Safety and Efficacy of External Beam Radiation Therapy in Hepatocellular Carcinoma Patients Previously Treated With Yttrium 90 Transarterial Radioembolization

IF 2.9 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2026-03-01 Epub Date: 2025-12-27 DOI:10.1016/j.adro.2025.101984

Kanokphorn Thonglert MD , Joseph Tsai MD, PhD , Wayne L. Monsky MD , August C. Anderson MD , Clemens Grassberger PhD , Stephen R. Bowen PhD , Matthew J. Nyflot PhD , Yulun He PhD , Peter Zaki MD , Guy E. Johnson MD , Smith Apisarnthanarax MD

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Abstract

Purpose

Data on the safety and efficacy of external beam radiation therapy (EBRT) after yttrium 90 transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) are limited. We report our experience using EBRT to treat HCC patients previously treated with TARE.

Methods and Materials

We retrospectively analyzed 31 HCC patients who received EBRT following TARE. Eighteen (58%) were treated with photon therapy, and 13 (42%) with proton therapy. Eighteen patients (58%) had been previously treated with TARE within the EBRT-treated lesion, with a median total dose of 72 mCi (range, 49-272). Twenty-one patients (68%) had prior TARE outside the EBRT zone, with a median total dose of 84 mCi (range, 21-330). Toxicities and survival outcomes were analyzed.

Results

The number of prior TARE treatments ranged from 1 to 5: 14 patients (45%) received 1, and 17 (55%) received 2 or more. Indications for EBRT included incomplete TARE response (n = 2), technical TARE limitations (n = 25), and other reasons (n = 4). The median tumor size was 3.8 cm (range, 1.6-19.4). Most patients (87%) had a Child-Pugh (CP)-A score. With a median follow-up of 30 months, the 2-year progression-free survival and overall survival rates were 18% and 43%, respectively. The 2-year cumulative incidence of local failure was 7%. CP+2 progression was observed in 4 patients (13%). There was no significant difference in local failure or CP+2 rates based on the EBRT target location relative to prior TARE. Grade 3+ biliary complications occurred in 3 patients (10%): 2 biloma and 1 biliary stricture. All 3 patients had received at least 2 prior TARE treatments that overlapped with the area treated with EBRT and had tumors located near the central bile duct.

Conclusions

EBRT for HCC patients previously treated with yttrium 90 is feasible and offers excellent local control. Liver dysfunction and biliary toxicities are potential complications and should be weighed against the clinical benefits.

Abstract Image

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外束放射治疗肝癌患者经动脉经90钇放射栓塞治疗的安全性和有效性。

目的：关于90钇经动脉放射栓塞（TARE）治疗肝细胞癌（HCC）后外束放射治疗（EBRT）的安全性和有效性的数据有限。我们报告了我们使用EBRT治疗先前接受TARE治疗的HCC患者的经验。方法和材料：我们回顾性分析了31例肝癌患者在TARE后接受EBRT治疗。光子治疗18例（58%），质子治疗13例（42%）。18名患者（58%）先前在ebrt治疗的病变内接受过TARE治疗，中位总剂量为72 mCi（范围49-272）。21名患者（68%）既往有EBRT区以外的TARE，中位总剂量为84 mCi（范围21-330）。分析毒性和生存结果。结果：接受过1 ~ 5次TARE治疗的患者14例（45%）接受过1次TARE治疗，17例（55%）接受过2次及以上TARE治疗。EBRT的适应症包括TARE反应不完全（n = 2）、技术性TARE限制（n = 25）和其他原因（n = 4）。中位肿瘤大小为3.8 cm（范围1.6 ~ 19.4）。大多数患者（87%）有Child-Pugh (CP)-A评分。中位随访时间为30个月，2年无进展生存率和总生存率分别为18%和43%。2年累积局部失败发生率为7%。4例（13%）患者出现CP+2进展。与之前的TARE相比，基于EBRT靶位置的局部失败或CP+2率没有显著差异。3级以上胆道并发症3例（10%）：2例胆囊瘤，1例胆道狭窄。所有3例患者都接受过至少2次TARE治疗，这些治疗与EBRT治疗的区域重叠，肿瘤位于中央胆管附近。结论：EBRT治疗先前接受过90钇治疗的HCC患者是可行的，并提供了良好的局部控制。肝功能障碍和胆道毒性是潜在的并发症，应与临床获益进行权衡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.