Ep. 673 Y90 for Liver-Directed Cancer Treatments: The PROACTIF Study with Dr. Tyler Sandow and Dr. Ryan Hickey

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.

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This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90.

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Timestamps

00:00 - Introduction02:36 - Resection After Radioembolization06:07 - Personal Practices Between HCC and Liver Metases07:26 - Bridging Radiation Segmentectomy 11:22 - Understanding Portal Vein Tumor Thrombus14:21 - Preferences in Dosimetry Software17:57 - Liver Reserve Limits25:11 - Microsphere Activity and Density29:16 - Diving into PROACTIF33:32 - RCTs and Trial Challenges36:57 - Patient Diversity in PROACTIF41:42 - Extrahepatic Disease43:03 - Data Gaps and Takeaways45:32 - Defining Personalized Dosimetry and Bridging Software50:15 - Mixed Delivery Approaches and Dose Thresholds01:01:36 - Response and Local Control01:04:26 - Treating PVT Subgroups01:09:03 - Comparison Between Dosing and Survival01:15:03 - Differences in Patients Quality of Life After Transplantation01:26:34 - Wrap-Up and Credits

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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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