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Objectives <p>To identify a tumor-mean absorbed dose (<i>D</i>mean) that can predict response to Yttrium-90 resin-microsphere transarterial radioembolization (TARE) in patients with hepatocellular carcinoma (HCC) and evaluate its efficacy and safety.</p> Materials and methods <p>Patients with HCC eligible for TARE in two centers between January 2020 and May 2024 were retrospectively analyzed. Clinical, radiological, and procedural data were collected. Objective response rate (ORR) on lesion, complete response (CR), overall response, time-to-local progression (TLP), and time-to-progression (TTP) were evaluated on contrast-enhanced CT at 3 and 6 months according to mRECIST. The optimal <i>D</i>mean of ORR on the target lesion and of CR was identified with ROC analysis at 3-months. Fischer’s test compared ORR, Kaplan–Meier survival outcomes, and Cox regression was used for uni-and multivariable analyses.</p> Results <p>Seventy-six lesions in 64 patients (mean age 71.3 ± 9.6; 54 men) were evaluated. Median follow-up was 15.0 months (IQR 8.0–24.3). Mean tumor diameter was 55.2 (± 31.8) mm. CR on target lesion at 3-months was achieved in 42 lesions. Mean TLP and OS were 27.6 ± 2.5 and 36.2 ± 2.9 months, respectively. The calculated <i>D</i>mean for ORR was 296.74 Gy (specificity 100, PPV 100%). Patients treated with equal or lower doses had a significantly shorter TLP (log-rank <i>p</i> = 0.001). <i>D</i>mean &gt; 296.74 Gy did not increase the risk of complications. A <i>D</i>mean &gt; 435.11 Gy predicts CR<i>.</i></p> Conclusion <p>A <i>D</i>mean threshold of 296.74 Gy provides significant therapeutic efficacy without compromising patient safety. All HCC lesions treated with &gt; 435.11 Gy achieved CR.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>In patients with HCC treated with 90Y-resin microsphere TARE, can an optimized personalized dose improve efficacy without compromising safety</i>?</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>The calculated mean dose (Dmean), even though above guideline indications, did not yield serious adverse events whilst enhancing response to treatment</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>HCC recurrence is associated with poor patient outcomes. Personalized dosimetry is best practice for tailoring radioactive doses, and the cut-off dose calculated in this cohort identifies that with the best response and yields additional data on resin microsphere doses</i>.</p> Graphical Abstract <p></p>

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Personalized dosimetry enhances hepatocellular carcinoma response in Yttrium-90 resin microsphere radioembolization

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月28日

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  • Ettore di Gaeta,
  • Makoto Taninokuchi Tomassoni,
  • Francesca Calabrese,
  • Giovanni Matassa,
  • Annarita Savi,
  • Carla Canevari,
  • Patrizia Magnani,
  • Giovanna Pepe,
  • Stephanie Steidler,
  • Francesca Ratti,
  • Federica Cipriani,
  • Margherita Rimini,
  • Andrea Casadei-Gardini,
  • Lorenzo Braccischi,
  • Maria Adriana Cocozza,
  • Lidia Strigari,
  • Giuseppe Della Gala,
  • Arber Golemi,
  • Elisa Lodi Rizzini,
  • Stefano Fanti,
  • Matteo Cescon,
  • Matteo Serenari,
  • Fabio Piscaglia,
  • Maria Cristina Morelli,
  • Arturo Chiti,
  • Cristina Mosconi,
  • Francesco De Cobelli

摘要

Objectives

To identify a tumor-mean absorbed dose (Dmean) that can predict response to Yttrium-90 resin-microsphere transarterial radioembolization (TARE) in patients with hepatocellular carcinoma (HCC) and evaluate its efficacy and safety.

Materials and methods

Patients with HCC eligible for TARE in two centers between January 2020 and May 2024 were retrospectively analyzed. Clinical, radiological, and procedural data were collected. Objective response rate (ORR) on lesion, complete response (CR), overall response, time-to-local progression (TLP), and time-to-progression (TTP) were evaluated on contrast-enhanced CT at 3 and 6 months according to mRECIST. The optimal Dmean of ORR on the target lesion and of CR was identified with ROC analysis at 3-months. Fischer’s test compared ORR, Kaplan–Meier survival outcomes, and Cox regression was used for uni-and multivariable analyses.

Results

Seventy-six lesions in 64 patients (mean age 71.3 ± 9.6; 54 men) were evaluated. Median follow-up was 15.0 months (IQR 8.0–24.3). Mean tumor diameter was 55.2 (± 31.8) mm. CR on target lesion at 3-months was achieved in 42 lesions. Mean TLP and OS were 27.6 ± 2.5 and 36.2 ± 2.9 months, respectively. The calculated Dmean for ORR was 296.74 Gy (specificity 100, PPV 100%). Patients treated with equal or lower doses had a significantly shorter TLP (log-rank p = 0.001). Dmean > 296.74 Gy did not increase the risk of complications. A Dmean > 435.11 Gy predicts CR.

Conclusion

A Dmean threshold of 296.74 Gy provides significant therapeutic efficacy without compromising patient safety. All HCC lesions treated with > 435.11 Gy achieved CR.

Key Points

Question In patients with HCC treated with 90Y-resin microsphere TARE, can an optimized personalized dose improve efficacy without compromising safety?

Findings The calculated mean dose (Dmean), even though above guideline indications, did not yield serious adverse events whilst enhancing response to treatment.

Clinical relevance HCC recurrence is associated with poor patient outcomes. Personalized dosimetry is best practice for tailoring radioactive doses, and the cut-off dose calculated in this cohort identifies that with the best response and yields additional data on resin microsphere doses.

Graphical Abstract