treated with radiation segmentectomy vs. conventional Y-90 selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) on an intent to treat basis. All patients treated with Y-90 SIRT for HCC with PVT over a 5-year and 1-month period (18th July 2011 to 9th August 2017) were reviewed. Categorical variables (dosimetric approach, glass vs resin, Child Pugh score and demographics) were retrospectively analyzed using the Chi-squared test. Continuous variables were analyzed using the Mann-Whitney test. Kaplan-Meier survival curves were used to analyze differences in survival between the two groups. The Kaplan-Meier survival curves were statistically compared using the Gehan-Breslow-Wilcoxon test. MIRD based dosimetry was applied for glass, and partition based dosimetry for resin. 78 patients satisfied the inclusion criteria. 67 patients underwent conventional SIRT technique (86%) and 11 were treated with radiation segmentectomy (14%). 52 conventional SIRT patients were treated with glass and 15 were treated with resin. 8 Radiation segmentectomy patients were treated with glass and 3 were treated with resin. All patients underwent single session SIRT. There were no significant differences in the patient groups regarding age, gender, Child-Pugh score or radioembolic. Median survival by Kaplan-Meier analysis was 1289 days for radiation segmentectomy and 171 for conventional SIRT. Of the patients who died during follow-up, the range of overall survival was 35-1289 days for radiation segmentectomy and 13-894 days for conventional SIRT. Patients treated by radiation segmentectomy had a significantly better survival than the patients treated with conventional SIRT (p = 0.0062). There were no radiation related complications. Results are ongoing. This study demonstrates the safety and effectiveness of radiation segmentectomy as a treatment for HCC with PVT utilizing either glass or resin SIRT. Furthermore, survival analysis demonstrates a significant increase in overall survival for patients treated with radiation segmentectomy compared to those treated with conventional SIRT.