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Realized tumor to normal ratios in hepatocellular carcinoma patients undergoing transarterial radioembolization: a retrospective evaluation

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Abstract 

Objectives

To determine the realized tumor to normal ratios (TNRs) in patients undergoing radiation segmentectomies (RS); determine the relationship between TNRs and particle load in transarterial radioembolization (TARE).

Methods

In total, 148 patients who underwent 184 TARE procedures for hepatocellular carcinoma were evaluated. Post treatment SPECT CT bremsstrahlung imaging was analyzed utilizing Simplicit90y™ to determine realized TNR. A model which normalized activity across all RS treatments to a level that would achieve 400 Gy by unicompartmental dosing was created to determine the affect realized TNR would have on tumor absorbed dose.

Results

The mean TNR in the setting of RS was 2.88 ± 1.60 and was higher for glass as compared to resin microspheres (3.07 ± 1.68 vs 2.24 ± 1.21, p = 0.01). The TNR was significantly greater in the RS as compared to the lobar deliveries (2.88 ± 1.60 vs 2.16 ± 1.12, p < 0.01). When normalizing the activity of RS treatments to the level required to achieve 400 Gy by unicompartmental calculations, there was found to be significant differences in the predicted tumor absorbed dose when separated by the median tumor dose (601.2 ± 133.3 vs 1146.9 ± 297.5, p < 0.01) or median realized TNR (1119.2 ± 341 Gy vs 635.7 ± 160.2 Gy, p < 0.01). Particle load was found to be associated with TNR on univariate (p < 0.01) and multivariate (p < 0.01) analysis.

Conclusion

Significant TNRs are seen in RS and perhaps argue for the use of multi-compartmental dosimetry techniques in this setting and particle load may affect TNR.

Key Points

• Tumor to normal ratios were significantly higher in radiation segmentectomies than lobar deliveries.

• Tumor to normal ratios were significantly higher when utilizing glass, as compared to resin microspheres.

• When creating a model that prescribed the activity required to reach 400 Gy by MIRD, realized tumor dose varied significantly in radiation segmentectomies.

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Abbreviations

BSA:

Body surface area

CT:

Computed tomography

HCC:

Hepatocellular carcinoma

IQR:

Interquartile range

MIRD:

Medical Internal Radiation Dose

ROI:

Region of interest

SPECT:

Single-photon emission computed tomography

TARE:

Transarterial radioembolization

Tc 99 m MAA:

Technetium-99 m macro-aggregated albumin

TNR:

Tumor to normal ratio

XRT:

External beam radiation

y90:

Yttrium-90

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Division of Interventional Radiology, Department of Radiology, University of Minnesota, 420 Delware St SE, MMC 292, Minneapolis, MN, 55455, USA

    Shamar Young, Ting Chen, Siobhan Flanagan & Jafar Golzarian

  2. Department of Radiology, Minneapolis VA Medical Center, Minneapolis, MN, USA

    Tina Sanghvi

Authors
  1. Shamar Young
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  2. Ting Chen
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  3. Siobhan Flanagan
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  4. Jafar Golzarian
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  5. Tina Sanghvi
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Correspondence to Shamar Young.

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Guarantor

The scientific guarantor of this publication is Shamar Young.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: SY is a consultant for Boston Scientific. JG is a consultant for Sirtex Medical.

Statistics and biometry

Nathan Rubin and Linda Young kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Young, S., Chen, T., Flanagan, S. et al. Realized tumor to normal ratios in hepatocellular carcinoma patients undergoing transarterial radioembolization: a retrospective evaluation. Eur Radiol 32, 4160–4167 (2022). https://doi.org/10.1007/s00330-021-08501-9

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  • DOI: https://doi.org/10.1007/s00330-021-08501-9

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