Efficacy of Yttrium-90 Transarterial Radioembolisation in Advanced Hepatocellular Carcinoma: An Experience With Hybrid Angio-Computed Tomography and Glass Microspheres

Abstract

BackgroundHepatocellular carcinoma is one of the most common malignancies worldwide. Transarterial radioembolization (TARE) involves selective intra-arterial administration of microspheres loaded with a radioactive compound like Yttrium90. Conventionally, C-arm based cone-beam computed tomography has been used extensively during TARE. However, Angio-CT is a relatively new modality which combines the advantages of both fluoroscopy and Computed Tomography (CT). There is scarce literature detailing the use of Angio-CT in Y90 TARE. MethodsThis was a retrospective study of primary liver cancer cases in which TARE procedure was done from November 2017 to December 2021. Glass-based Y-90 microspheres were used in all these cases. All the cases were performed in the hybrid Angio-CT suite. A Single Photon Emission Computed Tomography – Computed Tomography (SPECT-CT) done post planning session determined the lung shunt fraction and confirmed the accurate targeting of the lesion. Post drug delivery, PET-CT was obtained to confirm the distribution of the Y-90 particles. The technical success, median follow-up, objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were recorded. ResultsA total of 56 hepatocellular carcinoma patients underwent TARE during this period out of which 36 patients (30 males and 6 females) underwent Y90 TARE. The etiology of cirrhosis included non-alcoholic steatohepatitis (NASH) (11), hepatitis C (HCV) (11), hepatitis B (HBV) (9), metabolic dysfunction and alcohol associated liver disease (MetALD) (2), alcoholic liver disease (ALD) (1), cryptogenic (1) and autoimmune hepatitis (AIH) (1). The technical success was 100% and median follow-up was 7 months (range: 1 - 32 months). The median OS was 15 months (range 10.73 – 19.27 months; 95% CI) and the median local PFS was 4 months (range 3.03 – 4.97 months; 95% CI). The ORR (best response, CR + PR) was 58%. No major complications were seen in this study. ConclusionTARE is a viable option for liver cancers in all stages but more so in the advanced stages. The use of Angio-CT in TARE aids in the precise delivery of the particles to the tumour and avoids non-target embolization.