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Purpose: We aimed to evaluate the prognostic impact of baseline clinical features and treatment procedure, including liver function measured with albumin–bilirubin (ALBI) formula and dosing methods in HCC patients treated with SIRT. Material and methods: The study includes 82 consecutive patients with liver-dominant HCC treated with SIRT (90Y glass microspheres, TheraSphereTM) between October 2014 and September 2023. Twenty-five patients were treated with standard dosimetry, while for remaining patients, multi-compartment dosimetry was performed using Simplicit90YTM software. Impact of baseline patient's characteristics including presence of portal vein thrombosis (PVT), Child–Pugh score (CP), ALBI score, bilirubin levels, tumor size and prior locoregional liver-directed or systemic treatments was assessed through multivariable Cox proportional hazard model. Results: Median follow-up after treatment was 40.0 months (15.2–67.9). At univariable analysis, ALBI score and bilirubin levels were found to be independent prognostic factors for survival after SIRT (p = 0.001, respectively); furthermore, at Cox proportional hazards analysis, HR for death of ALBI 2 versus ALBI 1 was 10.54 (95% CI, 1.42–78.19, p = 0.021), while despite not significant, HR in patients with bilirubin levels over 1.1 mg/dl was 2.67 (0.75–9.44, p = 0.118). Conversely, no significant association was found between OS and cirrhosis, tumor size and PVT. Conclusion: ALBI score demonstrated to impact OS in HCC patients treated with SIRT thus going beyond a simple prediction of treatment-related toxicity. The present results are relevant for the selection of HCC patients for SIRT in a real-world clinical setting. [ABSTRACT FROM AUTHOR]

Transarterial radioembolization (TARE) with 166Ho-loaded microspheres is an established locoregional treatment for hepatocellular carcinoma (HCC), introduced in 2010. This study evaluates the clinical outcome of patients with HCC who underwent 166Ho-TARE with personalized dosimetry. Twenty-seven patients with 36 TARE procedures were analyzed. Treatment planning, execution, and evaluation was possible without complications in all cases. At the 3-month follow-up, disease control in the treated liver was achieved in 81.8% of patients (complete remission, partial remission, and stable disease in 36.4%, 31.8%, and 13.6%, respectively). The median overall survival (OS) was 17.2 months, and progression-free survival (PFS) in the treated liver was 11 months. Statistically significant positive correlations were observed between the achieved radiation dose for the tumor and both PFS (r = 0.62, p < 0.05) and OS (r = 0.48, p < 0.05), suggesting a direct dose–response relationship. The calculated achieved dose was 8.25 Gy lower than the planned dose, with relevant variance between planned and achieved doses in individual cases. These results confirm the efficacy of the 166Ho-TARE holmium platform and underscore the potential of voxel-based, personalized dosimetry to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this pilot study is to explore the relationship between changes in sarcopenia before and after one to three months of Transarterial Radioembolization (TARE) treatment with Holmium-166 (166Ho) and its effect on the rate of local response. Our primary objective is to assess whether the worsening of sarcopenia can function as an early indicator of a subgroup of patients at increased risk of disease progression in cases of hepatocellular carcinoma (HCC). Methods: A single-center retrospective analysis was performed on 25 patients with HCC who underwent 166Ho-TARE. Sarcopenia status was defined according to the measurement of the psoas muscle index (PMI) at baseline, one month, and three months after TARE. Radiological response according to mRECIST criteria was assessed and patients were grouped into responders and non-responders. The loco-regional response rate was evaluated for all patients before and after treatment, and was compared with sarcopenia status to identify any potential correlation. Results: A total of 20 patients were analyzed. According to the sarcopenia status at 1 month and 3 months, two groups were defined as follows: patients in which the deltaPMI was stable or increased (No-Sarcopenia group; n = 12) vs. patients in which the deltaPMI decreased (Sarcopenia group; n = 8). Three months after TARE, a significant difference in sarcopenia status was noted (p = 0.041) between the responders and non-responders, with the non-responder group showing a decrease in the sarcopenia values with a median deltaPMI of −0.57, compared to a median deltaPMI of 0.12 in the responder group. Therefore, deltaPMI measured three months post-TARE can be considered as a predictive biomarker for the local response rate (p = 0.028). Lastly, a minor deltaPMI variation (>−0.293) was found to be indicative of positive treatment outcomes (p = 0.0001). Conclusion: The decline in sarcopenia three months post-TARE with Holmium-166 is a reliable predictor of worse loco-regional response rate, as evaluated radiologically, in patients with HCC. Sarcopenia measurement has the potential to be a valuable assessment tool in the management of HCC patients undergoing TARE. However, further prospective and randomized studies involving larger cohorts are necessary to confirm and validate these findings. [ABSTRACT FROM AUTHOR]

