@article {Gayed632, author = {Isis Gayed and Allan Cohen and Harleen Kaur and Ahmed Abdel Aal}, title = {Selective high dose Y-90 Theraspheres treatment of malignant liver lesions}, volume = {61}, number = {supplement 1}, pages = {632--632}, year = {2020}, publisher = {Society of Nuclear Medicine}, abstract = {632Objectives: Evaluation of outcomes and safety of relatively high dose Y-90 Theraspheres (TS) therapy of hepatic malignant lesions in patients with liver cirrhosis. Methods: After obtaining IRB approval, we retrospectively reviewed the medical records of all patients who received Y-90 TS therapies at our institution during year 2019. Demographics, anatomic imaging (CT, MRI) and pre-therapy Tc-99m macroaggregated albumin (MAA) planning information as well as follow up anatomic imaging results were recorded. Patients were divided into two groups, those who had a low treatment dose (LD) below 135 Gy and those who had high dose (HD) \>135 Gy to the liver segment(s) hosting the malignant lesions. Response to therapy was evaluated using mRESICT criteria on follow up repeat anatomic imaging at variable intervals. Patients clinical symptoms within 3 month after therapy were recorded. Results: A total of 23 patients were treated with Y-90 TS, but only 18 patients (13 males, 5 females) had follow up anatomic imaging. The mean age was 61.9 years. Sixteen patients had hepatocellular carcinoma, one pancreatic and one gallbladder cancer. Y-90 TS therapies were selectively directed mainly to the most dominant lesion in the liver; which was in the right lobe in 12 patients and in the left lobe in 6 patients. The median pre-planning Tc-99m MAA lung shunt was 6.4+/- 2.0\% with no evidence of extra-hepatic organ perfusion and good tracer localization in the segment(s) where the dominant tumor lesion was located in all the patients. 14 out of 18 patients had \> 135 Gy (HD) and 4 patients had \< 135 Gy (LD) selective therapy to the lesions. Underlying liver cirrhosis was present in 12/14 patients (85.7\%) treated with HD and in 2/4 patients (50\%) treated with LD. The mean and median doses received in the HD group were 146.4 and 142.5 Gy respectively (range 135-183 Gy) and in the LD group were 114.0 and 117.5 Gy, respectively (range 97 -124 Gy). The mean and median dominant lesion size in the HD group were 5.3 and 3.6 cm and in the LD group were 2.0 and 2.2 cm, respectively. The median follow up interval for all patients was 4.5 months. The dominant lesion was completely treated in 11/14 patients (78.6\%), partially treated in 2/14 (14.3\%) and progressed in 1/14 (7.1\%) in the HD group. On the other hand, 2/4 patients (50\%) were completely treated, 1/4 patients (25\%) was partially treated and 1/4 (25\%) progressed in the LD group. The HD treatments were well tolerated by most patients except for 2 patients who had recurrent ascites, with abdominal pain in one of them. Self-limiting fever and pain for few days after the treatment in another patient and mild fatigue in one patient. Conclusions: HD treatments with Y-90 TS result in superior control of hepatic malignant lesions even with underlying liver cirrhosis. The treatments were well tolerated by most of the patients.}, issn = {0161-5505}, URL = {https://jnm.snmjournals.org/content/61/supplement_1/632}, eprint = {https://jnm.snmjournals.org/content}, journal = {Journal of Nuclear Medicine} }