Download PDF
CC BY 4.0 · The Arab Journal of Interventional Radiology 2025; 09(01): 025-033
DOI: 10.1055/s-0044-1788713
Original Article

Y90 Radiation Segmentectomy versus Microwave Ablation for Hepatocellular Carcinoma in Locations Suboptimal for Percutaneous Ablation

Olivia Kola 
1   Department of Radiology, Rutgers – New Jersey Medical School, Newark, New Jersey, United States
,
John A. Cieslak
2   Department of Radiology, Endeavor Health Medical Group, Evanston, Illinois, United States
,
Nirav Chauhan
3   Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Priya Gupta
4   Department of Radiology, Henry Ford Hospital, Detroit, Michigan, United States
,
Pratik Shukla
5   Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, New Jersey, United States
,
Abhishek Kumar
5   Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, Newark, New Jersey, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Purpose The purpose of our study was to evaluate outcomes following percutaneous microwave ablation (MWA) versus yttrium-90 (Y90) radiation segmentectomy (RS) for tumors in suboptimal locations for ablation.

Materials and Methods Retrospective review (January 2014–July 2019) was performed on patients who underwent Y90-RS or MWA (with or without prior transarterial chemoembolization [TACE]) with curative intent for early-stage hepatocellular carcinoma (HCC) lesions in suboptimal locations for percutaneous ablation, defined as locations in which needle placement is within 5 mm of critical structures (liver dome, liver capsule, gallbladder, and hilum). The primary endpoints were treatment response as per the modified Response Evaluation Criteria in Solid Tumors criteria and complications.

Statistical Analysis Fischer's exact test was performed for categorical variables, and Student's t-tests for nominal variables.

Results Twenty-three lesions in 20 patients (13 male, 67 ± 8.8 years) and 30 lesions in 30 patients (18 male, 62.5 ± 10.6 years) were treated with Y90-RS and MWA (19 with prior TACE), respectively. There were no differences in demographics (p > 0.05). Mean tumor diameter was 2.9 ± 1.0 in those treated with Y90-RS and 2.3 ± 0.9 for MWA (p < 0.05). Lesions were located adjacent to the following structures: dome (n = 22), capsule (n = 16), hilum (n = 9), and gallbladder (n = 6). All patients were Eastern Cooperative Oncology Group performance status 0 to 1. Of the MWA cohort, 19 were Child-Pugh class A, 5 were B, and 6 were C and the mean pretreatment laboratory values were as follows: Model for End-stage Liver Disease sodium (MELD-Na) 12.7 ± 4.6, alpha-fetoprotein (AFP) 848 ± 3168.0, aspartate aminotransferase (AST) 71.9 ± 49.1, alanine aminotransferase (ALT) 48.0 ± 32.4, and total bilirubin 2.4 ± 2.7. Of the Y90-RS cohort, 15 were Child-Pugh class A, 4 were B, and 1 was C and pretreatment laboratory values were as follows: MELD-Na 10.5 ± 3.3 (Y90-RS), AFP 762.2 ± 1793.8 (Y90), AST 50.3 ± 30.5 (Y90), ALT 30.1 ± 16.9 (Y90), and total bilirubin 1.6 ± 1.1 (Y90). Complete response rate following Y90 was 96 versus 76% for MWA, with no disease progression after Y90-RS within the follow-up period. Three (13%) lesions demonstrated progression of disease (time to progression 6.3 months) after MWA. No grade > 2 toxicities or procedure-related complications were noted following Y90-RS. There were 7 major (arterioportal fistula with hemoperitoneum, pneumothorax, liver infarction, and capsular burn) and 3 minor complications following MWA.

Conclusion Y90-RS is a valuable alternative to percutaneous MWA as a first-line therapy for early-stage HCC for tumors in suboptimal locations for ablation, offering a favorable treatment response and safety profile.

Keywords

ablation - hepatocellular carcinoma - locoregional therapy - microwave ablation - Y-90 - yttrium

Ethical Approval Statement

This study was conducted in accordance with ethical standards as defined in the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals guidelines, and approved by the relevant institutional review boards. The protocol (Pro2023002524) for this study was approved by the Institutional Review Board at Rutgers New Jersey Medical School.


