Radiation Dose Limits and Liver Toxicities Resulting from Multiple Yttrium-90 Radioembolization Treatments for Hepatocellular Carcinoma

Joseph Y. Young, Thomas K. Rhee, Bassel Atassi, Vanessa L. Gates, Laura Kulik, Mary F. Mulcahy, Andrew C. Larson, Robert K. Ryu, Kent T. Sato, Robert J. Lewandowski, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Purpose: To assess the relationship between cumulative hepatic lobar radiation dose and liver toxicities in patients with hepatocellular carcinoma (HCC) treated with multiple sessions of yttrium-90 radioembolization. Materials and Methods: Forty-one patients with HCC (age range, 46-82 years) underwent radioembolization with 90Y. Patients were classified according to the Okuda scoring system. All patients received single liver lobar treatments on two or more occasions according to standard clinical 90Y embolization protocol. Cumulative radiation dose to each liver lobe was measured and patients were followed to assess liver toxicities. Statistical analysis was performed with the Student t test and Kaplan-Meier analysis. Results: Patients with Okuda stage I disease received more treatments than those with Okuda stage II disease (mean, 2.65 vs 2.24; P < .05). For average cumulative radiation dose, patients with Okuda stage I disease received 247 Gy (range, 88-482 Gy) and those with Okuda stage II disease received 198 Gy (range, 51-361 Gy; P < .05). A total of 13 toxicities occurred in seven patients (16%). Patients with Okuda stage I disease were given a greater cumulative dose than patients with Okuda stage II disease before worsening of liver function: 390 Gy versus 196 Gy (P < .005). For patients with Okuda stage I disease, a higher cumulative radiation dose was associated with occurrence of one or more toxicities: 222 Gy (no toxicities) versus 390 Gy (≥1 toxicity; P < .005). No correlation between cumulative radiation dose and liver toxicities existed in patients with Okuda stage II disease. The maximum tolerated dose was between 222 and 390 Gy. Median survival times were 660 and 431 days for patients with Okuda stage I and stage II disease, respectively. Conclusions: Patients with HCC can tolerate high cumulative radiation doses with 90Y therapy. Compared with patients with Okuda stage II disease, patients with Okuda stage I disease tolerate a higher cumulative radiation dose without liver toxicity, but liver toxicities increase with increasing cumulative radiation doses.

Original languageEnglish (US)
Pages (from-to)1375-1382
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume18
Issue number11
DOIs
StatePublished - Nov 1 2007

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Yttrium
Hepatocellular Carcinoma
Radiation
Liver
Therapeutics
Maximum Tolerated Dose
Kaplan-Meier Estimate

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{652510cd8136418791f50b095011ddfc,
title = "Radiation Dose Limits and Liver Toxicities Resulting from Multiple Yttrium-90 Radioembolization Treatments for Hepatocellular Carcinoma",
abstract = "Purpose: To assess the relationship between cumulative hepatic lobar radiation dose and liver toxicities in patients with hepatocellular carcinoma (HCC) treated with multiple sessions of yttrium-90 radioembolization. Materials and Methods: Forty-one patients with HCC (age range, 46-82 years) underwent radioembolization with 90Y. Patients were classified according to the Okuda scoring system. All patients received single liver lobar treatments on two or more occasions according to standard clinical 90Y embolization protocol. Cumulative radiation dose to each liver lobe was measured and patients were followed to assess liver toxicities. Statistical analysis was performed with the Student t test and Kaplan-Meier analysis. Results: Patients with Okuda stage I disease received more treatments than those with Okuda stage II disease (mean, 2.65 vs 2.24; P < .05). For average cumulative radiation dose, patients with Okuda stage I disease received 247 Gy (range, 88-482 Gy) and those with Okuda stage II disease received 198 Gy (range, 51-361 Gy; P < .05). A total of 13 toxicities occurred in seven patients (16{\%}). Patients with Okuda stage I disease were given a greater cumulative dose than patients with Okuda stage II disease before worsening of liver function: 390 Gy versus 196 Gy (P < .005). For patients with Okuda stage I disease, a higher cumulative radiation dose was associated with occurrence of one or more toxicities: 222 Gy (no toxicities) versus 390 Gy (≥1 toxicity; P < .005). No correlation between cumulative radiation dose and liver toxicities existed in patients with Okuda stage II disease. The maximum tolerated dose was between 222 and 390 Gy. Median survival times were 660 and 431 days for patients with Okuda stage I and stage II disease, respectively. Conclusions: Patients with HCC can tolerate high cumulative radiation doses with 90Y therapy. Compared with patients with Okuda stage II disease, patients with Okuda stage I disease tolerate a higher cumulative radiation dose without liver toxicity, but liver toxicities increase with increasing cumulative radiation doses.",
author = "Young, {Joseph Y.} and Rhee, {Thomas K.} and Bassel Atassi and Gates, {Vanessa L.} and Laura Kulik and Mulcahy, {Mary F.} and Larson, {Andrew C.} and Ryu, {Robert K.} and Sato, {Kent T.} and Lewandowski, {Robert J.} and Omary, {Reed A.} and Riad Salem",
year = "2007",
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Radiation Dose Limits and Liver Toxicities Resulting from Multiple Yttrium-90 Radioembolization Treatments for Hepatocellular Carcinoma. / Young, Joseph Y.; Rhee, Thomas K.; Atassi, Bassel; Gates, Vanessa L.; Kulik, Laura; Mulcahy, Mary F.; Larson, Andrew C.; Ryu, Robert K.; Sato, Kent T.; Lewandowski, Robert J.; Omary, Reed A.; Salem, Riad.

