Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort

Arighno Das, Ahsun Riaz, Ahmed Gabr, Rehan Ali, Ronald Mora, Ali Al Asadi, Samdeep K Mouli, Robert J Lewandowski, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%. Methods: With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. Results: A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. Conclusion: Y90 can be performed in patients with LSF > 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF > 15% should not deter from treatment with Y90.

Original languageEnglish (US)
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
DOIs
StateAccepted/In press - Jan 1 2019

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Microspheres
Yttrium
Glass
Hepatocellular Carcinoma
Safety
Lung
Survival
Pulmonary Fibrosis
Research Ethics Committees
Liver
Technetium
Respiratory Sounds
Lung Injury
Cough
Dyspnea
Albumins
Thorax
Databases

Keywords

  • Hepatocellular carcinoma (HCC)
  • Lung shunt fraction (LSF)
  • Radioembolization
  • TARE

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{6fe298bbb20e4b93bb3af9e1642e956f,
title = "Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort",
abstract = "Background: Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15{\%}. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15{\%}. Methods: With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15{\%}. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. Results: A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4{\%} (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60{\%}) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7{\%}), 5 (5{\%}), 85 (83{\%}), and 6 (6{\%}) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32{\%}) demonstrated partial response, 57 stable disease, and 13 (13{\%}) had progressive disease. The median OS was 7.3 months (95{\%} CI 5.3, 11.47). Twenty patients (19{\%}) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. Conclusion: Y90 can be performed in patients with LSF > 15{\%}. The RECIST response was identified in 32{\%} of the patients. In isolation, LSF > 15{\%} should not deter from treatment with Y90.",
keywords = "Hepatocellular carcinoma (HCC), Lung shunt fraction (LSF), Radioembolization, TARE",
author = "Arighno Das and Ahsun Riaz and Ahmed Gabr and Rehan Ali and Ronald Mora and {Al Asadi}, Ali and Mouli, {Samdeep K} and Lewandowski, {Robert J} and Riad Salem",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00259-019-04517-y",
language = "English (US)",
journal = "European Journal Of Nuclear Medicine",
issn = "0340-6997",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction

T2 - analysis of a 103-patient cohort

AU - Das, Arighno

AU - Riaz, Ahsun

AU - Gabr, Ahmed

AU - Ali, Rehan

AU - Mora, Ronald

AU - Al Asadi, Ali

AU - Mouli, Samdeep K

AU - Lewandowski, Robert J

AU - Salem, Riad

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%. Methods: With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. Results: A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. Conclusion: Y90 can be performed in patients with LSF > 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF > 15% should not deter from treatment with Y90.

AB - Background: Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%. Methods: With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. Results: A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. Conclusion: Y90 can be performed in patients with LSF > 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF > 15% should not deter from treatment with Y90.

KW - Hepatocellular carcinoma (HCC)

KW - Lung shunt fraction (LSF)

KW - Radioembolization

KW - TARE

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U2 - 10.1007/s00259-019-04517-y

DO - 10.1007/s00259-019-04517-y

M3 - Article

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JO - European Journal Of Nuclear Medicine

JF - European Journal Of Nuclear Medicine

SN - 0340-6997

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