Digital twins for optimising intra-arterial therapy in liver cancer

Selective internal radiation therapy (SIRT) has emerged as an effective and safe treatment for patients with unresectable and chemorefractory hepatocellular carcinoma (HCC). It consists of intra-arterial administration of radioactive microspheres, typically loaded with Yttrium-90, via a catheter directly into the hepatic artery. Unfortunately, sub-optimal efficacy of the SIRT can occur, and consequently, optimising the treatment is of utmost importance. In this work, we aim to systematically evaluate the role of the different factors that may influence the treatment success through a digital twin of the liver vasculature specific to the patient. The digital twin allowed us to reproduce the intra-arterial administration of Therasphere® in a patient diagnosed with two HCCs. An optimisation strategy was then applied to estimate the effect of the injection parameters and to identify the optimal injection configuration. The digital twin showed that the longitudinal position of the catheter within the arterial tree plays a major role in the targeting of the tumor. In addition, the catheter's tip inclination with respect to the hepatic arterial vessels was also proved to influence the microspheres' delivery to the tumor and the non-tumor tissues. The developed digital twin and optimisation strategy could help the clinicians in personalizing the SIRT, thus improving the targeting of the tumor(s) while preserving healthy tissues.