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Purpose <p>To determine comprehensive treatment parameters predictive of complete pathologic necrosis (CPN) in early-stage hepatocellular carcinoma (HCC) treated with glass microsphere radiation segmentectomy (RS).</p> Methods <p>This study is a secondary analysis of 61 tumors with available post-treatment imaging from a previously published cohort treated with RS using Yttrium-90-containing glass microspheres prior to liver transplantation. Post-treatment Bremsstrahlung SPECT-CT single-compartment, multi-compartment, and voxel-based dosimetry analyses were performed using dose confirmation software and compared between tumors that achieved CPN vs. non-CPN.</p> Results <p>Median specific activity (SA [1242 vs. 867&#xa0;Bq, <i>p</i> = 0.018]), total angiosome dose (577 vs. 352 Gy, p = 0.005) tumor dose (1086 vs. 738&#xa0;Gy, <i>p</i> = 0.007), and angiosome hepatic parenchymal dose (490 vs. 309&#xa0;Gy, <i>p</i> = 0.005) were higher in the CPN (<i>n</i> = 43) vs. non-CPN (<i>n</i> = 18) cohort. Receiver operating characteristic (ROC) curve analyses (area under the curve [AUC], sensitivity, specificity) demonstrated that a SA ≥ 570&#xa0;Bq (0.69, 88%, 50%), total angiosome dose ≥ 439 Gy (0.73, 70%, 67%), tumor dose ≥ 844&#xa0;Gy (0.72, 76%, 67%), and angiosome hepatic parenchymal dose ≥ 420&#xa0;Gy (0.73, 60%, 78%) were predictive of CPN (<i>p</i> &lt; 0.05). No statistical difference was found between the tumor or angiosome particle density (PD), tumor volume, or angiosome volumes in the CPN and non-CPN cohorts. Subgroup ROC analysis of tumors that received SA &lt; 570&#xa0;Bq (<i>n</i> = 15) demonstrated that a total angiosome dose ≥ 263&#xa0;Gy (0.85, 83%, 89%) and tumor dose ≥ 451 Gy (0.83, 100%, 67%) and were predictive of CPN (<i>p</i> &lt; 0.05). An average angiosome  PD ≥ 11.4 × 10<sup>3</sup>/ml (AUC 0.81) was 83% sensitive and 79% specific to predict CPN in this subgroup (<i>p</i> &lt; 0.05). 88% of tumors that were treated above all identified treatment parameter thresholds achieved CPN, compared to zero of those which did not meet a single criterion. Tumors fulfilling all single-compartment treatment parameter thresholds also met all multi-compartment dosimetry thresholds.</p> Conclusion <p>CPN was predicted by a SA of ≥ 570 Bq, total angiosome dose of ≥ 439 Gy, tumor dose of ≥ 844&#xa0;Gy, and angiosome hepatic parenchymal dose ≥ 420&#xa0;Gy. A total angiosome PD of ≥ 11.4 × 10<sup>3</sup>/ml was associated with CPN in tumors treated with SA &lt; 570&#xa0;Bq. Both single-compartment and multi-compartment dosimetry had similar performance when optimized per the identified thresholds.</p> Clinical trial registration <p>Not applicable.</p>

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Achieving Complete Pathologic Necrosis in Hepatocellular Carcinoma Treated with Radiation Segmentectomy before Liver Transplantation: A Comprehensive Glass Microsphere Analysis

  • 期刊论文

  • 发表日期：

    2025年3月11日

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  • S. Ali Montazeri,
  • Cynthia De la Garza-Ramos,
  • Claudia Silver,
  • Ricardo Paz-Fumagalli,
  • Andrew R. Lewis,
  • Gregory T. Frey,
  • Beau B. Toskich

摘要

Purpose

To determine comprehensive treatment parameters predictive of complete pathologic necrosis (CPN) in early-stage hepatocellular carcinoma (HCC) treated with glass microsphere radiation segmentectomy (RS).

Methods

This study is a secondary analysis of 61 tumors with available post-treatment imaging from a previously published cohort treated with RS using Yttrium-90-containing glass microspheres prior to liver transplantation. Post-treatment Bremsstrahlung SPECT-CT single-compartment, multi-compartment, and voxel-based dosimetry analyses were performed using dose confirmation software and compared between tumors that achieved CPN vs. non-CPN.

Results

Median specific activity (SA [1242 vs. 867 Bq, p = 0.018]), total angiosome dose (577 vs. 352 Gy, p = 0.005) tumor dose (1086 vs. 738 Gy, p = 0.007), and angiosome hepatic parenchymal dose (490 vs. 309 Gy, p = 0.005) were higher in the CPN (n = 43) vs. non-CPN (n = 18) cohort. Receiver operating characteristic (ROC) curve analyses (area under the curve [AUC], sensitivity, specificity) demonstrated that a SA ≥ 570 Bq (0.69, 88%, 50%), total angiosome dose ≥ 439 Gy (0.73, 70%, 67%), tumor dose ≥ 844 Gy (0.72, 76%, 67%), and angiosome hepatic parenchymal dose ≥ 420 Gy (0.73, 60%, 78%) were predictive of CPN (p < 0.05). No statistical difference was found between the tumor or angiosome particle density (PD), tumor volume, or angiosome volumes in the CPN and non-CPN cohorts. Subgroup ROC analysis of tumors that received SA < 570 Bq (n = 15) demonstrated that a total angiosome dose ≥ 263 Gy (0.85, 83%, 89%) and tumor dose ≥ 451 Gy (0.83, 100%, 67%) and were predictive of CPN (p < 0.05). An average angiosome  PD ≥ 11.4 × 103/ml (AUC 0.81) was 83% sensitive and 79% specific to predict CPN in this subgroup (p < 0.05). 88% of tumors that were treated above all identified treatment parameter thresholds achieved CPN, compared to zero of those which did not meet a single criterion. Tumors fulfilling all single-compartment treatment parameter thresholds also met all multi-compartment dosimetry thresholds.

Conclusion

CPN was predicted by a SA of ≥ 570 Bq, total angiosome dose of ≥ 439 Gy, tumor dose of ≥ 844 Gy, and angiosome hepatic parenchymal dose ≥ 420 Gy. A total angiosome PD of ≥ 11.4 × 103/ml was associated with CPN in tumors treated with SA < 570 Bq. Both single-compartment and multi-compartment dosimetry had similar performance when optimized per the identified thresholds.

Clinical trial registration

Not applicable.