Abstract
To evaluate the efficacy and safety of resin yttrium-90 radioembolization using the Medical Internal Radiation Dosimetry (MIRD) model in patients with hepatocellular carcinoma (HCC) and portal vein invasion. IRB-approved, retrospective review of 23 consecutive patients (21 men and 2 woman; age, 65±9 years) with HCC and portal vein invasion at a single center who underwent resin Y90. Patients treated using the MIRD model were compared to a matched cohort of patients treated using the body surface area (BSA) model. Survival data were analyzed by the Kaplan-Meier method. Patients presented with mass forming HCC (Size: 3.4±1.8 cm), good performance status (ECOG 0-1), and normal LFTs (ALT:42±39, AST:42±43, bilirubin 0.8±0.7). After planning arteriography (extra-hepatic vessel embolization: 27% (3/11)), treatment dosimetry was performed using the MIRD model (target dose: 120-200 Gy) in 11 patients (10 men and 1 woman; age, 68±9 years). MIRD Y90 treatment was performed at a segmental [27% (3/11)] or lobar [73% (8/11)] level. Prescribed activity was successfully delivered in all cases (99-109% of prescribed dose). Y90 treatment was provided as first-line treatment in 91% (10/11) of patients. Median follow-up at this time is 13.1 months. No episodes of severe toxicity occurred. At 6 months, 11% (1/9) of patients had partial response, 67% (6/9) had stable disease, and 22% (2/9) had progressive disease. Overall survival is currently 64% (7/11) with 1-year survival at 88% (7/8) and 2-year survival at 66% (4/6) Progression-free survival was 45% (5/11). In patients who underwent treatment with BSA dosimetry (n=12), at 6 months, 13%(1/8) of patients had a partial response, 75%(6/8) had stable disease, and 13%(1/8) had progressive disease. Overall survival is currently 50% (6/12) with 1-year survival at 60% (6/10) and 2-year survival at 43% (3/7). Progression-free survival was 42%(5/12). Y90 radioembolization with resin microspheres using MIRD dosimetry is safe and has promising survival outcomes.
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