Authors' Contribution

The authors confirm contribution to the paper as follows: study conception and design: P.S., A.K., J.C.; data collection: J.C., N.C., P.G.; analysis and interpretation of results: O.K., P.G., J.C., N.C., P.S., A.K.; manuscript preparation: O.K., J.C., P.S., A.K.; all authors reviewed the results and approved the final version of the manuscript.




Publication History

Article published online:
06 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology 2021; 73 (Suppl 1, Suppl 1): 4-13
    CrossrefPubMedSearch in Google Scholar
  • 2 Reig M, Forner A, Rimola J. et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022; 76 (03) 681-693
    CrossrefPubMedSearch in Google Scholar
  • 3 Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology 2016; 150 (04) 835-853
    CrossrefPubMedSearch in Google Scholar
  • 4 Yu Q, Khanjyan M, Fidelman N, Pillai A. Contemporary applications of Y90 for the treatment of hepatocellular carcinoma. Hepatol Commun 2023; 7 (10) e0288
    PubMedSearch in Google Scholar
  • 5 Cho YK, Kim JK, Kim WT, Chung JW. Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis. Hepatology 2010; 51 (04) 1284-1290
    CrossrefPubMedSearch in Google Scholar
  • 6 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 2021; 44 (03) 401-413
    CrossrefPubMedSearch in Google Scholar
  • 7 Kim E, Sher A, Abboud G. et al. Radiation segmentectomy for curative intent of unresectable very early to early stage hepatocellular carcinoma (RASER): a single-centre, single-arm study. Lancet Gastroenterol Hepatol 2022; 7 (09) 843-850
    CrossrefPubMedSearch in Google Scholar
  • 8 Prachanronarong K, Kim E. Radiation segmentectomy. Semin Intervent Radiol 2021; 38 (04) 425-431
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Riaz A, Gates VL, Atassi B. et al. Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization. Int J Radiat Oncol Biol Phys 2011; 79 (01) 163-171
    CrossrefPubMedSearch in Google Scholar
  • 10 Johnson GE, Padia SA. Yttrium-90 radiation segmentectomy. Semin Intervent Radiol 2020; 37 (05) 537-542
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Saini A, Wallace A, Alzubaidi S. et al. History and evolution of yttrium-90 radioembolization for hepatocellular carcinoma. J Clin Med 2019; 8 (01) 55
    CrossrefPubMedSearch in Google Scholar
  • 12 Smolock AR, Shaw C. Hepatic microwave ablation in challenging locations. Semin Intervent Radiol 2019; 36 (05) 392-397
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Miller FH, Lopes Vendrami C, Gabr A. et al. Evolution of radioembolization in treatment of hepatocellular carcinoma: a pictorial review. Radiographics 2021; 41 (06) 1802-1818
    CrossrefPubMedSearch in Google Scholar
  • 14 Briody H, Duong D, Yeoh SW. et al. Radioembolization for treatment of hepatocellular carcinoma: current evidence and patterns of utilization. J Vasc Interv Radiol 2023; 34 (07) 1200-1213
    CrossrefPubMedSearch in Google Scholar
  • 15 Hamad A, Aziz H, Kamel IR, Diaz DA, Pawlik TM. Yttrium-90 radioembolization: current indications and outcomes. J Gastrointest Surg 2023; 27 (03) 604-614
    CrossrefPubMedSearch in Google Scholar
  • 16 Biederman DM, Titano JJ, Bishay VL. et al. Radiation segmentectomy versus TACE combined with microwave ablation for unresectable solitary hepatocellular carcinoma up to 3 cm: a propensity score matching study. Radiology 2017; 283 (03) 895-905
    CrossrefPubMedSearch in Google Scholar
  • 17 Song Y, Wu M, Zhou R, Zhao P, Mao D. Application and evaluation of hydrodissection in microwave ablation of liver tumours in difficult locations. Front Oncol 2023; 13: 1298757
    CrossrefPubMedSearch in Google Scholar
  • 18 Garnon J, Koch G, Caudrelier J. et al. Percutaneous image-guided cryoablation of challenging mediastinal lesions using large-volume hydrodissection: technical considerations and outcomes. Cardiovasc Intervent Radiol 2016; 39 (11) 1636-1643
