327. Radioembolization with Yttrium-90 Microspheres in Hepatocellular Carcinoma: Initial Experience

Abstract

Purpose We present our initial experience on transarterial radioembolization (TARE) with Yttrium-90 glass microspheres in Hepatocellular Carcinoma (HCC) patients. The first objective was to choose the procedure for defining the dose to be delivered to the patient and a first evaluation of its effectiveness. Methods From January 2016 to October 2017, 18 consecutive patients (M = 17, F = 1, median age 73 [24–85] years) with HCC were selected. TARE was performed using 90Y glass microspheres [1] . The administration activity was defined by the MIRD method based on the uptake volume [2] . Lung and gastrointestinal tract shunts were evaluated two weeks before the TARE, by a diagnostic angiography and, respectively, scintigraphy and SPECT/CT, after hepatic perfusion with 99mTc macroaggregated albumin (MAA). 90Y dose was personalized based on the 99mTc MAA SPECT/CT dose distribution. The mean dosimetric parameters are: Lesion Volume (cm3) 144, Target/Uptake Dose (Gy) 216, Target Volume (cm3) 371, Liver Treated (%) 25, Lung Shunt (%) 7, Non Tumoral Liver Dose (Gy) 6, Total Activity Administered (GBq) 1.6. Response evaluation was performed in 17 patients. Results Complete response occurred in 9 patients, partial response in 5 patients, while progression was seen in 3 patients. During a median clinical follow-up of 8 (3–18) months, 6 patients died. Median disease free survival and overall survival were respectively 13 and 16 months. One patient led to down-staging, allowing liver transplantation. Conclusions The dose definition procedure adopted proved to be effective, in the reduced number of cases treated. More data need to be acquired to confirm this preliminary result.