REGULAR CONTENT
Final ID
502
Type
Original Scientific Research-Oral or Pos
Authors
A Taylor1, C Meiers1, B Geller1, B Toskich1
Institutions
1University of Florida, Gainesville, FL
Purpose
To evaluate radiation segmentectomy, defined as ablative transarterial brachytherapy delivered to 2 or fewer hepatic segments, as a treatment for hepatic metastatic disease. The primary aim was to evaluate safety with a secondary goal of assessing initial efficacy.
Materials & Methods
A retrospective chart review of patients with hepatic metastatic disease treated with radiation segmentectomy from 8/2015-7/2016 was performed. Safety parameters evaluated were pre and post-procedure liver chemistry, MELD and ALBI scores, platelet count, and adverse events using Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0 and Clavien-Dindo classifications. MIRD dosimetry was utilized for all subjects. Initial efficacy was evaluated using mRECIST and PERCIST criteria based on initial post-procedure imaging.
Results
9 patients with hepatic metastases (5 colorectal, 1 breast, 1 leiomyosarcoma, 1 carcinoid, 1 Ewing sarcoma) unamenable to resection or thermal ablation underwent 13 radiation segmentectomies using glass microspheres. 2 patients had adverse events, 1 CTCAE Grade 3/Clavien-Dindo Grade 1 (diarrhea) and 1 CTCAE Grade 1/Clavien-Dindo Grade 1 (phrenic nerve irritation). There was asymptomatic, transient, transaminitis following 4/13 administrations. There was no significant post-treatment change in MELD score, ALBI score, or platelet count. Mean angiosomal radiation dose was 241 Gy (119-477 Gy). Initial efficacy based on imaging performed at a mean of 5 weeks post radiation segmentectomy demonstrated PERCIST complete metabolic response in 7 lesions (colorectal and breast, mean dose 232 Gy, 119–477 Gy), PERCIST partial metabolic response in 1 (colorectal, dose 133 Gy), and mRECIST complete response in 3 (non-colorectal/breast, mean dose 272 Gy, 120-394 Gy). 1 patient is awaiting imaging and 1 patient underwent segmentectomy which was technically unsuccessful.
Conclusions
Early evaluation of radiation segmentectomy indicates a safe treatment option for select patients with hepatic metastatic disease. Initial efficacy as definitive radiotherapy is promising, particularly in anatomic locations unamenable to resection or alternative means of ablation. Further investigation of long-term results is required.
Final ID
502
Type
Original Scientific Research-Oral or Pos
Authors
A Taylor1, C Meiers1, B Geller1, B Toskich1
Institutions
1University of Florida, Gainesville, FL
Purpose
To evaluate radiation segmentectomy, defined as ablative transarterial brachytherapy delivered to 2 or fewer hepatic segments, as a treatment for hepatic metastatic disease. The primary aim was to evaluate safety with a secondary goal of assessing initial efficacy.
Materials & Methods
A retrospective chart review of patients with hepatic metastatic disease treated with radiation segmentectomy from 8/2015-7/2016 was performed. Safety parameters evaluated were pre and post-procedure liver chemistry, MELD and ALBI scores, platelet count, and adverse events using Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0 and Clavien-Dindo classifications. MIRD dosimetry was utilized for all subjects. Initial efficacy was evaluated using mRECIST and PERCIST criteria based on initial post-procedure imaging.
Results
9 patients with hepatic metastases (5 colorectal, 1 breast, 1 leiomyosarcoma, 1 carcinoid, 1 Ewing sarcoma) unamenable to resection or thermal ablation underwent 13 radiation segmentectomies using glass microspheres. 2 patients had adverse events, 1 CTCAE Grade 3/Clavien-Dindo Grade 1 (diarrhea) and 1 CTCAE Grade 1/Clavien-Dindo Grade 1 (phrenic nerve irritation). There was asymptomatic, transient, transaminitis following 4/13 administrations. There was no significant post-treatment change in MELD score, ALBI score, or platelet count. Mean angiosomal radiation dose was 241 Gy (119-477 Gy). Initial efficacy based on imaging performed at a mean of 5 weeks post radiation segmentectomy demonstrated PERCIST complete metabolic response in 7 lesions (colorectal and breast, mean dose 232 Gy, 119–477 Gy), PERCIST partial metabolic response in 1 (colorectal, dose 133 Gy), and mRECIST complete response in 3 (non-colorectal/breast, mean dose 272 Gy, 120-394 Gy). 1 patient is awaiting imaging and 1 patient underwent segmentectomy which was technically unsuccessful.
Conclusions
Early evaluation of radiation segmentectomy indicates a safe treatment option for select patients with hepatic metastatic disease. Initial efficacy as definitive radiotherapy is promising, particularly in anatomic locations unamenable to resection or alternative means of ablation. Further investigation of long-term results is required.