In: Journal of Vascular and Interventional Radiology, Vol. 18, No. 11, 01.11.2007, p. 1375-1382.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiation Dose Limits and Liver Toxicities Resulting from Multiple Yttrium-90 Radioembolization Treatments for Hepatocellular Carcinoma

AU - Young, Joseph Y.

AU - Rhee, Thomas K.

AU - Atassi, Bassel

AU - Gates, Vanessa L.

AU - Kulik, Laura

AU - Mulcahy, Mary F.

AU - Larson, Andrew C.

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Lewandowski, Robert J.

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2007/11/1

Y1 - 2007/11/1

N2 - Purpose: To assess the relationship between cumulative hepatic lobar radiation dose and liver toxicities in patients with hepatocellular carcinoma (HCC) treated with multiple sessions of yttrium-90 radioembolization. Materials and Methods: Forty-one patients with HCC (age range, 46-82 years) underwent radioembolization with 90Y. Patients were classified according to the Okuda scoring system. All patients received single liver lobar treatments on two or more occasions according to standard clinical 90Y embolization protocol. Cumulative radiation dose to each liver lobe was measured and patients were followed to assess liver toxicities. Statistical analysis was performed with the Student t test and Kaplan-Meier analysis. Results: Patients with Okuda stage I disease received more treatments than those with Okuda stage II disease (mean, 2.65 vs 2.24; P < .05). For average cumulative radiation dose, patients with Okuda stage I disease received 247 Gy (range, 88-482 Gy) and those with Okuda stage II disease received 198 Gy (range, 51-361 Gy; P < .05). A total of 13 toxicities occurred in seven patients (16%). Patients with Okuda stage I disease were given a greater cumulative dose than patients with Okuda stage II disease before worsening of liver function: 390 Gy versus 196 Gy (P < .005). For patients with Okuda stage I disease, a higher cumulative radiation dose was associated with occurrence of one or more toxicities: 222 Gy (no toxicities) versus 390 Gy (≥1 toxicity; P < .005). No correlation between cumulative radiation dose and liver toxicities existed in patients with Okuda stage II disease. The maximum tolerated dose was between 222 and 390 Gy. Median survival times were 660 and 431 days for patients with Okuda stage I and stage II disease, respectively. Conclusions: Patients with HCC can tolerate high cumulative radiation doses with 90Y therapy. Compared with patients with Okuda stage II disease, patients with Okuda stage I disease tolerate a higher cumulative radiation dose without liver toxicity, but liver toxicities increase with increasing cumulative radiation doses.

AB - Purpose: To assess the relationship between cumulative hepatic lobar radiation dose and liver toxicities in patients with hepatocellular carcinoma (HCC) treated with multiple sessions of yttrium-90 radioembolization. Materials and Methods: Forty-one patients with HCC (age range, 46-82 years) underwent radioembolization with 90Y. Patients were classified according to the Okuda scoring system. All patients received single liver lobar treatments on two or more occasions according to standard clinical 90Y embolization protocol. Cumulative radiation dose to each liver lobe was measured and patients were followed to assess liver toxicities. Statistical analysis was performed with the Student t test and Kaplan-Meier analysis. Results: Patients with Okuda stage I disease received more treatments than those with Okuda stage II disease (mean, 2.65 vs 2.24; P < .05). For average cumulative radiation dose, patients with Okuda stage I disease received 247 Gy (range, 88-482 Gy) and those with Okuda stage II disease received 198 Gy (range, 51-361 Gy; P < .05). A total of 13 toxicities occurred in seven patients (16%). Patients with Okuda stage I disease were given a greater cumulative dose than patients with Okuda stage II disease before worsening of liver function: 390 Gy versus 196 Gy (P < .005). For patients with Okuda stage I disease, a higher cumulative radiation dose was associated with occurrence of one or more toxicities: 222 Gy (no toxicities) versus 390 Gy (≥1 toxicity; P < .005). No correlation between cumulative radiation dose and liver toxicities existed in patients with Okuda stage II disease. The maximum tolerated dose was between 222 and 390 Gy. Median survival times were 660 and 431 days for patients with Okuda stage I and stage II disease, respectively. Conclusions: Patients with HCC can tolerate high cumulative radiation doses with 90Y therapy. Compared with patients with Okuda stage II disease, patients with Okuda stage I disease tolerate a higher cumulative radiation dose without liver toxicity, but liver toxicities increase with increasing cumulative radiation doses.

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