Episode # 3 • 17 Jan 2025
Y90 for Liver-Directed Cancer Treatments: The PROACTIF Study
The key to personalizing Y90 may not just be treating the tumor, but understanding how much radiation a patient can tolerate, where to deliver it, and when to safely push the dose. In this episode of the BackTable Podcast, Drs. Tyler Sandow and Ryan Hickey join host Dr. Kavi Krishnasamy to explore strategies for using Y90 in hepatocellular carcinoma and liver metastases. They combine real-world data from a study of nearly 1,000 patients with insights into methodology and the many variables that influence these procedures.
This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90.
Timestamps
00:00 - Introduction
02:36 - Resection After Radioembolization
06:07 - Personal Practices Between HCC and Liver Metases
07:26 - Bridging Radiation Segmentectomy
11:22 - Understanding Portal Vein Tumor Thrombus
14:21 - Preferences in Dosimetry Software
17:57 - Liver Reserve Limits
25:11 - Microsphere Activity and Density
29:16 - Diving into PROACTIF
33:32 - RCTs and Trial Challenges
36:57 - Patient Diversity in PROACTIF
41:42 - Extrahepatic Disease
43:03 - Data Gaps and Takeaways
45:32 - Defining Personalized Dosimetry and Bridging Software
50:15 - Mixed Delivery Approaches and Dose Thresholds
01:01:36 - Response and Local Control
01:04:26 - Treating PVT Subgroups
01:09:03 - Comparison Between Dosing and Survival
01:15:03 - Differences in Patients Quality of Life After Transplantation
01:26:34 - Wrap-Up and Credits
Resources
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More about this episode
The discussion covers radiation segmentectomy and selective delivery, the nuances of portal vein tumor thrombus levels, and how multidisciplinary collaboration differs between resection and transplant. The doctors dive into the PROACTIF study, focusing on personalized dosimetry, dose escalation, trial challenges, tumor response, and survival outcomes across disease stages. Drs. Sandow and Hickey also explain the limits of Y90, such as lung shunts, liver reserve, and treated liver volume, and highlight how decision-making and tailored techniques are essential for improving outcomes in liver cancer care.
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