BackTable Vascular & Interventional Ep. 515 Curative Intent Therapies for HCC: Today and Tomorrow
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Feb 7, 2025 Dr. Kirema Garcia-Reyes, an interventional radiologist from Mount Sinai specializing in Y90, joins Dr. Sabeen Dhand and Dr. Kevin Burns, an early adopter of histotripsy. They delve into the complexities of treating hepatocellular carcinoma (HCC) through ablation. Key insights include comparing cryoablation and microwave ablation, discussing histotripsy's noninvasive approach, and highlighting the significance of advanced imaging techniques. They also explore the future of curative therapies and the importance of patient-specific strategies in optimizing treatment outcomes.
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Ablation Definition and Goal
- Define ablation as complete pathologic necrosis, aiming for total tumor cell death.
- Don't perform ablation if you cannot effectively achieve this goal.
Y90 for BCLC A HCC
- Consider Y90 for BCLC A HCC, especially if ablation feasibility is uncertain.
- If geography is a barrier, use same-session radioembolization, mapping, and treatment.
Same-Session Y90: Dosing and Imaging
- In same-session Y90, pre-order doses and assume a 5% lung shunt for small HCCs.
- Get good baseline imaging to identify unsuitable candidates early.