Efficacy of Yttrium-90 Transarterial Radioembolisation in Advanced Hepatocellular Carcinoma: An Experience With Hybrid Angio-Computed Tomography and Glass Microspheres

Abhiman Baloji; Naveen Kalra; Sreedhara Chaluvashetty; Harish Bhujade; Karamvir Chandel; Ajay Duseja; Sunil Taneja; Ujjwal Gorsi; Rajender Kumar; Harmandeep Singh; Ashwani Sood; Anish Bhattacharya; Baljinder Singh; Bhagwant R Mittal; Virendra Singh; Manavjit S Sandhu

doi:10.1016/j.jceh.2023.101342

Efficacy of Yttrium-90 Transarterial Radioembolisation in Advanced Hepatocellular Carcinoma: An Experience With Hybrid Angio-Computed Tomography and Glass Microspheres

J Clin Exp Hepatol. 2024 May-Jun;14(3):101342. doi: 10.1016/j.jceh.2023.101342. Epub 2023 Dec 26.

Authors

Abhiman Baloji¹, Naveen Kalra¹, Sreedhara Chaluvashetty¹, Harish Bhujade¹, Karamvir Chandel¹, Ajay Duseja², Sunil Taneja², Ujjwal Gorsi¹, Rajender Kumar³, Harmandeep Singh³, Ashwani Sood³, Anish Bhattacharya³, Baljinder Singh³, Bhagwant R Mittal³, Virendra Singh², Manavjit S Sandhu¹

Affiliations

¹ Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
² Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
³ Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

PMID: 38283702
PMCID: PMC10819781 (available on 2025-05-01)
DOI: 10.1016/j.jceh.2023.101342

Abstract

Background: Hepatocellular carcinoma is one of the most common malignancies worldwide. Transarterial radioembolisation (TARE) involves selective intra-arterial administration of microspheres loaded with a radioactive compound like Yttrium-90 (Y-90). Conventionally, C-arm-based cone-beam computed tomography has been extensively used during TARE. However, angio-computed tomography (CT) is a relatively new modality which combines the advantages of both fluoroscopy and fCT. There is scarce literature detailing the use of angio-CT in Y90 TARE.

Methods: This was a retrospective study of primary liver cancer cases in which the TARE procedure was done from November 2017 to December 2021. Glass-based Y-90 microspheres were used in all these cases. All the cases were performed in the hybrid angio-CT suite. A single photon emission computed tomography-computed comography (SPECT-CT) done postplanning session determined the lung shunt fraction and confirmed the accurate targeting of the lesion. Postdrug delivery, positron emission tomography-computed tomography (PET-CT) was obtained to confirm the distribution of the Y-90 particles. The technical success, median follow-up, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were recorded.

Results: A total of 56 hepatocellular carcinoma patients underwent TARE during this period, out of which 36 patients (30 males and 6 females) underwent Y90 TARE. The aetiology of cirrhosis included non-alcoholic steatohepatitis (NASH) (11), hepatitis C (HCV) (11), hepatitis B (HBV) (9), metabolic dysfunction and alcohol-associated liver disease (MetALD) (2), alcoholic liver disease (ALD) (1), cryptogenic (1), and autoimmune hepatitis (AIH) (1). The technical success was 100 % and the median follow-up was 7 months (range: 1-32 months). The median OS was 15 months (range 10.73-19.27 months; 95 % CI) and the median local PFS was 4 months (range 3.03-4.97 months; 95 % CI). The ORR (best response, CR + PR) was 58 %. No major complications were seen in this study.

Conclusion: TARE is a viable option for liver cancer in all stages, but more so in the advanced stages. The use of angio-CT in TARE aids in the precise delivery of the particles to the tumour and avoids non-target embolisation.

Keywords: HCC; TARE; Yttrium-90; angio-CT; glass microspheres.