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Advances in Radiotherapy
& Nuclear Medicine SIR-spheres Y-90 resin microspheres for HCC treatment

Table 2. SIRT treatment information Table 3. Tumor response by mRECIST 3 and 6 months
after SIRT
Treatment or tumor feature Frequency or mean
Dosimetry method (n [%]) mRECIST response, n (%) 3 Months (n=30) 6 Months (n=22)
BSA 14 (46.7) Complete response 7 (23.3) 7 (31.8)
Partition model 16 (53.3) Partial response 16 (53.3) 11 (50.0)
Tumor dose, Gy (mean [SD]) 179.2 (80.3) Stable disease 6 (20) 2 (9.1)
Normal liver dose, Gy (mean [SD]) 28.1 (10) Progressive disease 1 (3.3) 2 (9.1)
Lung dose, Gy (mean [SD]) 3.5 (3.2) Abbreviations: mRECIST: Modified response evaluation criteria in
solid tumors; SIRT: Selective internal radiation therapy.
Liver volume, cm (mean [SD])
3
Whole 1436.1 (301.5) 4. Discussion
Right lobe 1010.5 (297.5)
Left lobe 407 (192) We provide the first data report from Vietnam on using
Prescribed activity, GBq (mean [SD]) SIRT to treat patients with unresectable HCC and
confirm the safety and effectiveness of SIRT in clinical
Whole liver 1.9 practice. While 19 patients reported AEs, most were mild
Right lobe 1.3 (0.4) to moderate in severity. At 3 and 6 months, most tumor
Left lobe 1.2 responses were CR and PR; no patients died during the
SIRT treatment target 6 months after SIRT.
Whole liver (single catheter) (n [%]) 1 (3.3) It is unclear from published reports whether the
Whole liver (sequential lobar) (n [%]) 1 (3.3) etiology of HCC affects treatment efficacy . Hepatitis
[11]
Right lobe (n [%]) 27 (90.0) B virus (HBV) is a common risk factor for HCC and is
[14]
Left lobe (n [%]) 1 (3.3) highly endemic in Vietnam . A recent report indicated
Abbreviations: BSA: Body surface area; SIRT: Selective internal that advanced-staged HCC was strongly associated with
radiation therapy. HBV in a cohort of patients in Hanoi; 81.3% of the patients
with HCC were infected with HBV . However, a study
[15]
50.0% PR, 9.1% SD, and 9.1% PD (Table 3). Two patients on HCC and hepatitis from Southern Vietnam reported
were downstaged and underwent liver resection. infection rates of 62.3% for chronic HBV infection . In
[3]
On their last study visit, 28 patients had the same ECOG our study, the HBV rate was 56.7%, which is similar to the
[7]
[10]
performance status as they had at baseline, 1 patient improved rates reported by Khor et al. and Chow et al. for other
from 1 to 0 in ECOG performance status, and 1 patient was Asian cohorts. As expected, the rate of HBV infection
missing a final ECOG performance status value. All patients with HCC in Vietnam is substantially higher than those
were classified as Child-Pugh A at baseline; 21 of the 22 reported in US and European studies on using SIRT to
assessable patients remained Child-Pugh A at 6 months, and treat unresectable HCC [9,16,17] .
1 patient was classified as Child-Pugh B at 6 months. Between Vietnam ranks highly among all countries worldwide
baseline and 6 months after SIRT, no statistically significant in terms of liver cancer incidence . Furthermore, in
[1]
changes in the mean ALT, AST, GGT, total bilirubin, and Vietnam, patients often present with advanced-stage
AFP levels (P > 0.05) were detected by paired t-tests. disease [3,15] . In our study, the mean tumor burden was
3.4. Safety 8.6 cm in diameter at baseline. In this regard, Vietnam is
similar to many Asian countries where prognosis remains
Within 6 months of SIRT, 43 AEs were recorded in poor, with only 18% of patients surviving the past 5 years
19 patients (Table 4); most of these were mild to moderate. due to their advanced stage at diagnosis .
[18]
Common AEs included abdominal pain (36.7%), vomiting
(16.7%), and nausea (6.6%). Nine episodes (20%) of While OS remains a primary endpoint for most studies
abdominal pain were related to SIRT treatment and on the treatment of HCC, we focused on the tumor
experienced by 6 patients. Six patients (20%) had SAEs, responses according to mRECIST at 6 months to capture the
which included metastases in the lung (n = 2), lymph clinical benefits of treatment on disease progression before
[19]
nodes (n = 1), and abdominal node (n = 1); progressive they became diluted by sequential treatments . Kim et al.
cirrhosis (n = 1); and PD (n = 1); none were related to SIRT indicated that 26 of 40 patients in their study had adequate
treatment. No patient died during the 6-month follow-up hepatic reserve to undergo additional treatments, including
period. TACE alone (n = 11), TACE and radiofrequency ablation

Volume 1 Issue 1 (2023) 5 https://doi.org/10.36922/arnm.0385