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Hepatocellular carcinoma radiation segmentectomy treatment intensification prior to liver transplantation increases rates of complete pathologic necrosis: an explant analysis of 75 tumors

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An Editorial to this article was published on 11 May 2022

Abstract

Purpose

To verify the correlation between yttrium-90 glass microsphere radiation segmentectomy treatment intensification of hepatocellular carcinoma (HCC) and complete pathologic necrosis (CPN) at liver transplantation.

Methods

A retrospective, single center, analysis of patients with HCC who received radiation segmentectomy prior to liver transplantation from 2016 to 2021 was performed. The tumor treatment intensification cohort (n = 38) was prescribed radiation segmentectomy as per response recommendations identified in a previously published baseline cohort study (n = 37). Treatment intensification and baseline cohort treatment parameters were compared for rates of CPN. Both cohorts were then combined for an overall analysis of treatment parameter correlation with CPN.

Results

Sixty-three patients with a combined 75 tumors were analyzed. Specific activity, dose, and treatment activity were significantly higher in the treatment intensification cohort (all p < 0.01), while particles per cubic centimeter of treated liver were not. CPN was achieved in 76% (n = 29) of tumors in the treatment intensification cohort compared to 49% (n = 18) in the baseline cohort (p = 0.013). The combined cohort CPN rate was 63% (n = 47). ROC analysis showed that specific activity ≥ 327 Bq (AUC 0.75, p < 0.001), dose ≥ 446 Gy (AUC 0.69, p = 0.005), and treatment activity ≥ 2.55 Gbq (AUC 0.71, p = 0.002) were predictive of CPN. Multivariate logistic regression demonstrated that a specific activity ≥ 327 Bq was the sole independent predictor of CPN (p = 0.013).

Conclusion

Radiation segmentectomy treatment intensification for patients with HCC prior to liver transplantation increases rates of CPN. While dose strongly correlated with pathologic response, specific activity was the most significant independent radiation segmentectomy treatment parameter associated with CPN.

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Fig. 1

Abbreviations

BCLC:

Barcelona Clinic Liver Cancer

CPN:

Complete pathologic necrosis

FDA:

Food and Drug Administration

HCC:

Hepatocellular carcinoma

MRI:

Magnetic resonance imaging

MIRD:

Medical Internal Radiation Dose

MELD:

Model for End-stage Liver Disease

mRECIST:

Modified Response Evaluation Criteria in Solid Tumors

ROC:

Receiver operating characteristic

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Author notes

  1. S. Ali Montazeri and Cynthia De la Garza-Ramos contributed equally to this work.

Authors and Affiliations

  1. Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    S. Ali Montazeri, Cynthia De la Garza-Ramos, Andrew R. Lewis, Ricardo Paz-Fumagalli, Zlatko Devcic, Charles A. Ritchie, Gregory T. Frey, Lucas Vidal, J. Mark McKinney & Beau B. Toskich

  2. Department of Pathology, Mayo Clinic, Jacksonville, FL, USA

    Jason T. Lewis

  3. Department of Radiology, Mayo Clinic, Jacksonville, FL, USA

    Jordan D. LeGout & David M. Sella

  4. Department of Transplant, Mayo Clinic, Jacksonville, FL, USA

    Kristopher P. Croome, Denise Harnois & Tushar Patel

  5. Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA

    Sunil Krishnan

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  1. S. Ali Montazeri
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by S. Ali Montazeri, Cynthia De la Garza-Ramos, and Beau B. Toskich. Jason T. Lewis, Jordan D. LeGout, and David M. Sella contributed in pathologic and imaging analysis. All authors contributed in data gathering and manuscript editing. All authors read, edited, and approved the final manuscript.

Corresponding author

Correspondence to Beau B. Toskich.

Ethics declarations

Ethics approval

This retrospective study was approved by the Institutional Review Board and the need for informed consent was waived. This study was compliant with the Health Insurance Portability and Accountability Act.

Competing interests

B.B.T. is an advisor for Boston Scientific, Sirtex Medical, Johnson and Johnson, AstraZeneca, Genentech, Eisai, HistoSonics, VIVOS, and Turnstone Biologics. The authors reported no other potential conflicts of interest for this work.

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This article is part of the Topical Collection on Oncology - Digestive tract

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Montazeri, S.A., De la Garza-Ramos, C., Lewis, A.R. et al. Hepatocellular carcinoma radiation segmentectomy treatment intensification prior to liver transplantation increases rates of complete pathologic necrosis: an explant analysis of 75 tumors. Eur J Nucl Med Mol Imaging 49, 3892–3897 (2022). https://doi.org/10.1007/s00259-022-05776-y

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