Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort

Background Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%. Method...

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Veröffentlicht in:European journal of nuclear medicine and molecular imaging 2020-04, Vol.47 (4), p.807-815
Hauptverfasser: Das, Arighno, Riaz, Ahsun, Gabr, Ahmed, Ali, Rehan, Mora, Ronald, Al Asadi, Ali, Mouli, Samdeep, Lewandowski, Robert J., Salem, Riad
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container_issue 4
container_start_page 807
container_title European journal of nuclear medicine and molecular imaging
container_volume 47
creator Das, Arighno
Riaz, Ahsun
Gabr, Ahmed
Ali, Rehan
Mora, Ronald
Al Asadi, Ali
Mouli, Samdeep
Lewandowski, Robert J.
Salem, Riad
description Background Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%. Methods With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. Results A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. Conclusion Y90 can be performed in patients with LSF > 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF > 15% should not deter from treatment with Y90.
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Studies have debated the safety and efficacy of Y90 in patients with LSF &gt; 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF &gt; 15%. Methods With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF &gt; 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. Results A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. Conclusion Y90 can be performed in patients with LSF &gt; 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF &gt; 15% should not deter from treatment with Y90.</description><identifier>ISSN: 1619-7070</identifier><identifier>EISSN: 1619-7089</identifier><identifier>DOI: 10.1007/s00259-019-04517-y</identifier><identifier>PMID: 31502015</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Albumins ; Carcinoma, Hepatocellular - diagnostic imaging ; Carcinoma, Hepatocellular - radiotherapy ; Cardiology ; Cough ; Dosage ; Embolization, Therapeutic - adverse effects ; Fibrosis ; Hepatocellular carcinoma ; Humans ; Imaging ; Liver ; Liver cancer ; Liver Neoplasms - diagnostic imaging ; Liver Neoplasms - radiotherapy ; Lung ; Lung carcinoma ; Lung diseases ; Lungs ; Mathematical analysis ; Medicine ; Medicine &amp; Public Health ; Microspheres ; Nuclear Medicine ; Oncology ; Oncology – Digestive tract ; Original Article ; Orthopedics ; Patients ; Radiology ; Safety ; Signs and symptoms ; Technetium ; Technetium isotopes ; Thorax ; Treatment Outcome ; Wheezing ; Yttrium ; Yttrium isotopes ; Yttrium Radioisotopes - adverse effects</subject><ispartof>European journal of nuclear medicine and molecular imaging, 2020-04, Vol.47 (4), p.807-815</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>European Journal of Nuclear Medicine and Molecular Imaging is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-36fcf2426ba80cd256146a9a7d2dd783efad3363af19f3460e8f7d9978ef16ab3</citedby><cites>FETCH-LOGICAL-c375t-36fcf2426ba80cd256146a9a7d2dd783efad3363af19f3460e8f7d9978ef16ab3</cites><orcidid>0000-0001-9745-1825</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00259-019-04517-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00259-019-04517-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31502015$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Das, Arighno</creatorcontrib><creatorcontrib>Riaz, Ahsun</creatorcontrib><creatorcontrib>Gabr, Ahmed</creatorcontrib><creatorcontrib>Ali, Rehan</creatorcontrib><creatorcontrib>Mora, Ronald</creatorcontrib><creatorcontrib>Al Asadi, Ali</creatorcontrib><creatorcontrib>Mouli, Samdeep</creatorcontrib><creatorcontrib>Lewandowski, Robert J.</creatorcontrib><creatorcontrib>Salem, Riad</creatorcontrib><title>Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort</title><title>European journal of nuclear medicine and molecular imaging</title><addtitle>Eur J Nucl Med Mol Imaging</addtitle><addtitle>Eur J Nucl Med Mol Imaging</addtitle><description>Background Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF &gt; 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF &gt; 15%. Methods With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF &gt; 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. Results A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. Conclusion Y90 can be performed in patients with LSF &gt; 15%. The RECIST response was identified in 32% of the patients. 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Studies have debated the safety and efficacy of Y90 in patients with LSF &gt; 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF &gt; 15%. Methods With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF &gt; 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. Results A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1–28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15–28) and 29.5 Gy (IQR 20.5–44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7–224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. Conclusion Y90 can be performed in patients with LSF &gt; 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF &gt; 15% should not deter from treatment with Y90.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31502015</pmid><doi>10.1007/s00259-019-04517-y</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9745-1825</orcidid></addata></record>
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subjects Albumins
Carcinoma, Hepatocellular - diagnostic imaging
Carcinoma, Hepatocellular - radiotherapy
Cardiology
Cough
Dosage
Embolization, Therapeutic - adverse effects
Fibrosis
Hepatocellular carcinoma
Humans
Imaging
Liver
Liver cancer
Liver Neoplasms - diagnostic imaging
Liver Neoplasms - radiotherapy
Lung
Lung carcinoma
Lung diseases
Lungs
Mathematical analysis
Medicine
Medicine & Public Health
Microspheres
Nuclear Medicine
Oncology
Oncology – Digestive tract
Original Article
Orthopedics
Patients
Radiology
Safety
Signs and symptoms
Technetium
Technetium isotopes
Thorax
Treatment Outcome
Wheezing
Yttrium
Yttrium isotopes
Yttrium Radioisotopes - adverse effects
title Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort
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