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Correlation of Y90-absorbed radiation dose to pathological necrosis in hepatocellular carcinoma: confirmatory multicenter analysis in 45 explants

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Abstract

Purpose

To study the correlation between absorbed perfused liver dose using Y90 radioembolization and degree of hepatocellular carcinoma (HCC) necrosis in liver explants in a multicenter cohort analysis

Methods

A retrospective analysis of 45 HCC patients treated between 2014 and 2017 is presented. Inclusion criteria were treatment-naïve solitary HCC ≤ 8 cm and Child-Pugh A liver status using the radiation segmentectomy approach. All patients underwent liver resection or transplantation (LT). Liver explants were examined per institutional routine protocols to assess histopathological viability of HCC. Tumor pathological necrosis was classified into complete (100% necrosis), extensive (> 50% and ≤ 99%) necrosis, and partial (< 50%) necrosis. Absorbed perfused liver doses were estimated using MIRD calculations. Associations between dose and degree of necrosis were studied.

Results

Thirty-four (76%) patients underwent LT, and 11 (24%) patients underwent hepatic resection. Median radiation dose was 240 (IQR: 136–387) Gy. Thirty (67%) patients had complete pathologic necrosis (CPN) at explant, while 10 (22%) and 5 (11%) had extensive and partial necrosis, respectively. There were significant differences among perfused liver doses that exhibited partial, extensive, and complete necrosis (p = 0.001). Twenty-four out of twenty-eight (86%) patients who had dose > 190 Gy achieved CPN, while 11/17 (65%) who had < 190 Gy did not (Fisher’s exact test; p = 0.001). Using binary logistic regression, only absorbed radiation dose was significantly associated with CPN (p = 0.01), while tumor size was not (p = 0.35). All patients receiving > 400 Gy exhibited CPN.

Conclusion

Radiation segmentectomy for early HCC with ablative dosing > 400 Gy results in CPN. This represents the new standard target dose for radiation segmentectomy.

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References

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Authors and Affiliations

  1. Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA

    Ahmed Gabr, Ahsun Riaz, Robert J. Lewandowski & Riad Salem

  2. Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, WA, USA

    Guy E. Johnson

  3. Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY, USA

    Edward Kim

  4. Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, CA, USA

    Siddharth Padia

Authors
  1. Ahmed Gabr
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  2. Ahsun Riaz
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  3. Guy E. Johnson
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  4. Edward Kim
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  5. Siddharth Padia
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  6. Robert J. Lewandowski
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  7. Riad Salem
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Corresponding author

Correspondence to Riad Salem.

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Conflict of interest

All authors are advisors to Boston Scientific.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Northwestern University, University of Washington, Mount Sinai) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Oncology - General

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Gabr, A., Riaz, A., Johnson, G.E. et al. Correlation of Y90-absorbed radiation dose to pathological necrosis in hepatocellular carcinoma: confirmatory multicenter analysis in 45 explants. Eur J Nucl Med Mol Imaging 48, 580–583 (2021). https://doi.org/10.1007/s00259-020-04976-8

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  • DOI: https://doi.org/10.1007/s00259-020-04976-8

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