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Evaluation of Medium-Term Efficacy of Y90 Radiation Segmentectomy vs Percutaneous Microwave Ablation in Patients with Solitary Surgically Unresectable < 4 cm Hepatocellular Carcinoma: A Propensity Score Matched Study

  • Clinical Investigation
  • Interventional Oncology
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Abstract

Objective

To evaluate the efficacy and safety of Y90 radiation segmentectomy (RS) vs. percutaneous microwave ablation (MWA) in patients with solitary HCC ≤ 4 cm.

Methods

From 2014 to 2017, 68 consecutive treatment naïve patients were included (34 per treatment arm). Chi-square and t-test were used to evaluate differences in baseline demographics between groups. Objective response was evaluated using mRECIST and toxicity using CTCAE. Overall survival (OS) and progression free survival (PFS) in the targeted tumor and the remainder of liver from initial treatment was calculated using Kaplan–Meier estimation. Propensity score matching was then performed with n = 24 patients matched in each group. Similar outcome analysis was then pre-formed.

Results

In the overall study population, both groups had similar baseline characteristics with the exception of larger lesions in the RS group. There was no difference in toxicity, objective tumor response, OS and non-target liver PFS between the MWA and RS group (p’s > 0.05). In the matched cohort, the objective tumor response was 82.6% in MWA vs. 90.9%% in RS (p = 0.548). The mean OS in the MWA group (44.3 months) vs RS (59.0 months; p = 0.203). The targeted tumor mean PFS for the MWA groups was 38.6 months vs. 57.8 months in RS group (p = 0.005). There was no difference overall PFS and toxicity between the 2 matched groups.

Conclusions

Our data suggest Y90 RS achieves similar tumor response and OS with a similar safety compared to MWA in the management of HCC lesions ≤ 4 cm. Additionally, targeted tumor PFS appears to be prolonged in the RS group with similar non-target liver PFS between RS and MWA group.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA, 30322, USA

    Linzi Arndt

  2. Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Alexander Villalobos, William Wagstaff, Robert M. Ermentrout, Zachary Bercu, Mircea Cristescu, Bill S. Majdalany & Nima Kokabi

  3. Morehouse School of Medicine, Atlanta, GA, USA

    Bernard Cheng

  4. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Minzhi Xing

  5. Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Anand Shah & Joel Wedd

  6. Division of Transplant Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Joseph F. Magliocca & Marty T. Sellers

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  1. Linzi Arndt
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  2. Alexander Villalobos
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  14. Nima Kokabi
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Corresponding author

Correspondence to Linzi Arndt.

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Conflict of interest

Nima Kokabi conducts research partially supported by SIRTEX medical LTD. All other authors declare no conflict of interest.

Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of HELSINKI and its later amendments or comparable ethical standards. For this retrospective type of study, formal consent is not required.

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Arndt, L., Villalobos, A., Wagstaff, W. et al. Evaluation of Medium-Term Efficacy of Y90 Radiation Segmentectomy vs Percutaneous Microwave Ablation in Patients with Solitary Surgically Unresectable < 4 cm Hepatocellular Carcinoma: A Propensity Score Matched Study. Cardiovasc Intervent Radiol 44, 401–413 (2021). https://doi.org/10.1007/s00270-020-02712-1

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