    CrossrefPubMedSearch in Google Scholar
  • 19 Biederman DM, Titano JJ, Korff RA. et al. Radiation segmentectomy versus selective chemoembolization in the treatment of early-stage hepatocellular carcinoma. J Vasc Interv Radiol 2018; 29 (01) 30-37.e2
    CrossrefPubMedSearch in Google Scholar
  • 20 Vouche M, Habib A, Ward TJ. et al. Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy. Hepatology 2014; 60 (01) 192-201
    CrossrefPubMedSearch in Google Scholar
  • 21 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30 (01) 52-60
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Common Terminology Criteria for Adverse Events (CTCAE) v5.0. U.S. Department of Health and Human Services; November 27, 2017. Accessed October 31, 2023 at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf
  • 23 Guiu B, Garin E, Allimant C, Edeline J, Salem R. TARE in hepatocellular carcinoma: from the right to the left of BCLC. Cardiovasc Intervent Radiol 2022; 45 (11) 1599-1607
    CrossrefPubMedSearch in Google Scholar
  • 24 Garin E, Tselikas L, Guiu B. et al; DOSISPHERE-01 Study Group. Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial. Lancet Gastroenterol Hepatol 2021; 6 (01) 17-29
    CrossrefPubMedSearch in Google Scholar
  • 25 Memon K, Lewandowski RJ, Riaz A, Salem R. Yttrium 90 microspheres for the treatment of hepatocellular carcinoma. Recent Results Cancer Res 2013; 190: 207-224
    CrossrefPubMedSearch in Google Scholar
  • 26 Salem R, Johnson GE, Kim E. et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study. Hepatology 2021; 74 (05) 2342-2352
    CrossrefPubMedSearch in Google Scholar
  • 27 Padia SA, Johnson GE, Horton KJ. et al. Segmental yttrium-90 radioembolization versus segmental chemoembolization for localized hepatocellular carcinoma: results of a single-center, retrospective, propensity score-matched study. J Vasc Interv Radiol 2017; 28 (06) 777-785.e1
    CrossrefPubMedSearch in Google Scholar
  • 28 Lewandowski RJ, Gabr A, Abouchaleh N. et al. Radiation segmentectomy: potential curative therapy for early hepatocellular carcinoma. Radiology 2018; 287 (03) 1050-1058
    CrossrefPubMedSearch in Google Scholar
  • 29 Chen MS, Li JQ, Zheng Y. et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006; 243 (03) 321-328
    CrossrefPubMedSearch in Google Scholar
  • 30 Hatzidakis A, Müller L, Krokidis M, Kloeckner R. Local and regional therapies for hepatocellular carcinoma and future combinations. Cancers (Basel) 2022; 14 (10) 2469
    CrossrefPubMedSearch in Google Scholar
  • 31 Kloeckner R, Galle PR, Bruix J. Local and regional therapies for hepatocellular carcinoma. Hepatology 2021; 73 (Suppl. 01) 137-149
    CrossrefPubMedSearch in Google Scholar
  • 32 Gozzo C, Hermida M, Herrero A. et al. Non-transplantable recurrence after percutaneous thermal ablation of ≤3-cm HCC: predictors and implications for treatment allocation. Hepatol Commun 2022; 6 (10) 2975-2987
    CrossrefPubMedSearch in Google Scholar
  • 33 Jia Z, Wang C, Paz-Fumagalli R, Wang W. Radiation segmentectomy for hepatic malignancies: indications, devices, dosimetry, procedure, clinical outcomes, and toxicity of yttrium-90 microspheres. J Interv Med 2019; 2 (01) 1-4
    PubMedSearch in Google Scholar
  • 34 Izzo F, Granata V, Grassi R. et al. Radiofrequency ablation and microwave ablation in liver tumors: an update. Oncologist 2019; 24 (10) e990-e1005
    CrossrefPubMedSearch in Google Scholar
  • 35 Poggi G, Tosoratti N, Montagna B, Picchi C. Microwave ablation of hepatocellular carcinoma. World J Hepatol 2015; 7 (25) 2578-2589
    CrossrefPubMedSearch in Google Scholar
  • 36 Lubner MG, Brace CL, Hinshaw JL, Lee Jr FT. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21 (8, Suppl): S192-S203
