Tumor Size and Watershed Area Correlate with Incomplete Treatment and Tumor Progression after Selective Radioembolization for Hepatocellular Carcinoma

J Vasc Interv Radiol. 2024 May;35(5):712-721.e3. doi: 10.1016/j.jvir.2024.01.031. Epub 2024 Feb 7.

Abstract

Purpose: To identify factors of incomplete treatment after segmental transarterial radioembolization (TARE) for treatment-naive and solitary hepatocellular carcinoma (HCC).

Materials and methods: A total of 75 consecutive patients (age, 68.5 years [SD ± 8.0]; 25/75 [33.3%] women) with treatment-naive, solitary HCC underwent segmental or subsegmental TARE with glass microspheres (tumor size, 3.8 cm [SD ± 2.2]; administered dose, 222.6 Gy [SD ± 123.9]) at a single institution from November 2015 to June 2022. Radiologic response and progression-free survival (PFS) were assessed as per modified Response Evaluation Criteria in Solid Tumors.

Results: Complete treatment was achieved in 48 of 75 (64.0%) patients (mean follow-up, 33.2 months [SD ± 27.4]). Patients with incomplete treatment (27/75, 36%) presented with larger tumor size (5.0 [SD ± 2.5] vs 3.1 [SD ± 1.6] cm; P = .0001), with more tumors located in the watershed zone (81.5% vs 41.7%; P = .001). These patients were less likely to be bridged to transplant or resection (22.2% vs 52.1%; P = .015). Watershed tumors demonstrated worse target tumor PFS (median PFS, 19 months vs not reached; P = .0104) and overall PFS (9.1 months vs not reached; P = .0077). Watershed location was associated with worse PFS among tumors >3 cm in size (8.4 months vs not reached; P = .035) but not in tumors ≤3 cm in size (52.2 months vs not reached; P = .915).

Conclusions: Tumor size and watershed location were associated with incomplete treatment after segmental TARE for HCC. Watershed tumors were associated with worse PFS, particularly tumors larger than 3 cm. These tumors may require careful treatment planning and repeated treatments to ensure a durable response.

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular* / diagnostic imaging
  • Carcinoma, Hepatocellular* / mortality
  • Carcinoma, Hepatocellular* / pathology
  • Carcinoma, Hepatocellular* / radiotherapy
  • Carcinoma, Hepatocellular* / therapy
  • Disease Progression*
  • Embolization, Therapeutic* / adverse effects
  • Embolization, Therapeutic* / mortality
  • Female
  • Humans
  • Liver Neoplasms* / diagnostic imaging
  • Liver Neoplasms* / mortality
  • Liver Neoplasms* / pathology
  • Liver Neoplasms* / radiotherapy
  • Liver Neoplasms* / therapy
  • Male
  • Microspheres*
  • Middle Aged
  • Progression-Free Survival*
  • Radiopharmaceuticals* / administration & dosage
  • Radiopharmaceuticals* / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Tumor Burden*
  • Yttrium Radioisotopes / administration & dosage
  • Yttrium Radioisotopes / adverse effects

Substances

  • Radiopharmaceuticals
  • Yttrium Radioisotopes