Is EBRT after Y-90 safe for HCC patients?

External beam radiation therapy (EBRT) after Yttrium-90 radioembolization (Y-90) does not appear to worsen hepatoxicity or inferior oncologic outcomes in patients with hepatocellular carcinoma (HCC) when compared with EBRT alone, a study has shown.

The investigators conducted a retrospective review of 94 HCC patients treated with EBRT from 2016 to 2024, including 14 treated with Y-90. They assessed hepatoxicity using Albumin-Bilirubin (ALBI) score changes at 3 and 6 months after EBRT. Secondary outcomes were Common Terminology Criteria for Adverse Events (CTCAE) toxicity, local control, and survival.

The investigators also collected treatment details, prior locoregional therapies, and dosimetric parameters. Statistical comparisons were made using Fisher exact tests and Kaplan-Meier analyses.

Baseline demographics and liver function did not significantly differ between groups. Fractionated proton therapy was administered to nearly half of the Y-90 cohort (53 percent).

At month 6, two (13 percent) and four (27 percent) patients with prior Y-90 experienced grade 1 and 2 albumin-bilirubin deterioration compared with 17 (22 percent) and 21 (27 percent) patients with no prior Y-90 (p=0.77).

Grade ≥2 CTCAE toxicity occurred in two (13 percent) patients with prior Y-90 and in five (6 percent) with no prior Y-90. Patients treated with Y-90 achieved 92-percent local control with no local failures.

The median OS was 34 months with prior Y-90 and 39 months with no prior Y-90 (p=0.89).

“When delivered with individualized planning, including fractionation, EBRT represents a safe and effective salvage modality for patients with residual or recurrent HCC after Y-90,” the investigators said.