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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 08-04-2022 | Portal Vein Thrombosis | Original Article

A global evaluation of advanced dosimetry in transarterial radioembolization of hepatocellular carcinoma with Yttrium-90: the TARGET study

Authors: Marnix Lam, Etienne Garin, Marco Maccauro, S. Cheenu Kappadath, Daniel Y. Sze, Cuneyt Turkmen, Murat Cantasdemir, Paul Haste, Ken Herrmann, Hamad Saleh Alsuhaibani, Matthew Dreher, Kirk D. Fowers, Riad Salem

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2022

Abstract

Purpose

To investigate the relationships between tumor absorbed dose (TAD) or normal tissue absorbed dose (NTAD) and clinical outcomes in hepatocellular carcinoma (HCC) treated with yttrium-90 glass microspheres.

Methods

TARGET was a retrospective investigation in 13 centers across eight countries. Key inclusion criteria: liver-dominant HCC with or without portal vein thrombosis, < 10 tumors per lobe (at least one ≥ 3 cm), Child–Pugh stage A/B7, BCLC stages A–C, and no prior intra-arterial treatment. Multi-compartment pre-treatment dosimetry was performed retrospectively. Primary endpoint was the relationship between ≥ grade 3 hyperbilirubinemia (such that > 15% of patients experienced an event) without disease progression and NTAD. Secondary endpoints included relationships between (1) objective response (OR) and TAD, (2) overall survival (OS) and TAD, and (3) alpha fetoprotein (AFP) and TAD.

Results

No relationship was found between NTAD and ≥ grade 3 hyperbilirubinemia, which occurred in 4.8% of the 209 patients. The mRECIST OR rate over all lesions was 61.7%; for the target (largest) lesion, 70.8%. Responders and non-responders had geometric mean total perfused TADs of 225.5 Gy and 188.3 Gy (p = 0.048). Probability of OR was higher with increasing TAD (p = 0.044). Higher TAD was associated with longer OS (HR per 100 Gy increase = 0.83, 95% CI: 0.71–0.95; p = 0.009). Increased TAD was associated with higher probability of AFP response (p = 0.046 for baseline AFP ≥ 200 ng/mL).

Conclusion

Real-world data confirmed a significant association between TAD and OR, TAD and OS, and TAD and AFP response. No association was found between ≥ grade 3 hyperbilirubinemia and NTAD.

Trial registration number

NCT03295006.

Available only for authorised users

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Title: A global evaluation of advanced dosimetry in transarterial radioembolization of hepatocellular carcinoma with Yttrium-90: the TARGET study
Authors: Marnix Lam
Etienne Garin
Marco Maccauro
S. Cheenu Kappadath
Daniel Y. Sze
Cuneyt Turkmen
Murat Cantasdemir
Paul Haste
Ken Herrmann
Hamad Saleh Alsuhaibani
Matthew Dreher
Kirk D. Fowers
Riad Salem
Publication date: 08-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Portal Vein Thrombosis
Hepatocellular Carcinoma
Portal Vein Thrombosis
Hepatocellular Carcinoma
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2022
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-022-05774-0

At a glance: The STEP trials

Springer Medicine

A global evaluation of advanced dosimetry in transarterial radioembolization of hepatocellular carcinoma with Yttrium-90: the TARGET study

Abstract

Purpose

Methods

Results

Conclusion

Trial registration number

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration number

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