4:12 PM Abstract No. 245 Safety and efficacy of sequential Y90 radioembolization and portal vein embolization in patients with hepatocellular carcinoma and metastatic colorectal cancer

Abstract

The use of portal vein embolization is widely applied to induce hypertrophy of the future liver remnant in preoperative patients. Patients may not receive surgery for various reasons. The safety and efficacy of combined radioembolization and portal vein embolization is not understood. We present our experience of sequential Y90 RE and portal vein embolization. A retrospective review of patients treated with a combination of portal vein embolization and Y90 radioembolization between January 2008 and August 2019 was cataloged. Post procedure laboratory values, clinical notes, cross sectional imaging and adverse events were recorded. 14 patients (10 mCRC, 4 HCC) were treated both PVE and Y90 embolization. The mCRC patients received resin microspheres and the HCC patients received glass microspheres. 12 patients had PVE prior to Y90. Nine patients had Y90 after PVE for treatment of liver tumors after aborted surgery. Three patients had Y90 after PVE to induce further hypertrophy. Median time from PVE to Y90 was 250 days (65 – 1253). Two patients with HCC had Y90 prior to PVE with a median time from Y90 to PVE of 24 days (22 and 25). The combination treatment was performed for preoperative treatment and induction of hypertrophy. One patient was successfully resected. The median injected activity was 53 mCi (23 -139). No CTCAE 5.0 grade 3 or higher adverse events were seen at 30- and 90-day follow-up. Median survival of the entire cohort was 490 days. Treatment of HCC and metastatic CRC with a combination PVE and Y90 is safe and may be used to tumor control and induction of liver hypertrophy in select patients.