Radiation segmentectomy, a minimally invasive procedure that could be done on an outpatient, same-day basis, has been potential as curative as other curative strategies for early-stage hepatocellular carcinoma (HCC).
"Radiation segmentectomy (RS) is a targeted form of radioembolization with yttrium 90 (90Y), usually delivered to no more than two hepatic segments where the high tumor dose maximizes cytotoxic radiation delivery, whereas the focused delivery minimizes risk of collateral parenchymal damage," Robert Lewandowski, MD, Northwestern University, Chicago and collegues explained.
"Our outcomes suggest that RS may be considered curative in patients with unbeatable BCLC (Barcelona Clinic Liver Cancer) stage 0 or A lesions less than or equal to 5 cm," they conclude. Potentially curative strategies for early-stage HCC include resection, transplantation, and radiofrequency ablation.
The study was published online April 24 in Radiology. The analysis included 70 patients, median age 71 years, with a solitary HCC 5 cm or less that was not amenable to treatment with percutaneous ablation.
These 70 patients underwent RS treatment over a period of 14 years, the investigators note; 66% had RS to one segment containing the tumor, while the remaining 34% of patients required RS to two segments.
Most (71%) patients had tumors 3 cm or less, while the remaining 29% had tumors between 3 and 5 cm in size. Senior author, Riad Salem, MD, Northwestern University Feinberg School of Medicine in Chicago, Illinois, explained in a statement.
Cone-beam CT allows the radiologists to perform the segmental injections isolated to very small tumors, sparing most normal tissue with a high level of accuracy.
Responses to RS
Responses to the procedure were assessed by both the European Association for the Study of the Liver (EASL) criteria, as well as the necrosis criteria of the World Health Organization (WHO).
At a mean follow-up of 29 months, 90% of the group responded to treatment according to EASL criteria, 59% of them being complete responses. By WHO criteria, response rates were lower at 71%, some 16% of them being complete responses according to WHO response criteria.
Mohamed Bouattour, MD, Beaujon University Hospital, Clichy, France, suggested that the use of "selective" radioembolization as was deployed in the current study showed "impressive" results regarding tumor control and survival benefit for this population.
"Unlike advanced stage HCC, when compared or added to systemic therapies, radioembolization with yttrium 90 seems to have a promising effect on early HCC," Bouattour said.
Bouattour cautioned that study results need to be considered in light of the study's retrospective design and the limited size of the patient sample. He also pointed out that the center where these procedures were performed was one with great expertise in this arena, and he cautioned that less experienced centers might not be able to achieve similarly good results.