TY - JOUR
T1 - Pathologic Response of Hepatocellular Carcinoma Treated with Yttrium-90 Glass Microsphere Radiation Segmentectomy Prior to Liver Transplantation
T2 - A Validation Study
AU - Toskich, Beau
AU - Vidal, Lucas L.
AU - Olson, Matthew T.
AU - Lewis, Jason T.
AU - LeGout, Jordan D.
AU - Sella, David M.
AU - Montazeri, S. Ali
AU - Devcic, Zlatko
AU - Lewis, Andrew R.
AU - Frey, Greg T.
AU - Ritchie, Charles A.
AU - Paz-Fumagalli, Ricardo
AU - Croome, Kristopher P.
AU - Patel, Tushar C.
N1 - Funding Information:
This study was approved by the Institutional Review Board and was compliant with the Health Insurance Portability and Accountability Act. A single-center retrospective analysis was performed on 38 patients with HCC, who were treated with radiation segmentectomy and received a subsequent liver transplantation, from November 2016 to May 2020. The diagnosis of HCC was made with multiphase liver magnetic resonance (MR) imaging using the Organ Procurement and Transplantation Network/United Network for Organ Sharing criteria ( 12 ). All patients were deemed ineligible for liver resection by multidisciplinary tumor board assessment. In patients with Child-Pugh A cirrhosis, reasons for unresectability included tumor multifocality, portal hypertension, unfavorable tumor location, or inadequate predicted future liver remnant volume. All patients were subsequently deemed candidates for radiation segmentectomy after liver transplant selection committee approval. Patients were excluded if the targeted tumor had received any treatment other than radiation segmentectomy, although therapy to a separate tumor not treated with radioembolization was permitted. Patients were also excluded if the treatment angiosome (volume of liver parenchyma perfused by the targeted vessel) did not cover the entirety of the tumor per mapping angiography contrast-enhanced cone-beam computed tomography (CT), or if there was insufficient gross pathology data for analysis. The study was supported through institutional funds and did not receive extramural support.
Funding Information:
This work was supported by institutional funds. The authors would like to acknowledge the contributions of Drs. Denise Harnois, DO, Mark McKinney, MD, and Sunil Krishnan, MD, to this study and manuscript development.
Publisher Copyright:
© 2020 SIR
PY - 2021/4
Y1 - 2021/4
N2 - Purpose: To evaluate the pathologic outcomes of hepatocellular carcinoma (HCC) treated with Yttrium-90 radiation segmentectomy using glass microspheres prior to liver transplantation and explore parameters associated with pathologic necrosis. Materials and Methods: A single-institution retrospective analysis of HCC patients who received radiation segmentectomy prior to liver transplantation from November 2016 to May 2020 was performed. Patients were included if the treatment angiosome encompassed the entire tumor and could be correlated with available gross pathology. Archived histology slides were reviewed for percentage of pathologic necrosis. Thirty-three patients with 37 tumors were evaluated. The median tumor size was 2.3 cm (range, 1–6.7 cm). Results: All tumors received a single treatment. The median time from radiation segmentectomy to transplantation was 206 days (range, 58–550 days). Objective response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was 92% (complete response, 76%; partial response, 16%). A total of 68% (n = 25) of tumors demonstrated ≥99% pathologic necrosis. Complete pathologic necrosis was present in 53% and 75% of tumors treated with >190 Gy (n = 18) and >500 Gy (n = 8) single-compartment Medical Internal Radiation Dose, respectively. Complete response per mRECIST, posttreatment angiosome T1 hypointensity, dose >190 Gy, microsphere specific activity >297 Bq, and a longer time between treatment and transplant were associated with ≥99% tumor necrosis (P < .05). No posttransplant tumor recurrences occurred within a median follow-up of 604 days (range, 138–1,223 days). Conclusions: Radiation segmentectomy can serve as an ablative modality for the treatment of HCC prior to liver transplant.
AB - Purpose: To evaluate the pathologic outcomes of hepatocellular carcinoma (HCC) treated with Yttrium-90 radiation segmentectomy using glass microspheres prior to liver transplantation and explore parameters associated with pathologic necrosis. Materials and Methods: A single-institution retrospective analysis of HCC patients who received radiation segmentectomy prior to liver transplantation from November 2016 to May 2020 was performed. Patients were included if the treatment angiosome encompassed the entire tumor and could be correlated with available gross pathology. Archived histology slides were reviewed for percentage of pathologic necrosis. Thirty-three patients with 37 tumors were evaluated. The median tumor size was 2.3 cm (range, 1–6.7 cm). Results: All tumors received a single treatment. The median time from radiation segmentectomy to transplantation was 206 days (range, 58–550 days). Objective response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was 92% (complete response, 76%; partial response, 16%). A total of 68% (n = 25) of tumors demonstrated ≥99% pathologic necrosis. Complete pathologic necrosis was present in 53% and 75% of tumors treated with >190 Gy (n = 18) and >500 Gy (n = 8) single-compartment Medical Internal Radiation Dose, respectively. Complete response per mRECIST, posttreatment angiosome T1 hypointensity, dose >190 Gy, microsphere specific activity >297 Bq, and a longer time between treatment and transplant were associated with ≥99% tumor necrosis (P < .05). No posttransplant tumor recurrences occurred within a median follow-up of 604 days (range, 138–1,223 days). Conclusions: Radiation segmentectomy can serve as an ablative modality for the treatment of HCC prior to liver transplant.
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U2 - 10.1016/j.jvir.2020.12.019
DO - 10.1016/j.jvir.2020.12.019
M3 - Article
C2 - 33551304
AN - SCOPUS:85100426144
SN - 1051-0443
VL - 32
SP - 518-526.e1
JO - Journal of Vascular and Interventional Radiology
JF - Journal of Vascular and Interventional Radiology
IS - 4
ER -