Background: Introduced in the latest BCLC 2022, endovascular trans-arterial radioembolization (TARE) has an important role in the treatment of unresectable hepatocellular carcinoma (HCC) as a "bridge" or "downstaging" of disease. The evolution of TARE technology allows a more flexible and personalized target treatment, based on the anatomy and vascular characteristics of each HCC. The flex-dose delivery program is part of this perspective, which allows us to adjust the dose and its radio-embolizing power in relation to the size and type of cancer and to split the therapeutic dose of Y90 in different injections (split-bolus). Methods: From January 2020 to January 2022, we enrolled 19 patients affected by unresectable HCC and candidates for TARE treatment. Thirteen patients completed the treatment following the flex-dose delivery program. Response to treatment was assessed using the mRECIST criteria with CT performed 6 and 9 months after treatment. Two patients did not complete the radiological follow-up and were not included in this retrospective study. The final cohort of this study counts eleven patients. Results: According to mRECIST criteria, six months of follow-up were reported: five cases of complete response (CR, 45.4% of cases), four cases of partial response (PR, 36.4%), and two cases of progression disease (PD, 18.2%). Nine months follow-up reported five cases of complete response (CR, 45.4%), two cases of partial response (PR, 18.2%), and four cases of progression disease (PD, 36.4%). No intra and post-operative complications were described. The average absorbed doses to the hepatic lesion and to the healthy liver tissue were 319 Gy (range 133–447 Gy) and 9.5 Gy (range 2–19 Gy), respectively. Conclusions: The flex-dose delivery program represents a therapeutic protocol capable of "saving" portions of healthy liver parenchyma by designing a "custom-made" treatment for the patient. [ABSTRACT FROM AUTHOR]

There have been major advances in the armamentarium for hepatocellular carcinoma (HCC) since the last official update of the Barcelona Clinic Liver Cancer prognosis and treatment strategy published in 2018. Whilst there have been advances in all areas, we will focus on those that have led to a change in strategy and we will discuss why, despite being encouraging, data for select interventions are still too immature for them to be incorporated into an evidence-based model for clinicians and researchers. Finally, we describe the critical insight and expert knowledge that are required to make clinical decisions for individual patients, considering all of the parameters that must be considered to deliver personalised clinical management.

Purpose: The aim of this study was to report the safety and tumor response rate of combined transarterial radioembolization (TARE) through the intrahepatic arteries and transarterial chemoembolization (TACE) through the extrahepatic feeding arteries (EHFA) in patients with hepatocellular carcinoma (HCC). Methods: Patients with HCC, who had both intrahepatic and extrahepatic arterial supply visible on preinterventional multiphase CT and were treated between 2016 and 2021 with a combination of TACE and TARE on the same nodule, were retrospectively included. Epidemiological, clinical, biological, and radiological characteristics were recorded. Safety and tumor response were assessed at 6 months. Results: Nine patients (8 men, median age 62 years [IQR: 54–72 years]) were included. Seven patients had previous treatments on the target nodule (TARE: 5; TACE: 2). The median longest axis (LA) of the lesion was 70 mm (IQR: 60–79 mm). Three patients had portal vein invasion (VP3). The EHFA originated from the right diaphragmatic artery (n = 6), the right adrenal artery (n = 2), and the left gastric artery (n = 1). The LA of the tumor portion treated with TACE was 47 mm (range: 35–64 mm). The ratio between the LA of the entire lesion and the LA treated with TACE was 1.44 (range: 1.27–1.7). One major complication occurred: acute on chronic liver failure. Median follow-up was 23 months (range: 16–29 months). Seven patients underwent further treatment: on the same lesion (n = 2), on newly appeared nodules (n = 2), and systemic treatment (n = 3). At 6-month follow-up, seven patients showed a local objective response. Time-to-progression was 13 (3.5–19) months. Conclusion: The combination of TARE and extrahepatic TACE for HCC with both intrahepatic and extrahepatic arterial supplies seems feasible and safe. Further studies are needed to validate the effectiveness of these preliminary results.

