BACKGROUND Technetium-99m macroaggregated albumin is used to estimate lung shunt fraction (LSF) prior to yttrium-90 (Y90). Studies have debated the safety and efficacy of Y90 in patients with LSF > 15%. We aimed to assess the role of Y90 in hepatocellular carcinoma (HCC) with LSF > 15%. METHODS With IRB approval, we searched our prospectively acquired database of HCC patients with Y90 treated with LSF > 15%. Median LSF and liver and lung doses were calculated. The response was assessed using RECIST. Overall survival (OS) was calculated from date of first Y90. RESULTS A total of 103 HCC patients underwent Y90. The median baseline LSF was 24.4% (IQR 18.1-28.8). Patients exhibited multifocal disease (59/103, 60%) and median tumor size of 7.85 cm (IQR 5.2, 10.57). BCLC class was A, B, C, and D in 7 (7%), 5 (5%), 85 (83%), and 6 (6%) patients, respectively. The median liver dose was 84.6 Gy (IQR 57.4, 107.55). The median lung dose per session and cumulatively was 22.9 Gy (IQR 15-28) and 29.5 Gy (IQR 20.5-44.3). Thirty-three patients (32%) demonstrated partial response, 57 stable disease, and 13 (13%) had progressive disease. The median OS was 7.3 months (95% CI 5.3, 11.47). Twenty patients (19%) had non-specific pulmonary symptoms (cough, shortness of breath, wheezing) in the 1-year post-Y90. The median time to the appearance of non-specific pulmonary symptoms was 63 days (range 7-224). Thoracic imaging demonstrated no pulmonary fibrosis/injury following treatment in any patient. CONCLUSION Y90 can be performed in patients with LSF > 15%. The RECIST response was identified in 32% of the patients. In isolation, LSF > 15% should not deter from treatment with Y90.

中文翻译：

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玻璃微球体放射栓塞治疗肝分流分数升高的肝细胞癌患者的安全性和有效性：对103名患者的分析。

背景技术使用Technetium-99m宏观聚集白蛋白来评估90钇（Y90）之前的肺分流分数（LSF）。研究对YSF在LSF> 15％的患者中的安全性和有效性进行了辩论。我们旨在评估Y90在LSF> 15％的肝细胞癌（HCC）中的作用。方法经IRB批准，我们搜索了前瞻性获得的Y90且LSF> 15％的HCC患者的数据库。计算中位LSF以及肝和肺的剂量。使用RECIST评估反应。从第一个Y90开始计算总生存期（OS）。结果共有103例HCC患者接受Y90治疗。基线LSF中位数为24.4％（IQR 18.1-28.8）。患者表现出多灶性疾病（59/103，60％），中位肿瘤大小为7.85 cm（IQR 5.2，10.57）。BCLC类别分别为A，B，C和D，分别为7（7％），5（5％），85（83％），和6（6％）患者。中位肝剂量为84.6 Gy（IQR 57.4，107.55）。每个疗程的肺部中位剂量累计为22.9 Gy（IQR 15-28）和29.5 Gy（IQR 20.5-44.3）。33例患者（32％）表现出部分缓解，57例稳定疾病，13例（13％）患有进行性疾病。中位OS为7.3个月（95％CI 5.3，11.47）。在90年代后的1年中，有20名患者（19％）出现了非特异性的肺部症状（咳嗽，呼吸急促，喘息）。出现非特异性肺部症状的中位时间为63天（范围7-224）。胸影像学检查显示任何患者接受治疗后均未发生肺纤维化/损伤。结论Y90可以在LSF> 15％的患者中进行。在32％的患者中发现了RECIST反应。孤立地，LSF>