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• W3010268086 abstract "•Transarterial radioembolization with Y90 is now established as an effective locoregional therapy for patients with HCC. •A pre-treatment Tc-99m MAA (MAA) scan is routinely performed to estimate the possible radiation dose shunted to the lungs. •Herein, we show that the MAA scan can be removed from the treatment algorithm in certain patients with small HCCs. Background & Aims Pre-treatment Tc-99m macroaggregated albumin (MAA) scans are routinely performed prior to transarterial radioembolization (TARE) to estimate lung shunt fraction (LSF) and lung dose. In this study, we investigate LSF observed in early hepatocellular carcinoma (HCC) and provide the scientific rationale for eliminating this step from routine practice. Methods Patients with HCC who underwent Y90 from 2004 to 2018 were reviewed. Inclusion criteria were early stage HCC (UNOS T1/T2/Milan criteria: solitary ≤5 cm, 3 nodules ≤3 cm). LSF was determined using MAA in all patients. Associations between LSF and baseline characteristics were investigated. A “no-MAA” paradigm was then proposed based on a homogenous group that expressed very low LSF. Results Of 1,175 patients with HCC treated with TARE, 448 patients met inclusion criteria. Mean age was 65.6 years and 303 (68%) were males. A total of 352 (79%) had solitary lesions and 406 (91%) unilobar disease. Two-hundred and forty-three (54%), 178 (40%) and 27 (6%) patients were Child-Pugh class A, B and C, respectively. Median LSF was 3.9% (IQR 2.4–6%). Median administered activity was 0.9 GBq (IQR 0.6–1.4), for a median segmental volume of 170 cm3 (range: 60–530). Median lung dose was 1.9 Gy (IQR: 1.0–3.3). The presence of a transjugular intrahepatic portosystemic shunt (TIPS; n = 38) was associated with LSF >10% (odds ratio 12.2; 95% CI 5.2–28.6; p <0.001). Median LSF was 3.8% (IQR: 2.4–5.7%) and 6% (IQR: 3.8–15.3%) in no-TIPS vs. TIPS patients (p <0.001). Conclusion LSF is clinically negligible in patients with UNOS T1/T2 HCC without TIPS. When segmental injections are planned, this step can be eliminated, thereby reducing time-to-treatment, number of procedures, and improving convenience for patients traveling from faraway. Lay summary Transarterial radioembolization is a microembolic transarterial treatment for hepatocellular carcinoma. In our study, we found that early stage patients, where segmental injections are planned, exhibited low lung shunting, effectively eliminating the risk of radiation pneumonitis. We propose that the lung shunt study be eliminated in this subgroup, thus leading to fewer procedures, a cost reduction and improved convenience for patients. Pre-treatment Tc-99m macroaggregated albumin (MAA) scans are routinely performed prior to transarterial radioembolization (TARE) to estimate lung shunt fraction (LSF) and lung dose. In this study, we investigate LSF observed in early hepatocellular carcinoma (HCC) and provide the scientific rationale for eliminating this step from routine practice. Patients with HCC who underwent Y90 from 2004 to 2018 were reviewed. Inclusion criteria were early stage HCC (UNOS T1/T2/Milan criteria: solitary ≤5 cm, 3 nodules ≤3 cm). LSF was determined using MAA in all patients. Associations between LSF and baseline characteristics were investigated. A “no-MAA” paradigm was then proposed based on a homogenous group that expressed very low LSF. Of 1,175 patients with HCC treated with TARE, 448 patients met inclusion criteria. Mean age was 65.6 years and 303 (68%) were males. A total of 352 (79%) had solitary lesions and 406 (91%) unilobar disease. Two-hundred and forty-three (54%), 178 (40%) and 27 (6%) patients were Child-Pugh class A, B and C, respectively. Median LSF was 3.9% (IQR 2.4–6%). Median administered activity was 0.9 GBq (IQR 0.6–1.4), for a median segmental volume of 170 cm3 (range: 60–530). Median lung dose was 1.9 Gy (IQR: 1.0–3.3). The presence of a transjugular intrahepatic portosystemic shunt (TIPS; n = 38) was associated with LSF >10% (odds ratio 12.2; 95% CI 5.2–28.6; p <0.001). Median LSF was 3.8% (IQR: 2.4–5.7%) and 6% (IQR: 3.8–15.3%) in no-TIPS vs. TIPS patients (p <0.001). LSF is clinically negligible in patients with UNOS T1/T2 HCC without TIPS. When segmental injections are planned, this step can be eliminated, thereby reducing time-to-treatment, number of procedures, and improving convenience for patients traveling from faraway." @default.
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• W3010268086 date "2020-06-01" @default.
• W3010268086 modified "2023-09-27" @default.
• W3010268086 title "Streamlining radioembolization in UNOS T1/T2 hepatocellular carcinoma by eliminating lung shunt estimation" @default.
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• W3010268086 doi "https://doi.org/10.1016/j.jhep.2020.02.024" @default.
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