Analysis of failed therapy evaluations in radioembolization of primary and secondary liver cancers

PURPOSE: To analyze patients’ characteristics and reasons for not performing planned transarterial radioembolization (TARE) in liver cancer after (99m)Tc-labeled macroaggregated albumin ((99m)Tc-MAA) evaluation. METHODS: In this retrospective single-center cohort, all patients undergoing (99m)Tc-MAA evaluation prior to planned TARE for primary or secondary liver cancer between 2009 and 2018 were analyzed. Patients were assigned to either “TARE” or “no TARE” group. Patients’ characteristics, arising reasons for not performing the planned TARE treatment as well as predictive factors for occurrence of these causes were analyzed. RESULTS: 436 patients [male = 248, female = 188, median age 62 (23–88) years] with (99m)Tc-MAA evaluation prior to planned TARE of primary or secondary liver cancer were included in this study. 148 patients (33.9%) did not receive planned TARE. Patients with a hepatic tumor burden > 50%, no liver cirrhosis, no previous therapies and a higher bilirubin were significantly more frequent in “no TARE” compared to “TARE” group. Main reasons for not performing TARE were extrahepatic tracer accumulation (n = 70, 40.5%), non-target accumulation of (99m)Tc-MAA (n = 27, 15.6%) or a hepatopulmonary shunt fraction of more than 20% (n = 23, 13.3%). Independent preprocedural parameters for not performing planned TARE were elevated bilirubin (p = 0.021) and creatinine (p = 0.018) and lower MELD score (p = 0.031). CONCLUSION: A substantial number of patients are precluded from TARE following (99m)Tc-MAA evaluation, which is, therefore, implicitly needed to determine contraindications to TARE and should not be refrained from in pretreatment process. However, a preceding careful patient selection is needed especially in patients with high hepatic tumor burden and alteration in lab parameters.