Safety of Selective Y-90 Radioembolization for Treatment of Liver Cancers in Patients with Hyperbilirubinemia

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Sabina Cashin, MD

Resident Physician
Rush University Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Dustin Gulizia, MD (he/him/his)

IR/DR Resident
Rush University Medical Center
Alexander Podlaski, M.D.

Fellow Physician
Rush University Medical Center
BK

Bobak Khalili, B.S.

Medical Student
Rush University Medical Center
SR

Sahitya Raja, MMSc

Medical Student
Rush University
Bulent Arslan, MD FSIR

Professor and Chair, Vascular and Interventional Service Line
Rush University Medical Center
KM

Kumar Madassery, MD

Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center, Rush Oak Park
RR

Rehan Riaz, MD

Assistant Professor of Radiology
Rush University Medical Center
DT

David Tabriz, MD, RPVI

Assistant Professor of Radiology
Rush University
UT

Ulku C. Turba, MD FSIR

Professor, Vascular and Interventional Radiology
RUSH University Medical Center
Jordan Tasse, MD

Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center

Disclosure(s):

Sabina Cashin, MD: No financial relationships to disclose

Dustin Gulizia, MD: No financial relationships to disclose

Bulent Arslan, MD FSIR: Angiodynamics Inc: Advisory Committee or Review Panel Member (Ongoing), Consultant (Ongoing); BD Bard: Consultant (Ongoing), Speaking and Teaching (Ongoing); Blackswan Vascular Inc: Consultant (Ongoing), Ownership Interest (Ongoing), Speaking and Teaching (Ongoing); Cook Inc: Consultant (Ongoing), Speaking and Teaching (Ongoing); Medtronic Inc: Consultant (Ongoing), Speaking and Teaching (Ongoing); Penumbra: Speaking and Teaching (Ongoing)

Kumar Madassery, MD: Abbott Vascular: Consultant (Ongoing); Cook Mediical: Consultant (Ongoing); Koninklijke Philips: Consultant (Ongoing); PENUMBRA INC: Consultant (Ongoing)

Ulku C. Turba, MD FSIR: No financial relationships to disclose

Jordan Tasse, MD: No financial relationships to disclose

Purpose: Selective Y-90 radioembolization is commonly used to treat unresectable liver cancer. However, patients with primary liver cancers often have impaired liver function and lobar radioembolization is generally contraindicated in patients with elevated serum total bilirubin (BR) levels greater than 2 mg/dL. We assessed the safety of selective Y-90 of patients with liver tumors and hyperbilirubinemia.

Materials and Methods: All patients who underwent segmental or subsegmental Y-90 radioembolization using glass microspheres at our institution were reviewed. Patients with serum BR >/= 2.0 mg/dL on the day of treatment were selected. Patients with hyperbilirubinemia at prior Y-90 procedures, patients who underwent subsequent Y-90 procedures within the follow up period, and lab values following any liver transplantation were excluded. Measured outcomes included hepatic function labs (BR, AST, ALT, and ALP) documented at day of treatment and approximately 1, 3, and 6 months. Hepatobiliary toxicities were classified according to Common Terminology Criteria for Adverse Events, version 5 (CTCAE v.5).

Results:
16 patients between 2013-2022 had BR >/= 2.0 mg/dL on the date of Y-90 treatment (mean 3.0 mg/dL, range 2.2-4.4 mg/dL). Specifically, 4 patients had BR 2.0-2.4 mg/dL, 5 patients had BR 2.5-2.9 mg/dL, and 7 patients had BR >/= 3.0 mg/dL. 15/16 (94%) patients had HCC and 1/16 (6%) patients had cholangiocarcinoma. Mean tumor size in maximum dimension was 3.8 cm (range 0.9-10.0 cm).

12/17 (70.6%) patients had no clinically significant BR toxicity.

5 total patients developed grade 2 BR toxicity (2 patients in the 2.0-2.4 mg/dL group, 1 patient in the 2.5-2.9 mg/dL group, and 2 patients in the >/= 3.0 mg/dL group). 2/5 (40%) patients developed grade 2 BR toxicity at 1 month and 3/5 (60%) patients developed grade 2 BR toxicity at 3 months. 2 patients toxicity persisted at follow up, however there was no additional new BR toxicity at 6 months. No patients developed grade 3 or higher BR toxicity

2 patients developed grade 2 transaminase (AST +/- ALT) toxicity (1 patient in the 2.5-2.9 mg/dL group and 1 patient in the >/= 3.0 mg/dL group).

4/16 (25%) patients underwent subsequent liver transplantation. No patients developed clinical deterioration or radiation-induced liver failure related to Y-90 treatment.

Conclusion: Selective Y-90 treatment of liver tumors appears safe in select patients with concomitant hyperbilirubinemia and patients may become candidates for subsequent liver transplantation. Additional studies with increased sample sizes are needed for further evaluation.