    CrossrefPubMedSearch in Google Scholar
  • 37 Brace CL. Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences?. Curr Probl Diagn Radiol 2009; 38 (03) 135-143
    CrossrefPubMedSearch in Google Scholar
  • 38 Radosevic A, Quesada R, Serlavos C. et al. Microwave versus radiofrequency ablation for the treatment of liver malignancies: a randomized controlled phase 2 trial. Sci Rep 2022; 12 (01) 316
    CrossrefPubMedSearch in Google Scholar
  • 39 Li L, Yao J, Yan X. et al. Long-term efficacy and safety of microwave ablation for hepatocellular carcinoma adjacent to the gallbladder with a diameter ≤ 5 cm: a multicenter, propensity score matching study. Int J Hyperthermia 2023; 40 (01) 2248425
    CrossrefPubMedSearch in Google Scholar
  • 40 Han X, Ni JY, Li SL. et al. Radiofrequency versus microwave ablation for hepatocellular carcinoma within the Milan criteria in challenging locations: a retrospective controlled study. Abdom Radiol (NY) 2021; 46 (08) 3758-3771
    CrossrefPubMedSearch in Google Scholar
  • 41 Crocetti L, de Baére T, Pereira PL, Tarantino FP. CIRSE standards of practice on thermal ablation of liver tumours. Cardiovasc Intervent Radiol 2020; 43 (07) 951-962
    CrossrefPubMedSearch in Google Scholar
  • 42 Makovich Z, Logemann J, Chen L. et al. Liver tumor ablation in difficult locations: microwave ablation of perivascular and subdiaphragmatic hepatocellular carcinoma. Clin Imaging 2021; 71: 170-177
    CrossrefPubMedSearch in Google Scholar
  • 43 An C, Cheng Z, Yu X. et al. Ultrasound-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: oncologic outcomes and advanced assistive technology. Int J Hyperthermia 2020; 37 (01) 89-100
    CrossrefPubMedSearch in Google Scholar
  • 44 Patel PA, Ingram L, Wilson ID, Breen DJ. No-touch wedge ablation technique of microwave ablation for the treatment of subcapsular tumors in the liver. J Vasc Interv Radiol 2013; 24 (08) 1257-1262
    CrossrefPubMedSearch in Google Scholar
  • 45 De Muzio F, Cutolo C, Dell'Aversana F. et al. Complications after thermal ablation of hepatocellular carcinoma and liver metastases: imaging findings. Diagnostics (Basel) 2022; 12 (05) 1151
    CrossrefPubMedSearch in Google Scholar
  • 46 Ahmed M, Solbiati L, Brace CL. et al; International Working Group on Image-guided Tumor Ablation, Interventional Oncology Sans Frontières Expert Panel, Technology Assessment Committee of the Society of Interventional Radiology, Standard of Practice Committee of the Cardiovascular and Interventional Radiological Society of Europe. Image-guided tumor ablation: standardization of terminology and reporting criteria–a 10-year update. Radiology 2014; 273 (01) 241-260
    CrossrefPubMedSearch in Google Scholar
  • 47 Shin SW, Cho SK, Hyun D, Park KB, Park HS, Do YS. Guidewire-catheter induced hydrodissection to assist radiofrequency ablation for subcapsular hepatocellular carcinoma with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion. Diagn Interv Radiol 2021; 27 (06) 746-753
    CrossrefPubMedSearch in Google Scholar
  • 48 Tsoumakidou G, Buy X, Garnon J, Enescu J, Gangi A. Percutaneous thermal ablation: how to protect the surrounding organs. Tech Vasc Interv Radiol 2011; 14 (03) 170-176
    CrossrefPubMedSearch in Google Scholar
  • 49 Huang H, Liang P, Yu XL. et al. Safety assessment and therapeutic efficacy of percutaneous microwave ablation therapy combined with percutaneous ethanol injection for hepatocellular carcinoma adjacent to the gallbladder. Int J Hyperthermia 2015; 31 (01) 40-47
    CrossrefPubMedSearch in Google Scholar
  • 50 Li M, Li Z, Yu X. et al. Percutaneous radio-frequency ablation of hepatocellular carcinoma adjacent to the gastrointestinal tract. Int J Hyperthermia 2016; 32 (06) 600-606
    CrossrefPubMedSearch in Google Scholar