Background

Limited data are available on radiation segmentectomy (RS) for treatment of hepatocellular carcinoma (HCC) using yttrium 90 (⁹⁰Y) resin microsphere doses determined by using a single-compartment medical internal radiation dosimetry (MIRD) model.

Purpose

To evaluate the efficacy and safety of RS treatment of HCC with ⁹⁰Y resin microspheres using a single-compartment MIRD model and correlate posttreatment dose with outcomes.

Materials and Methods

This retrospective single-center study included adult patients with HCC who underwent RS with ⁹⁰Y resin microspheres between July 2014 and December 2022. Posttreatment PET/CT and dosimetry were performed. Adverse events were assessed using the Common Terminology Criteria for Adverse Events, version 5.0. Per-lesion and overall response rates (ie, complete response [CR], objective response, disease control, and duration of response) were assessed at imaging using the Modified Response Evaluation Criteria in Solid Tumors, and overall survival (OS) was assessed using Kaplan-Meier analysis.

Results

Among 67 patients (median age, 69 years [IQR, 63–78 years]; 54 male patients) with HCC, median tumor absorbed dose was 232 Gy (IQR, 163–405 Gy). At 3 months, per-lesion and overall (per-patient) CR was achieved in 47 (70%) and 41 (61%) of 67 patients, respectively. At 6 months (n = 46), per-lesion rates of objective response and disease control were both 94%, and per-patient rates were both 78%. A total of 88% (95% CI: 79 99) and 72% (95% CI: 58, 90) of patients had a per-lesion and overall duration of response of 1 year or greater. At 1 month, a grade 3 clinical adverse event (abdominal pain) occurred in one of 67 (1.5%) patients. Median posttreatment OS was 26 months (95% CI: 20, not reached). Disease progression at 2 years was lower in the group that received 300 Gy or more than in the group that received less than 300 Gy (17% vs 61%; P = .047), with no local progression in the former group through the end of follow-up.

Conclusion

Among patients with HCC who underwent RS with ⁹⁰Y resin microspheres, 88% and 72% achieved a per-lesion and overall duration of response of 1 year or greater, respectively, with one grade 3 adverse event. In patients whose tumors received 300 Gy or more according to posttreatment dosimetry, a disease progression benefit was noted.

© RSNA, 2024

Supplemental material is available for this article.

中文翻译：

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90Y树脂微球放射段切除术治疗肝细胞癌的疗效和安全性

 背景

关于使用钇 90 ( ⁹⁰ Y) 树脂微球剂量通过单室医学内辐射剂量测定 (MIRD) 模型确定的放射段切除术 (RS) 治疗肝细胞癌 (HCC) 的数据有限。

 目的

使用单室 MIRD 模型评估⁹⁰ Y 树脂微球 RS 治疗 HCC 的有效性和安全性，并将治疗后剂量与结果相关联。

 材料和方法

这项回顾性单中心研究纳入了 2014 年 7 月至 2022 年 12 月期间接受⁹⁰ Y 树脂微球 RS 治疗的成年 HCC 患者。治疗后进行了 PET/CT 和剂量测定。使用不良事件通用术语标准 5.0 版评估不良事件。使用实体瘤改良疗效评估标准在成像时评估每个病灶和总体缓解率（即完全缓解 [CR]、客观缓解、疾病控制和缓解持续时间），并使用卡普兰-迈耶分析。

 结果

在 67 名 HCC 患者（中位年龄 69 岁 [IQR，63-78 岁]；54 名男性患者）中，中位肿瘤吸收剂量为 232 Gy（IQR，163-405 Gy）。 3 个月时，67 名患者中分别有 47 名 (70%) 和 41 名 (61%) 实现了每个病灶和总体（每位患者）CR。 6 个月时（ n = 46），每个病灶的客观缓解率和疾病控制率均为 94%，每个患者的客观缓解率和疾病控制率均为 78%。总共 88% (95% CI: 79, 99) 和 72% (95% CI: 58, 90) 的患者的每个病灶和总体缓解持续时间为 1 年或更长。第 1 个月时，67 名患者中的一名 (1.5%) 发生了 3 级临床不良事件（腹痛）。治疗后中位 OS 为 26 个月（95% CI：20，未达到）。接受 300 Gy 或以上照射的组的 2 年疾病进展低于接受低于 300 Gy 的组（17% vs 61%； P = .047），前一组至治疗结束时均未出现局部进展的后续行动。

 结论

在接受⁹⁰ Y 树脂微球 RS 治疗的 HCC 患者中，88% 和 72% 的每个病灶和总体缓解持续时间分别达到 1 年或更长，并出现 1 起 3 级不良事件。根据治疗后剂量测定，在肿瘤接受 300 Gy 或更多剂量的患者中，发现了疾病进展的益处。

 © 北美放射学会，2024

本文提供了补充材料。