Charlie Alexander Hamm,1,2,&ast; Felix Busch,1,3,&ast; Anna Pöhlmann,4 Annabella Shewarega,5 Yubei He,1 Robin Schmidt,1 Han Xu,1 Gero Wieners,1 Bernhard Gebauer,1 Lynn Jeanette Savic1,2 1Department of Radiology, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany; 2Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany; 3Department of Anesthesiology, Division of Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany; 4Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany; 5Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA&ast;These authors contributed equally to this workCorrespondence: Lynn Jeanette Savic, Department of Radiology, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin, 13353, Germany, Email lynn-jeanette.savic@charite.dePurpose: To identify disease-specific profiles comprising patient characteristics and imaging biomarkers on contrast-enhanced (CE)-computed tomography (CT) that enable the non-invasive prediction of the hepatopulmonary shunt fraction (HPSF) in patients with hepatocellular carcinoma (HCC) before resin-based transarterial radioembolization (TARE).Patients and Methods: This institutional review board-approved (EA2/071/19) retrospective study included 56 patients with HCC recommended for TARE. All patients received tri-phasic CE-CT within 6 weeks prior to an angiographic TARE evaluation study using technetium-99m macroaggregated albumin. Imaging biomarkers representative of tumor extent, morphology, and perfusion, as well as disease-specific clinical parameters, were used to perform data-driven variable selection with backward elimination to generate multivariable linear regression models predictive of HPSF. Results were used to create clinically applicable risk scores for patients scheduled for TARE. Additionally, Cox regression was used to identify independent risk factors for poor overall survival (OS).Results: Mean HPSF was 13.11% ± 7.6% (range: 2.8– 35.97%). Index tumor diameter (p = 0.014) or volume (p = 0.034) in combination with index tumor non-rim arterial phase enhancement (APHE) (p < 0.001) and washout (p < 0.001) were identified as significant non-invasive predictors of HPSF on CE-CT. Specifically, the prediction models revealed that the HPSF increased with index lesion diameter or volume and showed higher HPSF if non-rim APHE was present. In contrast, index tumor washout was associated with decreased HPSF levels. Independent risk factors of poorer OS were radiogenomic venous invasion and ascites at baseline.Conclusion: The featured prediction models can be used for the initial non-invasive estimation of HPSF in patients with HCC before TARE to assist in clinical treatment evaluation while potentially sparing ineligible patients from the angiographic shunt evaluation study.Keywords: HCC, TARE, SIRT, liver cancer, contrast-enhanced computed tomography

Selective internal radiation therapy represents an endovascular treatment option for patients with primary liver malignancies, in different clinical stages. Potential applications of this treatment are in early-stage hepatocellular carcinoma, as a curative option, or in combination with systemic treatments in intermediate and advanced-stages. This review, based on existing literature and ongoing trials, will focus on the future of this treatment in patients with hepatocellular carcinoma, in combination with systemic treatments, or with the use of new devices and technological developments; it will also describe new potential future indications and structural and organizational perspectives. [ABSTRACT FROM AUTHOR]

Adjuvant sorafenib may further enhance the efficacy of transarterial radioembolization for the treatment of hepatocellular carcinoma. To evaluate the efficacy and safety of radioembolization plus sorafenib in hepatocellular carcinoma patients. With a literature search through October 2020, we identified 9 studies (632 patients). Primary outcome was overall survival. Results were expressed as pooled median, odds ratio, or hazard ratio and 95% confidence intervals. Pooled overall survival after radioembolization plus sorafenib was 10.79 months (95% confidence interval 9.19–12.39) and it was longer in Barcelona Clinic Liver Cancer (BCLC) B (14.47 months, 9.07–19.86) as compared to BCLC C patients (10.22 months, 7.53–12.9). No difference between combined therapy versus radioembolization alone was observed in terms of overall survival (hazard ratio 1.07, 0.89–1.30). Pooled median progression-free survival was 6.32 months (5.68–6.98), with 1-year progression-free survival pooled rate of 38.5% (12.7%-44.2%). No difference in progression-free survival (hazard ratio 0.94, 0.79–1.12) between the two treatments was observed. Pooled rate of severe adverse events was 48.9% (26.7%-71.2%), again with no difference between the two treatment regimens (odds ratio 1.52, 0.15–15.02). The association of sorafenib does not seem to prolong survival nor delay disease progression in patients treated with radioembolization. [ABSTRACT FROM AUTHOR]

