Neoadjuvant Radiation Lobectomy As an Alternative to Portal Vein Embolization in Hepatocellular Carcinoma

Ahmed Gabr, Praneet Polineni, Samdeep K Mouli, Ahsun Riaz, Robert J Lewandowski, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Surgical resection is considered first line and potentially curative for early stage hepatocellular carcinoma. However, many patients presenting with small tumors might not qualify as candidates for surgical resection given their small future liver remnant (FLR); such patients tend to undergo neoadjuvant therapies prior to resection to minimize the risk of hepatic decompensation after major hepatic resection. While there are several techniques for inducing FLR hypertrophy, a recent approach in hepatocellular carcinoma is Y90 radiation lobectomy (RL). RL was discovered serendipitously after noticing contralateral lobar hypertrophy in patients who had ipsilateral lobar Y90 radioembolization. This is now proactively used in bridging patients to surgical resection by inducing FLR hypertrophy. In this article we discuss the evolution of RL as an alternative to portal vein embolization which has been long used to induce FLR hypertrophy, albeit mostly in metastatic liver disease.

Original languageEnglish (US)
Pages (from-to)197-203
Number of pages7
JournalSeminars in Nuclear Medicine
Volume49
Issue number3
DOIs
StatePublished - May 1 2019

Fingerprint

Portal Vein
Hepatocellular Carcinoma
Radiation
Hypertrophy
Liver
Neoadjuvant Therapy
Liver Diseases
Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Neoadjuvant Radiation Lobectomy As an Alternative to Portal Vein Embolization in Hepatocellular Carcinoma",
abstract = "Surgical resection is considered first line and potentially curative for early stage hepatocellular carcinoma. However, many patients presenting with small tumors might not qualify as candidates for surgical resection given their small future liver remnant (FLR); such patients tend to undergo neoadjuvant therapies prior to resection to minimize the risk of hepatic decompensation after major hepatic resection. While there are several techniques for inducing FLR hypertrophy, a recent approach in hepatocellular carcinoma is Y90 radiation lobectomy (RL). RL was discovered serendipitously after noticing contralateral lobar hypertrophy in patients who had ipsilateral lobar Y90 radioembolization. This is now proactively used in bridging patients to surgical resection by inducing FLR hypertrophy. In this article we discuss the evolution of RL as an alternative to portal vein embolization which has been long used to induce FLR hypertrophy, albeit mostly in metastatic liver disease.",
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Neoadjuvant Radiation Lobectomy As an Alternative to Portal Vein Embolization in Hepatocellular Carcinoma. / Gabr, Ahmed; Polineni, Praneet; Mouli, Samdeep K; Riaz, Ahsun; Lewandowski, Robert J; Salem, Riad.

In: Seminars in Nuclear Medicine, Vol. 49, No. 3, 01.05.2019, p. 197-203.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Neoadjuvant Radiation Lobectomy As an Alternative to Portal Vein Embolization in Hepatocellular Carcinoma

AU - Gabr, Ahmed

AU - Polineni, Praneet

AU - Mouli, Samdeep K

AU - Riaz, Ahsun

AU - Lewandowski, Robert J

AU - Salem, Riad

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Surgical resection is considered first line and potentially curative for early stage hepatocellular carcinoma. However, many patients presenting with small tumors might not qualify as candidates for surgical resection given their small future liver remnant (FLR); such patients tend to undergo neoadjuvant therapies prior to resection to minimize the risk of hepatic decompensation after major hepatic resection. While there are several techniques for inducing FLR hypertrophy, a recent approach in hepatocellular carcinoma is Y90 radiation lobectomy (RL). RL was discovered serendipitously after noticing contralateral lobar hypertrophy in patients who had ipsilateral lobar Y90 radioembolization. This is now proactively used in bridging patients to surgical resection by inducing FLR hypertrophy. In this article we discuss the evolution of RL as an alternative to portal vein embolization which has been long used to induce FLR hypertrophy, albeit mostly in metastatic liver disease.

AB - Surgical resection is considered first line and potentially curative for early stage hepatocellular carcinoma. However, many patients presenting with small tumors might not qualify as candidates for surgical resection given their small future liver remnant (FLR); such patients tend to undergo neoadjuvant therapies prior to resection to minimize the risk of hepatic decompensation after major hepatic resection. While there are several techniques for inducing FLR hypertrophy, a recent approach in hepatocellular carcinoma is Y90 radiation lobectomy (RL). RL was discovered serendipitously after noticing contralateral lobar hypertrophy in patients who had ipsilateral lobar Y90 radioembolization. This is now proactively used in bridging patients to surgical resection by inducing FLR hypertrophy. In this article we discuss the evolution of RL as an alternative to portal vein embolization which has been long used to induce FLR hypertrophy, albeit mostly in metastatic liver disease.

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