Dabbous Howard, Gad Sandra, Mohnasky Michael, Villalobos Alex, Brandon David, Xing Minzhi, Kokabi Nima
Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Division of Vascular & Interventional Radiology, Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC, 27514, USA.
Cardiovasc Intervent Radiol. 2025 Jul 10. doi: 10.1007/s00270-025-04113-8.
To evaluate tumor dose (TD) as a predictor of oncological outcomes in patients with hepatocellular carcinoma (HCC) treated with resin Y90 radioembolization (RE), and to evaluate non-tumoral liver dose (NTLD) as a predictor of treatment-related toxicity.
A single-center retrospective review of treatment-naïve HCC patients who underwent resin-based Y90 between 2019 and 2022 was conducted. Baseline demographics, clinical history, and adverse events per CTCAE v5.0 were analyzed. Baseline imaging and post-treatment imaging were also evaluated using Response per Modified Response Evaluation Criteria in Solid Tumors (mRECIST) for tumor response.
78 patients (mean age:66.7 years) with 91 tumors underwent Y90-RE, with a median follow-up period of 28.3 months; 23 received lobar Y90-RE, while 55 patients received segmentectomies. Mean TD for the entire cohort was 336.6 ± 291.9 Gy. Mean TD was significantly higher in segmental Y90-RE (424.3 Gy) vs lobar Y90-RE (203.7 Gy) (p < 0.001). At 3 months, 98% of segmentectomy and 72% of lobar patients achieved an objective response (OR), with 90% and 40% achieving complete response (CR), respectively. At 6 months, 97% and 94% of segmentectomy patients achieved OR and CR, compared to 84% and 68% in lobar patients. Mean tumor dose > 250 Gy predicted prolonged overall and progression free survival. A mean NTLD dose of 103 Gy predicted grade 3 + adverse events in lobar treatments.
In patients with HCC treated with resin-based Y90-RE, personalized dosimetry is a key factor in ensuring favorable oncological outcomes. Level of evidence Level 3b, retrospective cohort study.
评估肿瘤剂量（TD）作为树脂钇-90放射性栓塞（RE）治疗肝细胞癌（HCC）患者肿瘤学结局的预测指标，并评估非肿瘤肝脏剂量（NTLD）作为治疗相关毒性的预测指标。
对2019年至2022年间接受基于树脂的钇-90治疗的初治HCC患者进行单中心回顾性研究。分析基线人口统计学、临床病史以及根据CTCAE v5.0标准记录的不良事件。还使用实体瘤改良反应评估标准（mRECIST）对基线影像学和治疗后影像学进行评估以确定肿瘤反应。
78例患者（平均年龄：66.7岁）共91个肿瘤接受了钇-90-RE治疗，中位随访期为28.3个月；23例接受叶钇-90-RE治疗，55例患者接受节段切除术。整个队列的平均TD为336.6±291.9 Gy。节段性钇-90-RE的平均TD（424.3 Gy）显著高于叶钇-90-RE（203.7 Gy）（p<0.001）。3个月时，98%的节段切除术患者和72%的叶治疗患者达到客观缓解（OR），分别有90%和40%达到完全缓解（CR）。6个月时，97%和94%的节段切除术患者达到OR和CR，而叶治疗患者分别为84%和68%。平均肿瘤剂量>250 Gy预测总生存期和无进展生存期延长。叶治疗中平均NTLD剂量为103 Gy预测3级及以上不良事件。
在接受基于树脂的钇-90-RE治疗的HCC患者中，个性化剂量测定是确保良好肿瘤学结局的关键因素。证据级别：3b级，回顾性队列研究。
