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Background <p>Selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) microspheres is an established locoregional treatment for early- to intermediate-stage hepatocellular carcinoma (HCC). While both resin and glass microspheres are widely used, their comparative effectiveness and safety in lobar infusion remain unclear. This study aimed to compare the effectiveness and safety of resin versus glass microspheres in patients with early- to intermediate-stage HCC undergoing lobar Y-90 SIRT.</p> Results <p>A retrospective single-center analysis was conducted on 37 consecutive patients with early- to intermediate-stage HCC who underwent lobar Y-90 SIRT (resin: <i>n</i> = 22; glass: <i>n</i> = 15). Baseline characteristics were comparable between the two groups, except for age (glass: 64 ± 6.9 years vs. resin: 69 ± 7.1 years; <i>P</i> = 0.036). Radiation doses to the tumour and non-tumoural liver were comparable between the resin and glass groups (all <i>P</i> &gt; 0.05). Patients treated with resin microspheres showed significantly longer progression-free survival (PFS) (median 9.3 vs. 6.4 months; <i>P</i> = 0.043) and overall survival (OS) (median 16.4 vs. 12.0 months; <i>P</i> = 0.035), and also demonstrated higher overall response rates, compared with those treated with glass microspheres. Univariate Cox regression identified resin microsphere use as a significant predictor of improved PFS and OS, while higher Barcelona Clinic Liver Cancer (BCLC) stage, multifocal disease, and tumour burden ≥ 25% were associated with worse survival (all <i>P</i> &lt; 0.05). Fine–Gray competing risk regression, accounting for post-SIRT treatments as competing events, further confirmed the OS benefit of resin microspheres compared with glass microspheres (subdistribution hazard ratio [SHR] = 0.35; <i>P</i> = 0.011). Subgroup analysis demonstrated that the survival advantage of resin microspheres was particularly evident in patients with a maximum tumour diameter ≥ 5&#xa0;cm (PFS: hazard ratio [HR] = 0.258, 95% confidence interval [CI]: 0.073–0.914; OS: HR = 0.111, 95% CI: 0.013–0.962). Safety outcomes were comparable between the two groups, with no significant differences in short- to long-term adverse events graded according to the Common Terminology Criteria for Adverse Events version 5.0, or in laboratory changes at 4-month follow-up (all <i>P</i> &gt; 0.05).</p> Conclusions <p>In lobar Y-90 SIRT for early-to intermediate-stage HCC, resin microspheres were associated with improved outcomes without increased toxicity compared to glass microspheres, particularly in patients with large tumours. These findings support a potential benefit of resin versus glass microspheres in lobar SIRT and warrant prospective validation in larger cohorts.</p>

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Single-center experience comparing glass and resin microspheres in lobar Y-90 SIRT for early- to intermediate-stage hepatocellular carcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Xinlin Zheng,
  • Huan Xi,
  • G. Matthijs Kater,
  • Gijs C. Bloemsma,
  • Reinoud P. H. Bokkers,
  • Aryan Mazuri,
  • Joyce van Sluis,
  • Gilles N. Stormezand,
  • Maarten W. Nijkamp,
  • Simeon J. S. Ruiter,
  • Walter Noordzij

摘要

Background

Selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) microspheres is an established locoregional treatment for early- to intermediate-stage hepatocellular carcinoma (HCC). While both resin and glass microspheres are widely used, their comparative effectiveness and safety in lobar infusion remain unclear. This study aimed to compare the effectiveness and safety of resin versus glass microspheres in patients with early- to intermediate-stage HCC undergoing lobar Y-90 SIRT.

Results

A retrospective single-center analysis was conducted on 37 consecutive patients with early- to intermediate-stage HCC who underwent lobar Y-90 SIRT (resin: n = 22; glass: n = 15). Baseline characteristics were comparable between the two groups, except for age (glass: 64 ± 6.9 years vs. resin: 69 ± 7.1 years; P = 0.036). Radiation doses to the tumour and non-tumoural liver were comparable between the resin and glass groups (all P > 0.05). Patients treated with resin microspheres showed significantly longer progression-free survival (PFS) (median 9.3 vs. 6.4 months; P = 0.043) and overall survival (OS) (median 16.4 vs. 12.0 months; P = 0.035), and also demonstrated higher overall response rates, compared with those treated with glass microspheres. Univariate Cox regression identified resin microsphere use as a significant predictor of improved PFS and OS, while higher Barcelona Clinic Liver Cancer (BCLC) stage, multifocal disease, and tumour burden ≥ 25% were associated with worse survival (all P < 0.05). Fine–Gray competing risk regression, accounting for post-SIRT treatments as competing events, further confirmed the OS benefit of resin microspheres compared with glass microspheres (subdistribution hazard ratio [SHR] = 0.35; P = 0.011). Subgroup analysis demonstrated that the survival advantage of resin microspheres was particularly evident in patients with a maximum tumour diameter ≥ 5 cm (PFS: hazard ratio [HR] = 0.258, 95% confidence interval [CI]: 0.073–0.914; OS: HR = 0.111, 95% CI: 0.013–0.962). Safety outcomes were comparable between the two groups, with no significant differences in short- to long-term adverse events graded according to the Common Terminology Criteria for Adverse Events version 5.0, or in laboratory changes at 4-month follow-up (all P > 0.05).

Conclusions

In lobar Y-90 SIRT for early-to intermediate-stage HCC, resin microspheres were associated with improved outcomes without increased toxicity compared to glass microspheres, particularly in patients with large tumours. These findings support a potential benefit of resin versus glass microspheres in lobar SIRT and warrant prospective validation in larger cohorts.