Baloji Abhiman, Kalra Naveen, Chaluvashetty Sreedhara, Bhujade Harish, Chandel Karamvir, Duseja Ajay, Taneja Sunil, Gorsi Ujjwal, Kumar Rajender, Singh Harmandeep, Sood Ashwani, Bhattacharya Anish, Singh Baljinder, Mittal Bhagwant R, Singh Virendra, Sandhu Manavjit S
Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Clin Exp Hepatol. 2024 May-Jun;14(3):101342. doi: 10.1016/j.jceh.2023.101342. Epub 2023 Dec 26.
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.
肝细胞癌是全球最常见的恶性肿瘤之一。经动脉放射性栓塞术（TARE）包括经动脉选择性给药载有放射性化合物（如钇 - 90，Y - 90）的微球。传统上，基于C形臂的锥形束计算机断层扫描在TARE过程中被广泛使用。然而，血管计算机断层扫描（CT）是一种相对较新的模式，它结合了荧光透视和fCT的优点。关于血管CT在Y90 TARE中的应用，详细文献较少。
这是一项对2017年11月至2021年12月期间接受TARE手术的原发性肝癌病例的回顾性研究。所有这些病例均使用玻璃基Y - 90微球。所有病例均在混合血管CT套房中进行。在计划后进行的单光子发射计算机断层扫描 - 计算机断层扫描（SPECT - CT）确定了肺分流分数并确认了病变的准确靶向。给药后，进行正电子发射断层扫描 - 计算机断层扫描（PET - CT）以确认Y - 90颗粒的分布。记录技术成功率、中位随访时间、客观缓解率（ORR）、无进展生存期（PFS）和总生存期（OS）。
在此期间，共有56例肝细胞癌患者接受了TARE，其中36例患者（30例男性和6例女性）接受了Y90 TARE。肝硬化的病因包括非酒精性脂肪性肝炎（NASH）（11例）、丙型肝炎（HCV）（11例）、乙型肝炎（HBV）（9例）、代谢功能障碍和酒精相关肝病（MetALD）（2例）、酒精性肝病（ALD）（1例）、隐源性（1例）和自身免疫性肝炎（AIH）（1例）。技术成功率为100%，中位随访时间为7个月（范围：1 - 32个月）。中位OS为15个月（范围10.73 - 19.27个月；95%CI），中位局部PFS为4个月（范围3.03 - 4.97个月；95%CI）。ORR（最佳反应，CR + PR）为58%。本研究中未观察到重大并发症。
TARE是各阶段肝癌的可行选择，在晚期尤其如此。血管CT在TARE中的应用有助于将颗粒精确递送至肿瘤并避免非靶向栓塞。
