The balance between targeting tumor and sparing healthy liver is delicate. How do the experts do it? In this case-based review, Drs. Zach Berman (UC San Diego) and Tyler Sandow (Ochsner Health) join host Dr. Kavi Krishnasamy to walk us through real-world scenarios and share how they approach Y90 dose optimization.

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This podcast is supported by:

Sirtex
https://www.sirtex.com/

Medtronic Emprint
https://www.medtronic.com/emprint

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SYNPOSIS

First, the doctors review a case of HCC and discuss key lab values, like albumin, and their role in planning. They also break down how they manipulate variables like microsphere activity, perfusion density, and total dose to deliver a tumor dose of around 1,100 Gy. The doctors also challenge the standard perfused dose of 400 Gy for large tumors and share when they feel comfortable pushing beyond it.
Next, they discuss nuances in treating portal vein tumor invasion and what decides which Vp classifications can be treated with Y90 or combination immunotherapy. A subsequent case involving a large central HCC tumor explores the risks of biliary stricture from high radiation and the challenge of missing tumor margins with overly selective catheterization. In the last case, the doctors discuss different scenarios in multifocal HCC liver lesions. Overall, the conversation explores different approaches based on tumor size, location, and patient liver function, and highlights the importance of multidisciplinary collaboration in optimizing patient outcomes.

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TIMESTAMPS

00:00 - Introduction and Case Overview
01:28 - Patient Case Study - Hep C and Alcoholic Cirrhosis
02:05 - Evaluating Liver Function and Treatment Approach
04:50 - Tumor Dose and Perfusion Density
15:49 - Portal Vein Tumor Invasion
21:42 - Case Study: Large Central HCC Tumor Treatment
22:19 - Challenges in Treating Large Central Tumors
22:48 - Dosimetry Considerations and Biliary Strictures
27:24 - Case Study: Assorted Multifocal HCC Lesions Scenarios