Abstract No. 6 Safety profile of multiple radiation segmentectomies in patients with hepatocellular carcinoma

Radiation-induced liver disease (RILD) is a known possible complication of radiation therapy, including intra-arterial Y90 radioembolization. Radiation segmentectomy with Y90 offers a safe (and potentially curative) treatment option in patients with hepatocellular carcinoma (HCC). With the understanding that additive radiation administration to the liver increases risk of complications, this study evaluates the safety profile of performing more than 1 radiation segmentectomy in patients with HCC. Patients who received multiple Y90 segmentectomies or single lobar radioembolizations between September 2018 and June 2020 at a single institution were included in this retrospective study. Data were collected from EMR. Radiation dose delivered, location of treatment field, and number of administrations were recorded. Additionally, AST and ALT levels at 3-month follow-up as well as ALBI score at 1-month and 3-month follow-ups were obtained. Patients were then assigned to 2 cohorts: patients with multiple segmentectomies and patients with lobar treatment only. Mean values for liver enzymes and ALBI scores for these two groups were compared using a one-tailed independent t-test. The secondary outcome of 6-month mortality was also compared between groups. A total of 18 consecutive patients (mean age 65.5years) were analyzed: 9 patients (mean age 66 years; 8 men) with > 2 segmentectomies and 9 patients (mean age 65years; 4 men) with single lobar Y90 radioembolizations. The mean number of segmentectomies per patient totaled 2.4. As expected, significantly more dose was delivered to patients receiving segmentectomies, both in total Gy delivered (P = .005) and Gy/cc delivered (P = .007). A one-tailed independent t-test found no significant difference between 3-month follow up AST levels (P = 0.22), 3-month follow up ALT levels (P = 0.18), 1-month follow up ALBI scores (P = 0.31), and 3-month follow up ALBI scores (P = 0.40) between the two cohorts. The 6-month mortality rate was 0% for both groups. Patients can receive multiple radiation segmentectomies for HCC with a similar safety profile as receiving conventional lobar radioembolization.