Dr. Zach Berman, an interventional radiologist from UC San Diego, and Dr. Tyler Sandow from Ochsner Health share their expertise on Y90 dose optimization strategies for liver cancer. They discuss the delicate balance of targeting tumors while preserving healthy liver tissue. The doctors delve into real-world cases, analyzing lab values that affect treatment decisions, strategies for managing portal vein invasion, and the complexities of large tumors. Their insights highlight the importance of a multidisciplinary approach to maximize patient outcomes.
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volunteer_activism ADVICE
Use Liver Function Trends
Always evaluate liver function trends over isolated values like bilirubin before treatment.
Consider albumin as a strong biomarker to decide how aggressively you can treat.
insights INSIGHT
Tumor Dose Sweet Spot
Tumor dose of approximately 1000-1100 Gy is the sweet spot for achieving complete response in HCC.
Perfused dose of 400 Gy applies mainly to small tumors; larger tumors may require higher doses.
volunteer_activism ADVICE
Raise Perfused Dose Floor
Raise the perfused dose floor to around 600 Gy for better tumor control.
Ensure to consider lung dose and normal liver exposure to avoid toxicity.
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The balance between targeting tumor and sparing healthy liver is delicate. How do the experts do it? In this case-based review, Drs. Zach Berman (UC San Diego) and Tyler Sandow (Ochsner Health) join host Dr. Kavi Krishnasamy to walk us through real-world scenarios and share how they approach Y90 dose optimization.
First, the doctors review a case of HCC and discuss key lab values, like albumin, and their role in planning. They also break down how they manipulate variables like microsphere activity, perfusion density, and total dose to deliver a tumor dose of around 1,100 Gy. The doctors also challenge the standard perfused dose of 400 Gy for large tumors and share when they feel comfortable pushing beyond it. Next, they discuss nuances in treating portal vein tumor invasion and what decides which Vp classifications can be treated with Y90 or combination immunotherapy. A subsequent case involving a large central HCC tumor explores the risks of biliary stricture from high radiation and the challenge of missing tumor margins with overly selective catheterization. In the last case, the doctors discuss different scenarios in multifocal HCC liver lesions. Overall, the conversation explores different approaches based on tumor size, location, and patient liver function, and highlights the importance of multidisciplinary collaboration in optimizing patient outcomes.
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TIMESTAMPS
00:00 - Introduction and Case Overview 01:28 - Patient Case Study - Hep C and Alcoholic Cirrhosis 02:05 - Evaluating Liver Function and Treatment Approach 04:50 - Tumor Dose and Perfusion Density 15:49 - Portal Vein Tumor Invasion 21:42 - Case Study: Large Central HCC Tumor Treatment 22:19 - Challenges in Treating Large Central Tumors 22:48 - Dosimetry Considerations and Biliary Strictures 27:24 - Case Study: Assorted Multifocal HCC Lesions Scenarios
BackTable Vascular & Interventional