Hamad Alsuhaibani,MD KING FAISAL SPECIALIST HOSPITAL &RESEARCH CENTRE.
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1 Hamad Alsuhaibani,MD KING FAISAL SPECIALIST HOSPITAL &RESEARCH CENTRE.
2 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA EFFICACY AND SAFETY OF YTTRIUM-90 RADIO- EMBOLIZATION FOR THE TREATMENT OF HEPATOCELLULAR CARCINOMA, a single center experience Hamad Alsuhaibani, Abdulmajeed Al Hazzani, Mohammed Al Sebayel, Almoutaz Hashim, Waleed Al Hamoudi, Hamad Al Bahili, Hussien ElSiesy, Faisal Aba AlKhail Department of Radiology and Department of Liver Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
3 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA Locoregional transarterial treatment Uses Yettrium90 (90Y) loaded on Microcepheres Gives high dose of radiation to the tumor with relative sparing of liver parenchyma Applicable to BCLC intermediate stage(b) or stages(0) and (A) if not candidate for curative treatments
4
5 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA Indications: Palliative Treatment Downstaging for Curative Treatment; RFA, Resection, Transplantation. Bridging to Transplantation.
6 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA Inclusion Criteria: Multidisciplinary tumor board Non-infiltrative tumor Not treatable by other modalities No extrahepatic disease Tumor burden < 50% Should fulfill criteria for Okuda stage 1, CLIP 2 or Child-Pugh Class A or early B Life expectancy >3 months Performance Status 0-1.
7 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA KFSH&RC Experience Retrospective review of patients done from January, 2008 to December, 2012 Eighty Eight HCC patients were treated ( 55 M & 33 F) Ninety Nine Treatment Sessions(1.12/pt) Age range y ( Mean 63 y) Portal Vein Thrombosis, Nine (9) Patients Follow up between 1-53 months( Mean 16.5 months)
8 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA Results1: KFSH&RC Experience No procedure-related complications Thirty days mortality=0 No pulmonary or GI complications Mild post embolization syndrome (Outpatient procedure)
9 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA Results2: Liver function; KFSH&RC Experience Stable: 58 (66%) patients Mild, mostly transient: 23(26%) patients Moderate: 5(5.7%) patients 4 died ( 2, 3m. 1, 5m, 1, 21m) Sever: 2(2.2%) patients, both died at 4 and 11.5 months post treatment.
10 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA Results3: Eleven ( 11) Patients underwent liver transplantation All are alive KFSH&RC Experience Histology available for 8 Patients( 9 tumors) No significant necrosis: % necrosis: % necrosis: 3 Complete necrosis: 2
11 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA KFSH&RC Experience Radiological Response Modified RECIST (mrecist) Complete Response(CR), Disappearance of any intratumoral enhancement in all target lesions Partial Response(PR), At least a 30% decrease in the sum of diameters of viable (enhancing) target lesions Stable Disease(SD), Any cases that do not qualify for either partial response or progressive disease Progressive Disease(PD), An increase of at least 20% in the sum of the viable (enhancing) target lesions
12 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA Results4: KFSH&RC Experience Radiological Response Available for 70(79%) patients CR 32 ( 46%) PR 17 ( 24%) SD 13 ( 18%) PD 8 ( 11%) Objective Response( CR+PR) 70%
13 YTTRIUM-90( 90 Y) TRANSARTERIAL HEPATIC RADIOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA Results5: KFSH&RC Experience Survival Data (Median survival) Overall : 30 months Without Portal Vein Thrombosis(PVT): 30 months With PVT: 11.5 months
14 Group Patients (n) Survival Median (95% CI) P Overall ( ) PVT Absent ( ) PVT Present (nc* ) *nc not calculable
15 Cum Survival HCC, Post Y90 Treatment at KFSH&RC Overall Survival Survival Function 1.0 Survival Function Censored F/U MONTH
16 Cum Survival HCC, Post Y90 Treatment at KFSH&RC Survival Functions PVT NO YES NO-censored YES-censored F/U MONTH
17 Conclusion: Treatment of appropriately selected HCC patients with Y 90 microsphere as locoregional therapy is effective and safe and is likely to improve patient s survival.
18 Pre 90 Y Case 1 82Y M HCC 4M 10M 19M Post 90 Y 4M 10M19M
19 Case 2 70 Y, M HCC Pre Y 90 Post Y 90 4M
20 HCC Case 3, 73 y, M Pre Y90 Post Y90 12M
21 HCC Case 4, 44 Y M, SEG#5 HCC+ PVT Pre Y 90 Post Y 90 7M11 2MM
22 Case 5, 56y, F Pre Y90 HCC Pre Y90
23 Tumor Necrosis- Gross appearance
24 Normal Hepatocytes Hepatocellular Carcinoma
25 Tumor Necrosis 2 Microsphere
26 Case 6 77y, M HCC Pre Y90 Post Y90 11M 37M
27 Case 7, 75y,M, Two Tx HCC Pre Y-90 Post Y-90 8M 17M
28 Case 7, 75y,M, Two Tx HCC Pre Y-90 Post Y-90 8M 17M
29 Case 8 59y, F HCC Pre Y90 Post Y90 12M
30 HCC Case 9 61,M Pre Y90 Post Y90 3 M
31 HCC Case 10 69, M Pre Y90 Post Y90 3 M 3 M
32 HCC Case 11 69,F Pre Y90 Post Y90 1M
33
34 Group Patients (n) Survival Median (95% CI) P Overall ( ) Female ( ) Male ( ) *nc not calculable
35 Cum Survival HCC, Post Y90 Treatment at KFSH&RC Survival Functions GENDER F M F-censored M-censored F/U MONTH
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