Journal of vascular and interventional radiology : JVIR · 2026
Rates of Successful Bridging or Downstaging and Safety of Segmental Radioembolization for Hepatocellular Carcinoma in Patients with Baseline Hyperbilirubinemia.
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Serhal Muhamad, Nadeem Arsalan, Gabr Ahmed, Entezari Pouya, Riaz Ahsun, Kulik Laura, Kalyan Aparna, Borja-Cacho Daniel, Dietch Zachary, Salem Riad, Gordon Andrew C, Lewandowski Robert J
Аннотация
PURPOSE: To evaluate the safety and rates of bridging or downstaging following segmental transarterial radioembolization (TARE) in hepatocellular carcinoma (HCC) patients with baseline hyperbilirubinemia (total bilirubin [TBili] level, ≥2.0 mg/dL).
MATERIALS AND METHODS: This single-institution retrospective study included 119 patients with HCC (median age, 64 years; interquartile range [IQR], 58-71 years) with baseline hyperbilirubinemia who underwent 129 segmental TARE procedures between 2006 and 2021. Baseline and posttreatment liver function, toxicities, overall survival (OS), and bridging/downstaging rates were analyzed. Patients were stratified by treatment intent: palliative, bridging, or downstaging.
RESULTS: The median absorbed dose was 211 Gy (IQR, 157-318 Gy); treatment volume, 160 mL (IQR, 109-227 mL); whole liver volume, 1,402 mL (IQR, 1,136-1,830 mL); and percentage of liver treated, 11.0% (IQR, 8.2%-15.5%). Median baseline TBili level was 2.7 mg/dL (IQR, 2.3-3.2 mg/dL). Grade 3/4 bilirubin toxicity occurred in 1.0% at 1 and 3 months and 8.0% at 6 months. Although TBili (P = .011) and albumin (P = .047) levels changed significantly over time, post hoc testing showed no differences between timepoints, and albumin-bilirubin grade remained stable (P = .900). Median intention-to-treat OS was not reached (95% CI, 59.0 months to not calculable [NC]). The palliative group had a median OS of 22.0 months (95% CI, 18.0-NC), whereas OS was not reached in the bridging group. Among 71 bridging patients, 92.0% remained within Milan criteria, and 78.0% underwent transplantation. Of 6 downstaging patients, 67.0% were successfully downstaged, and 2 underwent transplantation.
CONCLUSIONS: Segmental TARE is safe and well tolerated in patients with HCC with baseline hyperbilirubinemia, achieving high rates of successful bridging and downstaging to liver transplant with manageable toxicity.
MATERIALS AND METHODS: This single-institution retrospective study included 119 patients with HCC (median age, 64 years; interquartile range [IQR], 58-71 years) with baseline hyperbilirubinemia who underwent 129 segmental TARE procedures between 2006 and 2021. Baseline and posttreatment liver function, toxicities, overall survival (OS), and bridging/downstaging rates were analyzed. Patients were stratified by treatment intent: palliative, bridging, or downstaging.
RESULTS: The median absorbed dose was 211 Gy (IQR, 157-318 Gy); treatment volume, 160 mL (IQR, 109-227 mL); whole liver volume, 1,402 mL (IQR, 1,136-1,830 mL); and percentage of liver treated, 11.0% (IQR, 8.2%-15.5%). Median baseline TBili level was 2.7 mg/dL (IQR, 2.3-3.2 mg/dL). Grade 3/4 bilirubin toxicity occurred in 1.0% at 1 and 3 months and 8.0% at 6 months. Although TBili (P = .011) and albumin (P = .047) levels changed significantly over time, post hoc testing showed no differences between timepoints, and albumin-bilirubin grade remained stable (P = .900). Median intention-to-treat OS was not reached (95% CI, 59.0 months to not calculable [NC]). The palliative group had a median OS of 22.0 months (95% CI, 18.0-NC), whereas OS was not reached in the bridging group. Among 71 bridging patients, 92.0% remained within Milan criteria, and 78.0% underwent transplantation. Of 6 downstaging patients, 67.0% were successfully downstaged, and 2 underwent transplantation.
CONCLUSIONS: Segmental TARE is safe and well tolerated in patients with HCC with baseline hyperbilirubinemia, achieving high rates of successful bridging and downstaging to liver transplant with manageable toxicity.