S3275 Y90 Radioembolization: A Case Series in a Community-Based Setting

Abstract

INTRODUCTION: Hepatocellular carcinoma (HCC) represents the second-most common cause of cancer mortality worldwide and the most common primary liver cancer in the United States. Loco-regional therapies (LRT) with curative intent include resection, energy ablation, chemo or radioembolization, and liver transplantation. Frequently sequencing of different therapeutic modalities is required for cure or prolongation of survival. Trans arterial LRT include chemoembolization (TACE) and Yttrium-90 radioembolization (Y-90 TARE) have been successfully utilized in the management of primary multicentric HCC, recurrent HCC after other LRT, as well as metastatic colorectal cancer and neuroendocrine carcinoma. Current scientific literature describes the methodology, safety and clinical outcomes from major academic centers. Our series describes the experience in the management of primary and secondary liver malignancies with Y-90 TARE a community hospital. METHODS: After IRB approval, we conducted a retrospective review. De-identified data was collected for patients treated with Y-90 TARE with primary, multicentric HCC, and patients with metastatic cancer who did not meet criteria for any other LRT. Baseline patient and tumor characteristics pre Y-90 TARE were assessed (Table 1). This series report the initial experience with forty-two patients. Of those, 20 patients that had complete data suitable for analysis Modified Resist criteria (mRESIST) was utilized to assess radiographic response within the first year of treatment. Complications that required post treatment emergency department (ED) visit or hospitalization within 30 and 90 days after Y-90 TARE were recorded. RESULTS: Of the twenty patients with pre and post therapy imaging, 40% had partial and stable responses, 15% had a complete response, and 5% had progressive disease. Of the 42 patients initially treated with Y-90 TARE, 52% did not undergo subsequent radioembolization treatment, 38% underwent one additional treatment and 10% required two or more. 5% of the patients required ED of hospitalization in the first 90 days after y 90 TARE. There were no deaths (Table 2). CONCLUSION: The management of hepatocellular carcinoma varies tremendously without one single modality being ideal. Surgical resection and transplantation remain as the gold standard for cure. Our series documents, Y-90 TARE to be a safe, reproducible technique in a community hospital with minimal morbidity and no mortality.Table 1.: Pre treatment baseline characteristicsTable 2.: Post treatment outcomes