There is increasing evidence to support the concept of ablative-intent radioembolization, but the literature remains sparse for solitary hepatocellular carcinoma. IO Learning spoke with S. Ali Montazeri, MD, MPH, who presented his research on this topic at the Symposium for Clinical Interventional Oncology.
Why did you decide to study this topic, and what sets your study apart from what is already in the literature?
Many patients with early stage hepatocellular carcinoma (HCC) are not candidates for thermal ablation, and radioembolization has shown a longer time-to-progression than chemoembolization. Radiation segmentectomy has shown the potential to offer outcomes competitive with ablative modalities, but the literature remains scarce, as radioembolization is more commonly used for advanced disease. We wanted to study our experience with radiation segmentectomy to ascertain the reproducibility of reported outcomes, and expand on existing knowledge gaps, such as microsphere activity and blood supply.
Can you describe your findings?
We analyzed 63 patients with solitary HCC who received only radiation segmentectomy to the targeted tumor as definitive therapy or as a bridge to liver transplantation. Our radiation segmentectomy overall response rate was 98% at 3 and 6 months. Our median time to target-lesion progression was not ascertained, as only 1 patient in our cohort had progression (at 20 months). We found no grade 3 or 4 adverse events at 3 and 6 months. Ninety-seven percent of patients received a single treatment.
Tell me about something surprising you encountered while doing this research.
We were unable to perform many of the initially proposed analyses due to the lack of events.
How might your findings eventually affect clinical practice?
Radiation segmentectomy is reproducible and has outcomes that approximate thermal ablation. It can reduce the number of treatments that patients receive when compared with other transarterial therapies. It is very well tolerated. Hence, it has replaced chemoembolization as the primary transarterial therapy in our practice when treating solitary HCC.
What future studies would you like to see take place?
I would like to see a non-inferiority phase 3 randomized clinical trial comparing thermal ablation with radiation segmentectomy.
What are you hoping that attendees take away from your presentation?
Interventional radiologists should use multiple tools to treat patients with tailored therapies based on disease phenotype. Radiation segmentectomy may be perceived as a disruptive therapy by some, but it is undoubtedly a welcome addition to the interventional oncology toolset.
Abstract Title: Radiation Segmentectomy as Primary Therapy for Solitary Hepatocellular Carcinoma.
Authors: S. Ali Montazeri, MD, MPH; Zlatko Devcic, MD; Xi Li, MD, PhD; Ricardo Paz-Fumagalli, MD; Andrew R. Lewis, MD; Gregory T. Frey, MD, MPH; Charles A. Ritchie, MD; J. Mark McKinney, MD; Beau B. Toskich, MD; from the Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida.
Contact Email: firstname.lastname@example.org
Presented at CIO 2020 on October 27, 2020.
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