Safety and efficacy of repeat Y90 radioembolization to the same hepatic arterial territory

To study the efficacy and safety of repeat transarterial radioembolization (TARE) to similar hepatic arterial territories. Between 3/2011 and 4/2019, 26 patients (25 males and 1 Female, Mean Age: 65 yo, SD: 11.7 yo, Range: 18-83.0 yo) received TARE with Y90 glass microspheres to treat recurrent or r...

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Published in:British journal of radiology 2021-03, Vol.94 (1119), p.20200752
Main Authors: Badar, Wali, Van Ha, Thuong, Zangan, Steven, Navuluri, Rakesh, Pillai, Anjana, Baker, Talia, Dalag, Leonard, Han, Ross, Ahmed, Osman
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Brachytherapy - adverse effects
Brachytherapy - methods
Carcinoma, Hepatocellular - radiotherapy
Female
Hepatic Artery - radiation effects
Humans
Liver Neoplasms - radiotherapy
Male
Middle Aged
Retreatment
Treatment Outcome
Young Adult
Yttrium Radioisotopes - therapeutic use
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Summary:To study the efficacy and safety of repeat transarterial radioembolization (TARE) to similar hepatic arterial territories. Between 3/2011 and 4/2019, 26 patients (25 males and 1 Female, Mean Age: 65 yo, SD: 11.7 yo, Range: 18-83.0 yo) received TARE with Y90 glass microspheres to treat recurrent or residual primary disease in similar hepatic arterial lobe or segments. Tumor response was evaluated by imaging using the modified-RECIST criteria. Incidence of RILD and adverse events were categorized by a standardized scale using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0. Mean cumulative activity after the first treatment was 2.50 GBq (SD:1.04 GBq, Range:0.61-4.93 GBq) and second treatment was 2.27 GBq (SD:1.01 GBq, Range:0.92-5.46 GBq). Mean interval time between initial and repeat treatments was 9.6 months (Range: 1-53 months). Tumor responses were complete, partial, or progression in 73% ( = 19/26), 23% ( = 6/26), and 4% ( = 1/26) in repeat treatment patients, respectively. The incidence of RILD was 0%. Toxicity after first and second treatment was seen in 19% ( = 5/26) & 23% ( = 6/26) patients, respectively, and were all of CTCAE Grade 2. No significant predictors of treatment toxicity for repeat treatment were identified except increased MELD score ( = 0.04). Kaplan-Meier survival analysis in patients with repeat treatment showed a median survival of 15.0 months (95% CI 8.8-21.1 months) and 19.0 months (95% CI 8.1-29.9 months) in patients who only received one treatment with a value of 0.485. Repeat TARE with glass microspheres was an effective and safe treatment strategy for disease management in patients with residual or recurrent disease to the similar hepatic arterial territories without any major treatment related toxicity. Although safety and efficacy of repeat radioembolism has been studied, no study has focused on repeat treatment to similar hepatic arterial territories. The current study shows that repeat treatment to the same hepatic arterial territory is as safe as single treatment to the same territory.
ISSN:0007-1285
1748-880X
DOI:10.1259/bjr.20200752