Beta-thalassemia represents a heterogeneous group of haemoglobin inherited disorders, among the most common genetic diseases in the world, frequent in the Mediterranean basin. As beta-thalassemia patients' survival has increased over time, previously unknown complications are observed with increasing frequency. Among them, an increased risk of hepatocellular carcinoma (HCC) has been registered. Our aim is to reduce inequalities in diagnosis and treatment and to offer patients univocal recommendations in any institution.The members of the panel - gastroenterologists, radiologists, surgeons and oncologists -were selected on the basis of their publication records and expertise. Thirteen clinical questions, derived from clinical needs, and an integration of all the committee members' suggestions, were formulated. Modified Delphi approach involving a detailed literature review and the collective judgement of experts, was applied to this work.Thirteen statements were derived from expert opinions' based on the current literature, on recently developed reviews and on technological advancements. Each statement is discussed in a short paragraph reporting the current key evidence. As this is an emerging issue, the number of papers on HCC in beta-thalassemia patients is limited and based on anecdotal cases rather than on randomized controlled studies. Therefore, the panel has discussed, step by step, the possible differences between beta-thalassemia and non beta-thalassemia patients. Despite the paucity of the literature, practical and concise statements were generated.This paper offers a practical guide organized by statements describing how to manage HCC in patients with beta-thalassemia. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma is one of the most common malignancies worldwide. Transarterial radioembolisation (TARE) involves selective intra-arterial administration of microspheres loaded with a radioactive compound like Yttrium-90 (Y-90). Conventionally, C-arm-based cone-beam computed tomography has been extensively used during TARE. However, angio-computed tomography (CT) is a relatively new modality which combines the advantages of both fluoroscopy and fCT. There is scarce literature detailing the use of angio-CT in Y90 TARE. This was a retrospective study of primary liver cancer cases in which the TARE procedure was done from November 2017 to December 2021. Glass-based Y-90 microspheres were used in all these cases. All the cases were performed in the hybrid angio-CT suite. A single photon emission computed tomography–computed comography (SPECT-CT) done postplanning session determined the lung shunt fraction and confirmed the accurate targeting of the lesion. Postdrug delivery, positron emission tomography-computed tomography (PET-CT) was obtained to confirm the distribution of the Y-90 particles. The technical success, median follow-up, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were recorded. A total of 56 hepatocellular carcinoma patients underwent TARE during this period, out of which 36 patients (30 males and 6 females) underwent Y90 TARE. The aetiology of cirrhosis included non-alcoholic steatohepatitis (NASH) (11), hepatitis C (HCV) (11), hepatitis B (HBV) (9), metabolic dysfunction and alcohol-associated liver disease (MetALD) (2), alcoholic liver disease (ALD) (1), cryptogenic (1), and autoimmune hepatitis (AIH) (1). The technical success was 100 % and the median follow-up was 7 months (range: 1–32 months). The median OS was 15 months (range 10.73–19.27 months; 95 % CI) and the median local PFS was 4 months (range 3.03–4.97 months; 95 % CI). The ORR (best response, CR + PR) was 58 %. No major complications were seen in this study. TARE is a viable option for liver cancer in all stages, but more so in the advanced stages. The use of angio-CT in TARE aids in the precise delivery of the particles to the tumour and avoids non-target embolisation. [Display omitted] [ABSTRACT FROM AUTHOR]

(1) Background: To demonstrate correlation between skeletal muscle depletion measured before and after one month of TARE treatment and its induced local response rate. (2) Material and methods: For this retrospective, single center study, we evaluated 86 patients with HCC treated with TARE. Sarcopenia status was measured using the psoas muscle index (PMI). The PMI was calculated according to the formula: PMI [mm/m2]: [(minor diameter of left psoas + major diameter of left psoas + minor diameter of right psoas + major diameter of right psoas)/4]/height in m2. Population was divided in two groups according to the delta value of PMI measured at the time of TARE and one month after TARE, a group in which the delta PMI was stable or increased (No-Sarcopenia group; n = 42) vs. a group in which the delta-PMI decreased (Sarcopenia group; n = 44). Patient response was evaluated at 1, 3 and 6 months after TARE treatment with CT/MRI. (3) Results: When the radiological response of the tumor was evaluated according to the mRECIST criteria, the two groups were similar in terms of rates of complete response (p = 0.42), partial response (p = 0.26) and stable disease (p = 0.59). Progressive disease (PD) was more commonly observed in the Sarcopenia group (38.6% vs. 11.9%; p = 0.006). (4) Conclusions: Worsening of sarcopenia status measured one month after TARE is able to predict patients who will undergo disease progression.

