Lobar Yttrium-90 Radioembolization with BSA-Based Dosimetry for Unresectable Hepatocellular Carcinoma: Baseline...

This retrospective study investigates the benefit of combining lobar radioembolization (TARE), performed using a body surface area (BSA) dose prescription model, with targeted therapy (TT) in hepatocellular carcinoma (HCC), and aims to identify predictors of response through contrast-enhanced MRI tumour volumetry.

Ninety-two HCC patients who underwent TARE at our center between 10/2008 and 01/2022 and a baseline MRI within 60 days prior to TARE as well as follow-up MRI were included. Pre- and post-treatment target lesion volumes were measured as total-tumour-volume (TTV) and enhancing-tumour-volume (ETV). Kaplan-Meier analysis, Log rank tests, and Cox regression were used to assess the impact of clinical and imaging variables on time to target lesion progression and overall survival.

The mean patient age was 65 (SD 10) years; 67 patients had liver cirrhosis. Median overall survival (mOS) was 13 months (95% CI 11-16). A baseline ETV/TTV ratio >50% was associated with a median ETV reduction of 41% versus a 61% increase in those with low vascularity (p<0.001), and a longer time to target lesion progression (28 vs 3 months, p=0.002). Of 45 patients receiving TT, 21 were treated within 2 months before TARE. In this subgroup with pre-interventional TT, high vascularity correlated with significantly improved mOS (>17 vs 6 months, p=0.027), while no survival difference was observed in other cohorts.

High baseline vascularization may help identify patients who benefit from conventional lobar TARE and a narrowly timed combination with TT in terms of mOS, suggesting synergistic effects in patients not eligible for resection or ablation.