Lung shunt fraction in Y-90 Radiation Segmentectomy: Is Technetium-99 m Macroaggregated Albumin (99mTc-MAA) Scan Necessary?

Sunday, March 5, 2023

4:12 PM – 4:21 PM

Location: Phoenix Convention Center, 227ABC

Presenting Author(s)

Cynthia De La Garza Ramos, MD

Interventional Radiology Resident
Department of Radiology, Division of Interventional Radiology, Mayo Clinic, Jacksonville, FL 32224, United States

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AM

Ali Montazeri, MD MPH

Diagnostic Radiology Resident
Mayo Clinic Florida
RP

Ricardo Paz-Fumagalli, MD

Interventional Radiologist
Mayo Clinic Florida
AL

Andrew R. Lewis, MD

Assistant Professor
Mayo Clinic Florida
ZD

Zlatko Devcic, MD

Assistant professor
Mayo Clinic
GF

Gregory T. Frey, MD MPH

Assistant Professor
Mayo Clinic
CR

Charles A. Ritchie, MD

Assistant Professor of Radiology
Mayo Clinic
JM

J. Mark McKinney, MD

Dept Chair
Mayo Clinic
Beau B. Toskich, MD, FSIR

Professor
Department of Radiology, Division of Interventional Radiology, Mayo Clinic, Jacksonville, FL 32224, United States

Disclosure(s):

Cynthia De La Garza Ramos, MD: No financial relationships to disclose

Beau B. Toskich, MD, FSIR: No relevant disclosure to display

Purpose:

To investigate the lung shunt fraction (LSF) in patients with solitary hepatocellular carcinoma (HCC) who received Yttrium-90 radiation segmentectomy (RS) and explore the necessity of 99mTc-MAA scan as a preventive measure to avoid lung radiation injury.

Materials and Methods: A retrospective medical chart review of patients who underwent radiation segmentectomy with glass microspheres as initial treatment for solitary HCC at a single destination medical center from January 2017 through September 2022 was performed. Inclusion criteria were HCC diagnosis by radiologic criteria or biopsy, solitary tumor ≤8 cm, absence of macrovascular invasion or extrahepatic disease, an Eastern Cooperative Oncology Cohort performance status of 0-1, and total single compartment MIRD ≥190 Gy. The studied population was limited to solitary tumors with a size cut-off of ≤8 cm per FDA indication and BCLC guideline recommendations. All patients underwent 99mTc-MAA scan into the angiosome feeding artery and planar scintigraphy and SPECT/CT to estimate the LSF. Then, they were treated with RS per established guidelines.

Results:

Of 162 patients who met inclusion criteria, median age was 68 years, 76% were male, 36% had NASH, 34% had HCV-related liver disease, and 80% had Child-Pugh A liver disease. The prevalence of BCLC 0, A, and C stages were 18%, 66%, and 18%, respectively. Median tumor size was 2.3 cm (IQR, 2.0-3.1). The median angiosome volume was 207 cc (IQR, 121-323). Median administered dose and specific activity were 489 Gy (IQR, 349-633) and 700 Bq (IQR, 325-906), respectively. The median lung dose was 1.7 Gy (IQR, 1.0-2.9; 95% CI, 0.2-10.0) and median LSF was 1.7% (IQR, 1.0-2.9; 95%CI, 0.5-7.4). No significant difference in LSF was found between different tumor size categories (P=0.169). However, In BCLC A patients, median LSF was 1.6% (IQR, 1.0-2.5) and 2.0% (IQR, 1.2-3.7) in tumors ≤ 3 cm > 3 cm, respectively (p=0.036).

Conclusion:

Radiation segmentectomy offers minimal toxicity in patients with solitary HCC, with a lung dose below the established safety limit of 30 Gy for a single treatment. In BCLC A, LSF was lower in patients with HCC ≤ 3 cm compared to patients with larger HCCs.

Lung shunt fraction in Y-90 Radiation Segmentectomy: Is Technetium-99 m Macroaggregated Albumin (99mTc-MAA) Scan Necessary?

Presenting Author(s)

Author/Co-author(s)

Lung shunt fraction in Y-90 Radiation Segmentectomy: Is Technetium-99 m Macroaggregated Albumin (99mTc-MAA) Scan Necessary?