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Arterial hypoperfusion as a negative predictive marker for primary hepatic malignancies treated with Y-90 glass
Bita Kalaghchi1, Semra Ince1, Justin Barnes1
1School of Medicine, Washington University in St. Louis, St. Louis, MO, United States.
Background:
Radioembolization with yttrium-90 (Y-90) is utilized to treat primary liver malignancies. The efficacy of this intra-arterial therapy in arterially hypoperfused tumors is not known.
Methods:
We reviewed data of patients with primary liver tumors treated with Y-90 prescription doses of at least 150 Gy. Baseline patient characteristics, treatment history, imaging-based tumor response assessments, and clinical outcome metrics were recorded. Tumors were classified as arterially hyperperfused versus hypoperfused on post-TARE Y-90 SPECT/CTs or pre-TARE hepatic perfusion SPECT/CTs. Perfusion status was correlated with tumor response assessments and clinical outcomes. Cox proportional hazards models were utilized to compare survival and progression-free survival. Inverse probability weighting was utilized to account for clinical factors and adjusted multivariable proportional hazards analyses to examine the relationship of quantitative perfusion and cancer outcomes.
Results:
Of 400 Y-90 treatments, 88 patients received a prescribed dose of at least 150 Gy and had pre- or post-treatment SPECT/CT images. 11 and 77 patients had arterially hypoperfused and hyperperfused lesions, respectively. On dedicated liver MRI or CT at 3 months after Y-90, the complete response rates were 5.6% and 16.5% in the hypoperfused and hyperperfused cohort, respectively (P = 0.60). When controlling for various clinical features, including tumor histology, patients with arterially hypoperfused tumors had significantly shorter progression-free survival (HR 1.87, 95% CI - 1.03 - 3.37, P = 0.039) and greater elsewhere liver (HR 3.36, 95% CI = 1.23 - 9.20, P = 0.019) and distant failure (HR 7.64 (2.71 - 21.54, P < 0.001). In inverse probability weighted analysis, patients with arterially hypoperfused tumors had worse overall survival (P = 0.032). In the quantitative analysis, lower levels of lesion perfusion were also associated with worse clinical outcomes, again controlling for tumor histology.
Conclusion:
Compared to arterially hyperperfused tumors, hypoperfused primary liver tumors treated with Y-90 may have worse clinical outcomes.
Insights
Radioembolization with yttrium-90 (Y-90) may be less effective for arterially hypoperfused liver tumors. These tumors showed worse progression-free survival and overall survival compared to hyperperfused tumors.
Area of Science:
- Hepatobiliary Malignancies
- Interventional Radiology
- Nuclear Medicine
Background:
- Radioembolization using yttrium-90 (Y-90) is a standard treatment for primary liver cancers.
- The effectiveness of Y-90 radioembolization in liver tumors with reduced arterial blood flow (hypoperfused) remains unclear.
Purpose of the Study:
- To investigate the clinical outcomes of Y-90 radioembolization in primary liver tumors based on their arterial perfusion status.
- To determine if hypoperfused tumors have different treatment responses and survival rates compared to hyperperfused tumors.
Main Methods:
- Retrospective analysis of 88 patients with primary liver tumors treated with Y-90 doses ≥150 Gy.
- Tumor perfusion status (hypoperfused vs. hyperperfused) was assessed using pre- or post-treatment SPECT/CT imaging.
- Outcomes including tumor response, progression-free survival (PFS), and overall survival (OS) were analyzed using Cox proportional hazards models and inverse probability weighting.
Main Results:
- Complete response rates at 3 months did not significantly differ between hypoperfused (5.6%) and hyperperfused (16.5%) tumors.
- Hypoperfused tumors showed significantly shorter PFS (HR 1.87) and increased risk of liver failure elsewhere (HR 3.36) and distant failure (HR 7.64).
- Inverse probability weighted analysis revealed worse OS for patients with hypoperfused tumors (P=0.032), with lower lesion perfusion correlating with poorer outcomes.
Conclusions:
- Arterially hypoperfused primary liver tumors treated with Y-90 radioembolization may experience worse clinical outcomes compared to hyperperfused tumors.
- Perfusion status is a critical factor influencing the efficacy of Y-90 radioembolization in liver malignancies.
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