This review focuses upon interactions and potential therapeutic targets in the 'vicious cycle' between hypoxia and neoangiogenesis following treatment of hepatocellular carcinoma with transarterial loco-regional therapies. Biomarkers correlated with angiogenesis have been studied by many authors as prognostic determinants following transarterial intrahepatic therapy. According to these results future therapies directed toward specific factors related to angiogenesis could play a significant role in preventing local tumor recurrence and remote metastasis. [ABSTRACT FROM AUTHOR]

Venous invasion by hepatic tumors most commonly occurs with hepatocellular carcinoma and is associated with worse patient prognosis. Imaging plays an important role in the diagnosis of tumor thrombus in the liver. Moreover, differentiating between bland and tumor thrombus in the liver has important diagnostic, staging, therapeutic, and prognostic implications and may require a multimodal imaging approach including ultrasound, computed tomography, and/or magnetic resonance imaging. Treatment of hepatic malignancies with associated tumor thrombus is dependent on tumor type, disease extent within the liver, liver hemodynamics, and underlying liver function. Treatment of such tumors may involve surgical, locoregional and/or systemic therapies. The current review will focus on the imaging characteristics of venous invasion by hepatic tumors. The imaging findings most useful for differentiating hepatic venous tumor thrombus and bland thrombus will be highlighted and demonstrated with imaging examples. Imaging findings with implications for subsequent patient management will be described. [ABSTRACT FROM AUTHOR]

Background: Transarterial radioembolization (TARE) has emerged as a newer regional therapy to transarterial chemoembolization (TACE) for treatment of unresectable hepatocellular carcinoma (HCC). The aim of this study is to compare clinical outcomes of both the techniques.Methods: Online search for studies comparing TARE to TACE from 2005 to present was performed. Primary outcome was overall survival rate for up to 4 years. Secondary outcomes included post-treatment complications and treatment response. Quality of included studies was evaluated by STrengthening the Reporting of OBservational studies in Epidemiology criteria. Relative risk (RR) and 95 % confidence intervals (CI) were calculated from pooled data.Results: The search strategy yielded 172 studies, five met selection criteria and included 553 patients with unresectable HCC, 284 underwent TACE and 269 underwent TARE. Median ages were 63 and 64 years for TACE and TARE, respectively. Meta-analysis showed no statistically significant difference in survival for up to 4 years between the two groups (HR = 1.06; 95 % CI 0.81-1.46, p = 0.567). TACE required at least one day of hospital stay compared to TARE which was mostly an outpatient procedure. TACE had more post-treatment pain than TARE (RR = 0.51, 95 % CI 0.36-0.72, p < 0.01), but less subjective fatigue (RR = 1.68, 95 % CI 1.08-2.62, p < 0.01). There was no difference between the two groups in the incidence of post-treatment nausea, vomiting, fever, or other complications. In addition, there was no difference in partial or complete response rates between the two groups.Conclusion: TARE appears to be a safe alternative treatment to TACE with comparable complication profile and survival rates. Larger prospective randomized trials, focusing on patient-reported outcomes and cost-benefit analysis are required to consolidate these results. [ABSTRACT FROM AUTHOR]

Simple Summary: Liver cancer is a leading cause of cancer deaths in the United States and is frequently complicated by a condition called portal vein tumor thrombus, which indicates advanced disease with a short life expectancy. Recent advances in treatment of portal vein tumor thrombus have been shown to improve life expectancy in multiple trials and the evidence supporting these treatments is reviewed here. Hepatocellular carcinoma is the fourth leading cause of cancer worldwide, and the fastest increasing cause of cancer mortality in the United States. Its propensity for vascular invasion leads to the presence of portal vein tumor thrombus in up to half of patients. PVTT results in a classification of advanced disease, given the risk recurrence secondary to intravascular spread, and formal guidelines recommend systemic therapy in these patients. However, recent advances in locoregional therapies including TACE, TARE, and ablation have demonstrated the potential to drastically improve overall survival in patients with HCC complicated by PVTT. [ABSTRACT FROM AUTHOR]

