AASLD 2022: Is Personalized Yttrium-90 Tumor Dose Predictive of Survival in Unresectable Liver Cancer?

By: Emily Rhode
Posted: Thursday, November 10, 2022

In a prospective, single-arm study, presented at the 2022 American Association for the Study of Liver Diseases (AASLD) Annual Meeting (Abstract 5038), researchers evaluated the efficacy of a personalized resin yttrium-90 (Y-90) tumor dose to predict overall survival in patients with surgically unresectable hepatocellular carcinoma. Nima Kokabi, MD, FRCP, of Emory University School of Medicine, Atlanta, and colleagues assessed the impact of personal dosimetry and identified a favorable therapeutic dose that may be associated with an improved outcome.

“In patients with treatment-naive, surgically unresectable hepatocellular carcinoma treated with resin Y-90 radioembolization, mean [total dose] > 250 Gy appears to be an independent predictor of prolonged overall survival,” concluded the study authors. 

The trial evaluated a total of 30 eligible patients with treatment-naive hepatocellular carcinoma. Patients were administered a mean Y-90 scout dose of 343 Gy and a cumulative (scout plus therapeutic) mean tumor dose of 493 Gy. Of 29 surviving patients at the 3-month imaging follow-up, 24 (83%) had an objective response, with 21 (72%) showing a complete response. The mean overall survival for all patients in the study cohort was 24.9 months. Excluding five patients who underwent orthotopic liver transplantation after treatment, the mean overall survival for remaining patients was 23.8 months.

In patients treated with a mean tumor dose of at least 250 Gy, the overall survival was 26.2 months, which exceeded the overall survival of 16 months observed in the remaining patients (P = .003). Log-rank univariate analysis revealed that albumin-bilirubin grade, Child-Pugh score, overall response, and complete response were predictors of longer overall survival. However, multivariate analysis with Cox logistic regression showed that the sole independent predictor of overall survival was a mean therapeutic dose of at least 250 Gy (hazard ratio = 0.013; P = .032). 

Disclosure: To view Dr. Kokabi’s disclosures, visit aasld.org.

2022 AASLD Annual Meeting

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