Lung Shunt Reduction for Yttrium-90 Radioembolization: Chemoembolization Versus Radioembolization.

Abstract

To evaluate the efficacy of chemoembolization versus radioembolization in reducing lung shunt fraction (LSF) in patients with hepatocellular carcinoma (HCC). In this retrospective study, from March 2012 to January 2021, 457 patients with HCC underwent planning angiography and 99mTc-macroaggregated albumin imaging for possible yttrium-90 radioembolization. Ten patients underwent radioembolization, and seven patients underwent conventional chemoembolization for LSF reduction, and a second 99mTc-macroaggregated albumin imaging was obtained approximately 1 month later. LSF under both procedures was compared with the Mann-Whitney U-test and the Wilcoxon signed-rank test. In the radioembolization group, the mean first and second LSF were 13.0±6.9% and 20.9±9.6%, respectively (p=0.059); after radioembolization, LSF was lower in three patients but higher in seven patients. In the chemoembolization group, the mean first and second LSF were 26.1±17.3% and 8.7±5.5%, respectively (p=0.018); after chemoembolization, LSF was reduced in all seven patients. Chemoembolization appears to be more effective in reducing LSF within 1 month compared with radioembolization.