Simple Summary: Sarcopenia measured at one-month CT follow up after TARE (transarterial radioembolization) treatment is a predictive factor for the best tumor response in patients with locally advanced HCC. (1) Background: To demonstrate correlation between skeletal muscle depletion measured before and after one month of TARE treatment and its induced local response rate. (2) Material and methods: For this retrospective, single center study, we evaluated 86 patients with HCC treated with TARE. Sarcopenia status was measured using the psoas muscle index (PMI). The PMI was calculated according to the formula: PMI [mm/m2]: [(minor diameter of left psoas + major diameter of left psoas + minor diameter of right psoas + major diameter of right psoas)/4]/height in m2. Population was divided in two groups according to the delta value of PMI measured at the time of TARE and one month after TARE, a group in which the delta PMI was stable or increased (No-Sarcopenia group; n = 42) vs. a group in which the delta-PMI decreased (Sarcopenia group; n = 44). Patient response was evaluated at 1, 3 and 6 months after TARE treatment with CT/MRI. (3) Results: When the radiological response of the tumor was evaluated according to the mRECIST criteria, the two groups were similar in terms of rates of complete response (p = 0.42), partial response (p = 0.26) and stable disease (p = 0.59). Progressive disease (PD) was more commonly observed in the Sarcopenia group (38.6% vs. 11.9%; p = 0.006). (4) Conclusions: Worsening of sarcopenia status measured one month after TARE is able to predict patients who will undergo disease progression. [ABSTRACT FROM AUTHOR]

Background: Adjuvant sorafenib may enhance the efficacy of transarterial radioembolization with yttrium-90 in hepatocellular carcinoma patients. The aim of this study is to assess the efficacy and safety of radioembolization plus sorafenib in comparison to radioembolization alone. Methods: Out of 175 hepatocellular carcinoma (HCC) patients treated with radioembolization between 2011 and 2018, after propensity score matching, two groups were compared: a group of 45 patients that underwent radioembolization while being on sorafenib (Group 1) and a second group of 90 patients that underwent radioembolization alone (Group 2). Results: Baseline characteristics of the two groups were well balanced concerning liver function and tumor burden. No significant differences in survival outcomes were identified (median overall survival 10 vs. 10 months; p = 0.711), median progression-free survival 6 vs. 7 months (p = 0.992) in Group 1 and Group 2). The objective response rate in Group 1 vs. Group 2 was 45.5% vs. 42.8% (p = 1) according to mRECIST. No differences in toxicity nor in liver decompensation rates were registered. Conclusions: The association of sorafenib does not prolong survival nor delay progression in patients treated with radioembolization. Liver toxicity does not differ among the two therapeutic schemes. [ABSTRACT FROM AUTHOR]

