Relationship of Tumor Radiation-absorbed Dose to Survival and Response in Hepatocellular Carcinoma Treated with Transarterial Radioembolization with 90Y in the SARAH Study

Background: Little is known about factors that influence the efficacy of transarterial radioembolization (TARE). Purpose: To determine the relationship between tumor radiation-absorbed dose and survival and tumor response in locally advanced inoperable hepatocellular carcinoma treated with TARE. Materials and Methods: Ibis was a secondary analysis of prospectively acquired data (between December 2011 and March 2015) from participants who received TARE in the Sorafenib versus Radioernbolization in Advanced Hepatocellular Carcinoma (SARAH) trial (Clinicalfrials.gm identifier: NCT01482442). Turnor-absorbed dose was computed using technetium 99m (Tc-99m) macroawregated human albumin (MAA) SPECTX:F. Visual agreement among Cl, Tc-99m-M.A.A SPECTICI; and yttrium 90 (Y-90) SPELT/CT or PET/CT was scored as optimal, suboptimal, or not optimal. Overall survival (OS) and tumor response at 6-month follow-up CT (Response Evaluation Criteria in Solid Tumors, version 1.1) were assessed. OS was evaluated using Kaplan-Meier tests. A propensity score comparing participants receiving a tumor dose greater titan or equal to 100 Gy (best cut-ofraccording to the receiver operating characteristic curve and median tumor radiation absorbed dose values in the study groups) with those receiving sorafenib was calculated. Results: One hundred twenty-one participants (median age, 67 years; interquartile range [IQR]: 61-73 years; 110 men) were evaluated in the dose-survival group, and 109 (median age, 66 years; IQR: 61 71 years; 100 men) were evaluated in the dust tumor response group. In the dose-survival group, median OS was 9.3 months (95% confidence interval [CI]: 6.7 months, 10.7 months), and median tumor radiation-absorbed dose was 112 Gy (IQR: 68-220 Gy). Participants who received at least 100 Gy (n = 67) had longer survival than those who received less than 100 Gy (median, 14.1 months [959% Cl: 9.6 months, 18.6 months] vs 6.1 months [95% CI: 4.9 months, 6.8 months], respectively: P < .001), and those with optimal agreement (n = 21) had the longest median OS (24.9 months; 959h CI: 9.6 months, 33.9 months). In the dose tumor response group, tumor radiation absorbed dose was higher in participants with disease control versus those with progressive disease (median, 121 Gy [IQR: 86-190 Gy] vs 85 Gy [IQR: 5-164Gy]; P = .02). The highest disease control rate was observed in 31 of 40 participants (78%) with a tumor radiation-absorbed dose greater than or equal to 100 Gy and optimal agreement. Conclusion: Higher tumor radiation-absorbed dose computed at technetium 99m macroaggregated hunum albumin SPECT/CT was associated with better over-all survival and disease control in hepatocellular carcinoma treated with transarterial radioembolization with yttrium 90 in the Sorafenib versus Radioembolization in Advanced Hepatocellular Carcinoma trial. (C) RSNA, 2020