Siddharth A. Padia

Among patients with treatment-naive hepatocellular carcinoma, glass microsphere radiation segmentectomy before liver transplant achieved high rates of complete pathologic necrosis, which was positively associated with the number of optimized treatment parameter thresholds.

Purpose: Assessing the safety and efficacy of Yttrium-90 ( ⁹⁰ Y) segmentectomy and lobar radioembolization as a treatment option for patients with hepatic uveal melanoma metastases. Materials and Methods: An IRB-approved retrospective study of patients with liver metastases from uveal melanoma treated by radioembolization from 2017 to 2023 was performed. 25 patients (9 males, 16 females) with a median age at metastatic diagnosis of 62 years (range 30–78) underwent a total of 52 glass radioembolization procedures. Date of diagnosis and metastasis, tumor characteristics, concomitant therapies, treatment dosage, treatment related toxicities, survival, and imaging response were collected and reviewed. Imaging response was based on RECIST criteria as well as complete or partial radiographic response of the index tumor. Results: Mean index tumor size was 4.1 ± 1.0 cm (range 0.9–20). Complete radiographic response (n = 32) or partial response (n = 17) was achieved in 49/52 (94%) treatments. Segmental radioembolization showed higher rates of complete radiographic response compared to lobar radioembolization (78% vs. 35%, p < 0.05). Index tumor size was an independent factor in achieving optimal response rates for radiation segmentectomy ( p < 0.05). Overall RECIST disease control rate was 84% (21/25). Median progression free survival and median overall survival from index treatment was 8.0 months (range 0.7–49.0) and 20.3 months (range 1.6–53.1), respectively. One year survival was 76% (19/25). Twelve mild Grade 1a clinical toxicities were reported (48%). Conclusion: This study supports ⁹⁰ Y radioembolization as a safe and effective treatment option for patients with hepatic metastatic uveal melanoma, with radiation segmentectomy achieving high rates of radiographic response and disease control rates. Graphical

Arterial embolization is a minimally invasive alternative for treating chronic joint pain when conservative therapies fail; patient selection and procedural standardization for arterial embolization for chronic joint pain will achieve consistent results in pain and function improvement.

Purpose: Concerns may exist as to potential healing complications after knee arthroplasty (KA) following genicular artery embolization (GAE) for knee osteoarthritis (OA). This study evaluates the adverse events related to KA following GAE. Materials and Methods: This IRB-approved multi-institution retrospective study (2019–2024) analyzed 47 patients who underwent 48 KA’s following 48 GAEs (out of a total of 300 GAEs).. Post KA records were reviewed for the presence of adverse events. Results: KA was performed by one of 16 orthopedic surgeons at 10 hospitals. Mean time between GAE and KA was 512 ± 330 days. There were 39/48 (81.2%) TKAs and 9/48 (18.8%) partial KAs. Follow-up time after KA was a mean of 369 (± 350) days. Four (4/48 = 8.3%) AEs were reported including two (2/48 = 4.2%) cases of wound healing issues, a stitch abscess and non-infected fluid discharge at the surgical incision. All AEs resolved. There were no significant differences between mean age (64.3 ± 4.2 vs. 68.7 ± 10.7 years, P = 0.239), BMI (25.4 ± 2.67 vs. 27.9 ± 5.2, P = 0.324), number of arteries treated (2.0 ± 0.8 vs. 1.8 ± 0.7, P = 0.693), and time between GAE and KA (491.8 ± 416.5 vs 513.4 ± 326.6 days, P = 0.787) between groups with and without AEs, respectively. Conclusion: Adverse events related to GAE for patients undergoing KA are low. GAE should not be considered a contraindication for future KA and may serve as a bridge in those trying to defer KA to a future date. Graphical

Purpose: Renal angiomyolipomas (AMLs) are benign renal neoplasms that may lead to spontaneous hemorrhage. Transcatheter arterial embolization (TAE) is a nephron-sparing treatment option, yet data on predictors of hemorrhage and re-intervention remain limited. This study evaluates clinical and radiologic outcomes of TAE and identifies predictors of hemorrhage and repeat embolization. Materials and Methods: A retrospective review of 66 patients (69 AMLs) undergoing TAE between 2010 and 2024 was conducted. Clinical, radiological, and procedural variables were analyzed. Tumor size, vascularity, and aneurysmal features were assessed pre- and post-embolization. Logistic regression models identified predictors of hemorrhage and repeat TAE. Results: Pre-treatment tumor diameter was the only significant predictor of hemorrhage (p = 0.011), with a threshold of 6.8 cm yielding 84.6% sensitivity and 71.3% specificity. All hemorrhagic tumors measured ≥4 cm. Post-embolization tumor volume predicted repeat TAE (p = 0.001), with a 248 mL cutoff. TAE significantly reduced tumor diameter (−33.5%) and volume (−60%) (p < 0.001). Radiologic success was achieved in 97% of cases, with a durable success rate of 84%. Clinical success was 94%, and complications occurred in 7.2% of patients, including two major events. Conclusions: TAE is a safe and effective treatment for renal AMLs. Tumor diameter >6.8 cm is a strong predictor of hemorrhage, while larger post-embolization volumes predict the need for re-intervention. These findings challenge the conventional 4 cm treatment threshold and support more individualized management strategies incorporating tumor morphology and response to embolization.

Transarterial radioembolization (TARE) is an image-guided cancer treatment that delivers microspheres carrying radiation-emitting isotopes, such as yttrium 90 (⁹⁰Y), to liver malignancy via the hepatic arteries. Historically a palliative therapy for advanced liver cancer, TARE with ⁹⁰Y has evolved via the segmental delivery of ⁹⁰Y microspheres with ablative intent, known as radiation segmentectomy. The purpose of radiation segmentectomy is to deliver high radiation doses to targeted hepatic segments, limiting the volume of normal hepatic parenchyma exposed to radiation. Radiation segmentectomy is characterized by high, sustained response rates and high rates of explant necrosis. Currently, radiation segmentectomy is a recognized treatment option for patients with Child-Pugh class A liver function and solitary hepatocellular carcinoma that is 8 cm or smaller in size. It can be applied for hepatic metastases not amenable to resection or thermal ablation. Advancements in patient selection, technique, and radiation dosimetry for radiation segmentectomy have redefined the goal of TARE as a curative therapy. With improved dosimetry and patient selection, it has become more common to observe early responses at posttreatment imaging after radiation segmentectomy, even complete response within the first month of treatment. This article reviews the history of radiation segmentectomy, its expanding applications, and future directions.