Purpose: Transarterial radioembolization (TARE) is a common technique to treat patients with hepatocellular carcinoma refractory to transarterial chemoembolization (TACE). TARE can cause liver toxicity. The degree of toxicity may be heightened due to previous liver injury from prior endovascular therapies. This study assessed the safety and changes in liver function after TARE for multifocal hepatocellular carcinoma refractory to previous embolization.
Materials and Methods: Retrospective chart review was performed between 2017-2019 to identify patients who underwent TACE or bland embolization followed by TARE for hepatocellular carcinoma. Demographic, laboratory, and imaging information was collected prior to TARE and 3, 6, 9, 12, 18, and 24 months after TARE (if available).
Results: 30 patients were included. Mean age was 67.5 years (53-89), 10 were females. There was a median of 2 prior lesion specific treatments for each patient. The mean prescribed Y90 activity per was 2.6 GBq. Thirteen patients died. Median overall survival had not been met with a median follow-up of 22.4 months from the time of TARE. There was a significant increase in INR from before (1.2) to 6 months (1.6) (p = 0.012), MELD score from before (9.8) to 6 months(14.1) (p = 0.021), and in Child-Pugh score from before (6.2) to 3 months (7.2) (p = 0.0002), 6 months (8.1) (p = 0.003), and 9 months (7.5) (p = .03) after treatment. There was also worsening in ALBI score from before (-2.3) to 3 months (-1.7) (p = 0.001) and 6 months (-1.76) (p = 0.018) after treatment. There was a trend towards worsening total bilirubin from baseline (1.3) to 3 months (2.2, p = 0.09) and 6 months (3.3, p= 0.09). No statistical differences were noted in any variables after 9 months with levels returning to baseline. The absorbed Y90 activity delivered was associated with an increase in total bilirubin at three months (p = .02), but not thereafter. There were three mortalities which could be attributed to radioembolization-induced liver disease. At 3-month follow-up, 41% of patients had a complete response and 34% had a partial response using mRECIST criteria. One patient underwent liver transplantation and was found to have >90% necrosis of the HCC on explant pathologic analysis.
Conclusion: TARE frequently results in tumor responses in patients previously refractory to TACE or bland embolization. Transient deterioration of liver function and clinical scores can be expected but is usually observed to return to baseline after 9 months.