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Erschienen in:
01.06.2009 | Hepatobiliary and Pancreatic Tumors
Radiation Lobectomy: Preliminary Findings of Hepatic Volumetric Response to Lobar Yttrium-90 Radioembolization
Erschienen in: Annals of Surgical Oncology | Ausgabe 6/2009
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Purpose
To describe volumetric changes of “radiation lobectomy,” a manifestation of hepatic parenchymal response to lobar 90Y microsphere radioembolization.
Methods
Twenty patients exhibiting this phenomenon were identified. Pre- and posttreatment absolute right and left hepatic lobar volume (HLV), relative HLV (rHLV = HLV/total liver volume), and degree of lobar atrophy (DA) or hypertrophy (DH) (DA or DH = |posttreatment rHLV – pretreatment rHLV|) were determined. Laboratory toxicities, tumor response, and patient survival were also assessed.
Results
Twenty patients with primary (HCC, n = 17; peripheral cholangiocarcinoma, n = 3) liver malignancies demonstrated findings of radiation lobectomy. Initial absolute right and left HLV was 955 cm3 (range 644–1,842 cm3, rHLV = 57%) and 719 cm3 (range 328–1,387 cm3, rHLV = 43%), respectively. Following 90Y, absolute right HLV decreased to 460 cm3 (range 185–948 cm3, 52% reduction, rHLV = 31%, DA = 26%, P < 0.0001), while absolute left HLV increased to 1,004 cm3 (range 560–1,558 cm3, 40% increase, rHLV = 69%, DH = 26%, P < 0.0001). No grade 3 or 4 bilirubin toxicities were encountered. Tumor response ranged from 55% to 70% by size criteria. Forty-six percent 5-year survival was achieved in HCC patients.
Conclusions
Radiation lobectomy following 90Y radioembolization of right lobe tumors manifests extensive contralateral lobar hypertrophy, high response rates, and prolonged survival. This phenomenon was noted in 6.4% (20/315) of the entire cohort and 19.8% (20/101) of patients with unilobar right lobe tumors. Further investigation is necessary to determine contributing factors that may predict this effect.