3:45 PM Abstract No. 142 Safety and efficacy of repeat Y90 radioembolization to the same hepatic arterial territory

Abstract

To investigate the safety and efficacy of repeat transarterial radioembolization (TARE) to the same hepatic territory for the treatment of residual or recurrent hepatocellular carcinoma (HCC). Between March 2011 and April 2019, 27 patients underwent TARE with Y90 glass microspheres to treat residual or recurrent HCC in the same hepatic arterial segment or lobe. Baseline demographics in addition to treatment indication, tumor distribution, Child Pugh score, and BCLC were recorded. Tumor response was documented according to modified RECIST criteria. Adverse events were graded by standardized criteria using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Kaplan-Meier survival analysis was used to analyze overall survival of repeat procedures. Mean cumulative dose after the 1st treatment was 2.53 GBq (SD: 1.04; range, 0.61-4.93) and 2nd treatment was 2.29 GBq (SD, 1.01; range, 0.92-5.46). Mean interval between treatments was 9.6 months (range, 1-53 months). Tumor responses were complete, partial, or progression in 74%, 22%, and 4% of patients respectively. Treatment administration was segmental in 48% of patients and in this group 69% had complete response, 23% had partial, and 8% had tumor progression. The remaining 52% of patients received lobar treatment with 79% showing complete response and 21% showing partial response. The incidence of radiation induced liver disease was 0%. Toxicity after 1st and 2nd treatment was seen in 22% and 11% patients respectively and were all of CTCAE grade 2. The toxicities included fever, nausea, and pain. Kaplan-Meier survival analysis in retreatment patients showed a median survival of 15.0 months (95% CI¬ 8.8-21.1). Repeat TARE with glass microspheres was a safe and effective treatment strategy for disease control in patients with recurrent or residual HCC to the same hepatic arterial territory and did not result in any instances of radiation induced liver disease. The findings of this study contradict previous literature that cites a higher risk of liver injury due to cumulative radiation to the same hepatic lobe or segment.Tabled 1Patient #Child-Pugh Score (CPS)BCLCAdverse Events After First Procedure (CTCAE Grade)Adverse Events after Second Procedure (CTCAE Grade)IndicationTumor LobeSegmental or LobarFirst Dose (GBq)Second Dose (GBq)Modified RECIST Response15 (A)BNoneNoneHCCRLobar3.043.57Partial27 (B)BNoneNoneHCCLLobar2.471.78Complete35 (A)CNoneNoneHCCLLobar2.062.22Partial47 (B)ANoneNoneHCCRSegmental2.152.12Partial56 (A)ANoneNoneHCCRSegmental2.21.7Complete65 (A)BPain to right shoulder (2), chest pain (2)Nausea and Abdominal pain (2)METRSegmental3.293.09Complete75 (A)AAbdominal Pain (2)NoneHCCRSegmental3.063.15Complete85 (A)CFevers (2)NoneHCCRSegmental4.935.46Complete95 (A)CNoneNoneHCCRLobar4.562.87Complete105 (A)ANoneNoneHCCRSegmental2.451.22Complete116 (A)ANoneNoneHCCRSegmental3.411.21Complete126 (A)ANoneNoneHCCRLobar2.863.12Complete137 (A)AAbdominal Pain (2)NoneHCCRLobar1.692.4Complete145 (A)ANoneAbdominal Pain and nausea (2)HCCRSegmental2.853.08Partial155 (A)BNoneNoneHCCLSegmental2.770.92Progression165 (A)ANoneNoneHCCRSegmental0.611.11Complete176 (A)ANoneAbdominal Pain and nausea (2)HCCRLobar0.992.85Complete186 (A)ANoneNoneHCCRSegmental1.073.29Complete195 (A)ANoneNoneCholangiocarcinomaRLobar1.641.32Complete207 (A)AFevers (2)NoneHCCRSegmental3.632.16Complete215 (A)BNoneNoneHCCRLobar1.952.26Complete225 (A)CAbdominal Pain (2)NoneHCCRSegmental2.52.61Partial235 (A)ANoneNoneHCCRLobar3.572.59Complete245 (A)ANoneNoneHCCRLobar1.280.94Complete256 (A)BNoneNoneHCCRLobar1.781.35Partial265 (A)ANoneNoneHCCRLobar2.031.63Complete275 (A)BNoneNoneHCCRLobar Open table in a new tab