Abstract 157P
Background
REILD is a rare but potentially life-threatening adverse event of Y90-SIRT, with a previously reported incidence of 0-8%. To date, risk factors for REILD remain poorly defined. We aim to define risk factors for REILD in a large cohort of patients treated with Y90-SIRT for HCC from a single institution.
Methods
This is a retrospective study of consecutive patients treated with Y90 for locally advanced HCC from 2007 to 2019 at the National Cancer Centre Singapore and Singapore General Hospital. Excluded were patients lost to follow-up and those with other concomitant cancer. REILD was defined by the presence of ascites and jaundice between 4-8 weeks post-Y90-SIRT in the absence of tumor progression or bile duct obstruction. Patient demographics, clinical history, pertinent laboratory values and radiological findings were collected. Ethical approval was granted by the Institutional Review Board (IRB 2017/2541).
Results
593 patients received Y90 during the study period, of which 472 met the inclusion/exclusion criteria. 12 patients (2.54%) developed REILD. Risk factors for REILD included baseline grade 2 ALBI score (P=0.039), BCLC C HCC (P=0.003), AFP ≥400 pre-Y90 (P=0.005), and radiological ascites (P=0.003). T/N ratio and total administered Y90 dose did not correlate with REILD development. No patients demised from REILD. However, median overall survival (OS) post-Y90 was shorter for REILD patients (22.3 weeks) compared to non-REILD patients (49.1 weeks) (P=0.017). Table: 157P
Baseline characteristics | REILD | Non-REILD | P | |
N = 12 | N = 460 | |||
ALBI grade | 1 | 0 (0.00%) | 130 (28.3%) | 0.039 |
2 | 12 (100%) | 297 (64.6%) | ||
3 | 0 (0.00%) | 33 (7.17%) | ||
BCLC stage | A | 0 (0.00%) | 77 (16.7%) | 0.003 |
B | 0 (0.00%) | 171 (37.2%) | ||
C | 12 (100%) | 208 (45.2%) | ||
D | 0 (0.00%) | 4 (0.87%) | ||
AFP Pre-Y90 | <400 | 2 (20.0%) | 267 (63.9%) | 0.005 |
≥400 | 8 (80.0%) | 151 (36.1%) | ||
NA | 2 | 42 | ||
Radiological ascites | N | 9 (75.0%) | 424 (92.2%) | 0.003 |
Y | 3 (25.0%) | 36 (7.8%) | ||
T/N ratio | Mean (SD) | 3.67 (2.17) | 4.30 (4.14) | 0.369 |
Median (IQR) | 3.46 (2.15-5.37) | 3.12 (2.07-5.31) | ||
Y90 dose (Gbq) | Mean (SD) | 1.73 (1.03) | 1.70 (0.955) | 0.454 |
Median (IQR) | 1.50 (1.33-1.90) | 1.47 (0.980-2.30) |
Conclusions
Risk factors for REILD are varied and multifactorial. HCC stage and underlying liver function are major determinants of REILD risk. The risk of REILD is not dependent on factors related to Y90-SIRT delivery such as median T/N ratio and radiation dose delivered.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
CIRB.
Funding
Has not received any funding.
Disclosure
P. Chow: Financial Interests, Institutional, Advisory Role: Sirtex Medical; Financial Interests, Institutional, Speaker’s Bureau: Sirtex Medical; Financial Interests, Institutional, Research Funding: Sirtex Medical. All other authors have declared no conflicts of interest.
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