Amaç: Yttrium-90 (Yt-90) tedavisi hepatosellüler kanserli hastalarda yaygınlaşarak kullanılan bir tedavi yöntemidir. Cerrahi şansını yitirmiş ve transarteryal kemoembolizasyon için uygun olmayan hastalar tarafımıza tedavisi açısından yönlendirilmiş olup hastaların tamamı orta-ileri evre (BCLC kriterlerine göre B ve C) hastalardan oluşmaktadır. Tedavinin etkinliğini belirlemek ve genel sağkalım üzerine değerlendirme yapmak amacıyla bu çalışma planlanmıştır. Yöntem: 2009-2018 yılları arasında başvuran HCC tanılı 127 hasta incelendi. 58 hasta TARE tedavisine uygun görülmüş olup çalışmamıza 52 adet hasta dahil edildi. Çalışma retrospektif kohort olarak hazırlanmıştır. Genel sağkalım için kaplan meier metodu uygulanmıştır. Bulgular: Yaş ortalaması 66,42±8,22 olan toplam 52 hastaya Yt-90 tedavisi başarı ile uygulandı. Elli iki hastanın 9 tanesi kadın (%17,3), 43 tanesi erkekti (%82,7). Hastalarda tedavi sonrası major bir komplikasyon gelişmedi. Ortanca sağkalım 11,05 (1,3-77,2) ay bulundu. 2 ve 5 yıllık genel sağkalım sırasıyla %22,2 ve %9,2 olarak bulundu. Bu hastalar içerisinde tam regresyon veya karaciğer transplantı şansı sayesinde küratif tedavi alan hastalar mevcuttur. Sonuç: Literatürde BCLC B ve C grubu HCC hastalarında tedavisiz sağkalım sırasıyla 9,5 ve 3,4 ay olarak belirtilmiştir. Tedavi verdiğimiz hastalarda 11,05 ay ortalama sağkalım görülmesi tedavinin faydasını ortaya koymaktadır. Kimi yabancı kaynakların BCLC A grubu hastalara ilk basamak tedavi olarak önermeye başladığı Y-90 SIRT tedavisinin yakın gelecekte yaygınlaşması olasıdır. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmanın amacı Y-90 transarteriel radyoembolizasyon (TARE) tedavisi verilen hastalarda sağkalımı ve sağkalımı öngörmeyi sağlayan faktörleri değerlendirmektir. Yöntem: Şubat 2013-Aralık 2018 tarihleri arasında merkezimizde TARE tedavisi verilen hastalar retrospektif olarak incelendi. PET/BT tedavi yanıtı PERCIST kriterleri, BT ve MR tedavi yanıtları ise RECIST 1.1 kriterleri, hematolojik ve biyokimyasal toksisite ise Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5) ile değerlendirildi. Kaplan-Meier ile sağkalım analizi yapıldı. Bulgular: Yüz sekiz hastaya TARE tedavisi verildi. Otuz altı hastanın HCC (%33,3), 22 hastanın kolorektal Ca (%20,4), 18 hastanın nöroendokrin tümör (%16,7), 7 hastanın kolanjiokarsinom (%6,5), 5 hastanın pankreas Ca (%4,6), 5 hastanın meme Ca (%4,6), 2 hastanın akciğer Ca (%1,9), 1 hastanın adrenokortikal karsinom (%0,9), 1 hastanın nazofarenks Ca (%0,9), 1 hastanın anjiosarkom (%0,9), 1 hastanın medüller tiroid karsinom (%0,9) ve 6 hastanın primeri bilinmeyen karsinom (%5,6) tanısı vardı. Kaplan-Meier sağkalım analizinde tüm hastalarda medyan sağkalım 11,9±1,4 ay, HCC hastalarında 18,4±3,7 ay, kolorektal karsinom hastalarında 10,3±2 ay, NET tanılı hastalarda ise 56,2 ay olarak hesaplandı. Tedavi sonrası albumin değerlerinde azalma olan hastalarda sağkalım daha kısaydı (4,9±0,4 ay, p <0,001). Lokal tedavi alan hastalarda sağkalım 23,6±7,8 ay iken almayanlarda 8,7±1,8 ay olarak hesaplandı (p= 0,005). 1 kür TARE tedavisi alan hastalar ve 1'den fazla tedavi alanlar arasında sağkalımda istatistiksel olarak anlamlı fark saptandı; 1'den fazla tedavi öyküsü olan hastalarda sağkalım daha uzundu (16,7±6 ay, p=0,027). Alınan TARE tedavi sayısı, tedavi öncesi lokal tedavi varlığı ve tedavi sonrasında albuminde değişim varlığı Cox regresyon analizi ile değerlendirildiğinde tedavi sonrası albumin değerinde azalma olan hastalarda azalma olmayanlara göre sağkalımın daha kısa olduğu saptandı (p=0,049, HR: 2,332, 1,002-5,428, %95 CI). Ayrıca TARE öncesi lokal tedavi alan hastalarda sağkalım almayanlara göre daha uzun olduğu sonucuna varıldı (p=0,07, HR: 2,351, 0,933-5,923, %95 CI). Sonuç: Tedavi sonrası albümin düzeyinin stabil izlenmesi ve TARE öncesi lokal tedavi alan hastalarda, sağkalımın belirgin olarak uzun izlendiği saptanmıştır. TARE tedavisi alan hastalarda; primer lezyon alanı, TARE öncesi tedaviler, TARE sonrası hemogram ve biyokimyasal değişikliklere göre sağkalımın ön görülebileceği düşünülmektedir. [ABSTRACT FROM AUTHOR]