Abstract No. 715 Y90 radiation segmentectomy versus microwave ablation for hepatocellular carcinoma in locations suboptimal for percutaneous ablation

Abstract

Y90 radiation segmentectomy achieves response rates and survival outcomes comparable to curative-intent treatments such as ablation and resection for early stage for hepatocellular carcinoma (HCC) (1-3). The purpose of our study was to evaluate outcomes following percutaneous microwave ablation versus Y90 radiation segmentectomy for tumors in suboptimal locations for percutaneous ablation. Retrospective review (January 2014–July 2019) was performed on patients who underwent either Y90 segmentectomy or microwave ablation (with or without prior TACE), with curative intent, for HCC lesions located in suboptimal locations for percutaneous ablation (adjacent to the liver dome, capsule, hilum, and gallbladder). Demographic data, follow-up imaging and clinical data were analyzed. The primary endpoints were treatment response by modified RECIST criteria and complications. Chi-square analysis was used for categorical variables and student’s t tests for nominal variables. 23 lesions in 20 patients (13 male, 7 female, mean age 67.4 ± 8.8 years) were treated with Y90 segmentectomy. 30 lesions in 30 patients (18 male, 12 female, mean age 62.5 ± 10.6 years,) were treated with microwave ablation (19 treated in combination with conventional TACE). There were no differences in demographics between groups (Table 1, P > 0.05). There was a statistically significant higher complete response rate in the Y90 group (96%) versus the ablation group (76%) (P < 0.05). There was no disease progression in the Y90 group during the follow-up period. Of the responders in the ablation group, 3/23 lesions (13%) demonstrated progression of disease with a mean time to progression of 6.3 months. No grade >2 toxicities or procedure related complications were noted in the Y90 group. There were 7 major (23%) and 3 minor (10%) complications in the ablation group. Major complications included arterioportal fistula with hemoperitoneum, pneumothorax, liver infarction, capsular burn. Although percutaneous microwave ablation may be technically feasible for lesions in suboptimal locations, Y90 segmentectomy offers superior treatment response and a favorable safety profile for these tumors.Table 1CharacteristicAblation (n = 30)Tace/ablation (n = 19)Ablation (n = 11)Y90 (n = 20)PDemographicsSex0.13 Male18 (63)13 (65) Female12 (27)7 (35)Age0.1 Mean62.567.4 Range27-8053-86Child-Pugh (at treatment)0.33 A19 (63)15 (76) B5 (17)4 (19) C6 (20)1 (5)Treatment DetailsLesions, n3023Location, n0.23 Capsule11 (37)5 (22) Dome10 (33)12 (52) Hilum4 (13)5 (22) Gallbladder5 (17)1 (4)Tumor size, cm0.01 Mean (std dev)2.3 (0.9)2.9 (1.0) Range1.0-4.51.2-5.0Response (mRECIST)0.05 CR23 (76)22 (96) PR7 (24)0 (0) SD0 (0)1 (4)Complication n10 (33)0 (0)Progression n3 (13)0 Mean TTP, months6.3N/AFollow up Mean, months7.04.6 Range3.0-11.01.0-16.0 Open table in a new tab