Cardiovascular and interventional radiology · 2026
High-Specific-Activity Resin Yttrium-90 Radiation Segmentectomy of Hepatocellular Carcinoma: A Study of Efficacy, Safety, and Dosimetry Considerations.
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Villalobos Alexander, Alfrasiabi Ali, Varela Paolo, Valentine Roshan, Gholami Bahareh, Shahbazian Haneyeh, Moon Andrew M, Shah Neil, Du Pisanie Johannes L, Yu Hyeon, Mauro David M, Kokabi Nima
Аннотация
PURPOSE: To evaluate efficacy, safety, particle density, and dosimetry of high-specific-activity (HSA) resin-based (RB) Yttrium-90 radiation segmentectomy (Y90-RS) for hepatocellular carcinoma (HCC).
MATERIALS AND METHODS: All 4- and 5-day pre-calibration (DPC) Y90-RS performed on patients with HCC were retrospectively analyzed at a single-center between July 2023 and May 2025. Tumor response and adverse events (AE) were assessed using mRECIST and CTCAE v5 at 3, 6, and 12-months. Voxel-based dosimetry analysis on post-Y90 SPECT/CT was performed to create tumor dose (TD) volume histograms and particle density (PD) assessment. Receiver Operating Characteristic (ROC) curves were used to evaluate the dose thresholds able to predict a tumor complete response (CR) in relation to TD and PD. Variable differences were assessed with a Mann-Whitney U Test and the Chi-Square tests.
RESULTS: Sixty patients (63 tumors) underwent HSA RB Y90-RS (62% 4-DPC). The cohort was 62% male, median age 66 years (IQR, 62-71), with 95% solitary HCC. At 3 months, tumor control was 100% and CR was 79%. Treatment was well tolerated, with only two patients developing grade 3 AEs. The median delivered mean TD was 423 Gy (IQR 316-712), with the CR cohort showing higher mean TD than the incomplete response cohort (546 Gy vs. 299 Gy; p = 0.0003). Tumor PD and Mean TD thresholds predicting 3-month CR were 45,494 microspheres/mL (AUC = 0.80) and 416 Gy (AUC = 0.83), respectively. D95 TD of > 245 Gy was associated with CR (AUC = 0.81).
CONCLUSION: Curative intent ablative Y90-RS of HCC with HSA RB microspheres is efficacious and well tolerated. Mean TD threshold of ≥ 416 Gy and tumor-PD of ≥ 45,494 microspheres/mL were associated with 3-month tumor CR.
MATERIALS AND METHODS: All 4- and 5-day pre-calibration (DPC) Y90-RS performed on patients with HCC were retrospectively analyzed at a single-center between July 2023 and May 2025. Tumor response and adverse events (AE) were assessed using mRECIST and CTCAE v5 at 3, 6, and 12-months. Voxel-based dosimetry analysis on post-Y90 SPECT/CT was performed to create tumor dose (TD) volume histograms and particle density (PD) assessment. Receiver Operating Characteristic (ROC) curves were used to evaluate the dose thresholds able to predict a tumor complete response (CR) in relation to TD and PD. Variable differences were assessed with a Mann-Whitney U Test and the Chi-Square tests.
RESULTS: Sixty patients (63 tumors) underwent HSA RB Y90-RS (62% 4-DPC). The cohort was 62% male, median age 66 years (IQR, 62-71), with 95% solitary HCC. At 3 months, tumor control was 100% and CR was 79%. Treatment was well tolerated, with only two patients developing grade 3 AEs. The median delivered mean TD was 423 Gy (IQR 316-712), with the CR cohort showing higher mean TD than the incomplete response cohort (546 Gy vs. 299 Gy; p = 0.0003). Tumor PD and Mean TD thresholds predicting 3-month CR were 45,494 microspheres/mL (AUC = 0.80) and 416 Gy (AUC = 0.83), respectively. D95 TD of > 245 Gy was associated with CR (AUC = 0.81).
CONCLUSION: Curative intent ablative Y90-RS of HCC with HSA RB microspheres is efficacious and well tolerated. Mean TD threshold of ≥ 416 Gy and tumor-PD of ≥ 45,494 microspheres/mL were associated with 3-month tumor CR.