Daniel B. Brown, MD, FSIR, Vanderbilt University Medical Center, Nashville, Tennessee, discusses an analysis of the RESiN registry, evaluating the use of Y90 embolization among patients with hepatocellular carcinoma who have undergone prior resection.

This study found that patients with HCC who had undergone a prior resection did not have a shorter overall survival or greater incidence of toxic events when receiving Y90 radioembolization for recurrence.

These results were first presented at the Society for Interventional Radiology 2024 Annual Meeting in Salt Lake City, Utah.

Transcript:

Hi, I'm Dan Brown. I'm the interim chair of radiology at Vanderbilt University Medical Center I'm an interventional radiologist who's focused on interventional oncology during my career.

The RESiN analysis, we closed it this year. It was 45 sites, a prospective observational data. And we did some big tumor projects where we looked at all the HCC people and all the cholangiocarcinoma people and all the colorectal. And the last year or so, we started looking at things that in subgroups that we can analyze. And there's not a lot out there on people who had previous surgery in the liver and how you dose them. It's a consideration because when you look at the total liver volume, do you have to adjust the dose down if you're treating an area? It's really unknown and there's very little literature on it focused on that group.

We know that for colorectal cancer, 15% of the colorectal patients were resected in RESiN. In HCC, I think it was about 10% somewhere around there had previous resections. We thought this was an opportunity to look at those types of patients. The University of Kansas group separately did the colorectal analysis. They had a poster at the [SIR] meeting. For the HCC patients, we had 20 that had previous resections: trisegmentectomy, a bunch of lobectomies, and there were a few that were not reported.

What we found was that there was no increased toxicity following treatment which is a big deal. There was an expert panel put together a few years back that got published and they were good experts, but they were recommending much lower dose prescriptions than what we found with the RESiN data. People just kind of did what they did. The doses that were given to patients are consistent with HCC papers otherwise.

And there was no difference in our project, in the doses received by the surgical-naive patients versus those who had previous resection. For HCC, most of the time, treating a small part of the liver and less than half the liver, that you don't really need to drop your dose down in order to do an effective safe treatment.

This validates that post-resection patients can be treated safely. The groups aren't identically matched because even though it's a prospective, observational study, it's just whoever got entered. It wasn't really controlled for enrollment. There were differences. between the groups, they weren’t perfect matches.

But the overall survival is the same. Both groups lived over 30 or 31 months median, which is pretty good, and the toxicities were low in both groups.

Source:

Carlos C, Lipin D, Sze DY, et al. Safety and efficacy of Y-90 embolization in hepatocellular carcinoma (HCC) patients who have undergone prior resection: analysis of the RESiN registry (NCT02685631). Presented at the Society of Interventional Radiology Annual Meeting. March 23-28, 2024; Salt Lake City, UT