Purpose: Radiation-induced liver disease (RILD) is a known possible complication of radiation therapy, including intra-arterial Y90 radioembolization1. Radiation segmentectomy with Y90 offers a safe (and potentially curative) treatment option in patients with HCC2. With the understanding that additive radiation administration to the liver increases risk of complications, this study evaluates the safety profile of performing more than 1 radiation segmentectomy in patients with HCC.
Materials and Methods: Patients who received multiple Y90 segmentectomies or single lobar radioembolizations between September 2018 – June 2020 at a single institution were included in this retrospective study. Data were collected from EMR. Radiation dose delivered, location of treatment field, and number of administrations were recorded. Additionally, AST and ALT levels at 3 month as well as ALBI score at 1 month and 3 month follow-ups were obtained. Patients were then assigned to 2 cohorts: patients with multiple segmentectomies and patients with lobar treatment only. Mean values for liver enzymes and ALBI score for these two groups were compared using a one-tailed independent t-test. The secondary outcome of 6 month mortality was also compared between groups.
Results: A total of 18 consecutive patients (mean age 66 yrs) were analyzed: 9 patients (mean age 66 yrs; 8 men with >2 segmentectomies and 9 patients (mean age >65yrs; 4 men with single lobar Y90 radioembolizations. The mean number of segmentectomies per patient totaled 2.4.As expected, significantly more dose was delivered to patients receiving segmentectomies, both in total Gy delivered (p=.005) and Gy/cc delivered (p=.007). A one-tailed independent t-test found no significant difference between 3-month follow up AST levels (p=0.22), 3-month follow up ALT levels (p=0.18), 1-month follow up ALBI scores (p=0.31), and 3-month follow up ALBI scores (p=0.40) between the two cohorts. The 6-month mortality rate was 0% for both groups.
Conclusion: Patients can receive multiple radiation segmentectomies for HCC with a similar safety profile asreceiving conventional lobarradioembolization.
Riaz A, Lewandowski RJ, Kulik LM, et al. Complications Following Radioembolization with Yttrium-90 Microspheres: A Comprehensive Literature Review. J Vasc Interv Radiol 2009; 20:1121–1130
Lewandowski RJ, Gabr A, Abouchaleh N, et al. Radiation Segmentectomy: Potential Curative Therapy for Early Hepatocellular Carcinoma. Radiology 2018 Jun; 287(3):1050-1058