Outcomes of Surgical Resection after Radioembolization for Hepatocellular Carcinoma

Ahmed Gabr, Nadine Abouchaleh, Rehan Ali, Talia Baker, Juan C Caicedo, Nitin N Katariya, Michael Messod Abecassis, Ahsun Riaz, Robert J Lewandowski, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose: To longitudinally study clinical and radiologic outcomes of patients with hepatocellular carcinoma (HCC) who underwent yttrium-90 transarterial radioembolization (TARE) as a bridge to surgical resection. Materials and Methods: TARE was performed in 31 patients with HCC before resection. Of patients, 25 underwent major hepatic resection (16 received right hepatectomy and 9 received trisegmentectomy), and 6 underwent partial hepatectomy. Clinical outcomes after TARE and after resection were recorded. Future liver remnant (FLR) was calculated before and after TARE, and actual liver remnant volume was calculated after resection. Radiologic response after TARE and pathologic necrosis were assessed. Overall and recurrence-free survivals after resection were estimated. Results: Median time between TARE and resection was 2.9 months (interquartile range [IQR]: 2–5 months). Median FLR hypertrophy after TARE (and before resection) was 23.3% (IQR:10%–48%) for patients who had radiation lobectomy and 9% (IQR: 6%–25%) for patients who had radiation segmentectomy (P =.037). Median augmented hypertrophy of the liver remnant 3 months after resection was 72% (IQR:45%–88%) in patients who had radiation lobectomy and 94% (IQR: 72%–146%) in patients who had radiation segmentectomy. Complete, 50%–99%, and < 50% pathologic tumor necrosis was identified in 14 (45%), 10 (32%), and 7 (23%) tumors. Disease control was achieved in all 31 patients. Survival rates at 1 and 3 years were 96% and 86%, respectively. Median recurrence-free survival was 34.2 months (95% confidence interval,18.7–34.2). Conclusions: TARE can serve as a safe bridge to resection providing FLR hypertrophy and disease control.

Original languageEnglish (US)
JournalJournal of Vascular and Interventional Radiology
DOIs
StateAccepted/In press - Jan 1 2018

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Hepatocellular Carcinoma
Liver
Radiation
Hypertrophy
Segmental Mastectomy
Hepatectomy
Necrosis
Yttrium
Recurrence
Survival
Neoplasms
Survival Rate
Confidence Intervals

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{a49a51c6316e4410a7ae873b3554c08c,
title = "Outcomes of Surgical Resection after Radioembolization for Hepatocellular Carcinoma",
abstract = "Purpose: To longitudinally study clinical and radiologic outcomes of patients with hepatocellular carcinoma (HCC) who underwent yttrium-90 transarterial radioembolization (TARE) as a bridge to surgical resection. Materials and Methods: TARE was performed in 31 patients with HCC before resection. Of patients, 25 underwent major hepatic resection (16 received right hepatectomy and 9 received trisegmentectomy), and 6 underwent partial hepatectomy. Clinical outcomes after TARE and after resection were recorded. Future liver remnant (FLR) was calculated before and after TARE, and actual liver remnant volume was calculated after resection. Radiologic response after TARE and pathologic necrosis were assessed. Overall and recurrence-free survivals after resection were estimated. Results: Median time between TARE and resection was 2.9 months (interquartile range [IQR]: 2–5 months). Median FLR hypertrophy after TARE (and before resection) was 23.3{\%} (IQR:10{\%}–48{\%}) for patients who had radiation lobectomy and 9{\%} (IQR: 6{\%}–25{\%}) for patients who had radiation segmentectomy (P =.037). Median augmented hypertrophy of the liver remnant 3 months after resection was 72{\%} (IQR:45{\%}–88{\%}) in patients who had radiation lobectomy and 94{\%} (IQR: 72{\%}–146{\%}) in patients who had radiation segmentectomy. Complete, 50{\%}–99{\%}, and < 50{\%} pathologic tumor necrosis was identified in 14 (45{\%}), 10 (32{\%}), and 7 (23{\%}) tumors. Disease control was achieved in all 31 patients. Survival rates at 1 and 3 years were 96{\%} and 86{\%}, respectively. Median recurrence-free survival was 34.2 months (95{\%} confidence interval,18.7–34.2). Conclusions: TARE can serve as a safe bridge to resection providing FLR hypertrophy and disease control.",
author = "Ahmed Gabr and Nadine Abouchaleh and Rehan Ali and Talia Baker and Caicedo, {Juan C} and Katariya, {Nitin N} and Abecassis, {Michael Messod} and Ahsun Riaz and Lewandowski, {Robert J} and Riad Salem",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jvir.2018.06.027",
language = "English (US)",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Outcomes of Surgical Resection after Radioembolization for Hepatocellular Carcinoma

AU - Gabr, Ahmed

AU - Abouchaleh, Nadine

AU - Ali, Rehan

AU - Baker, Talia

AU - Caicedo, Juan C

AU - Katariya, Nitin N

AU - Abecassis, Michael Messod

AU - Riaz, Ahsun

AU - Lewandowski, Robert J

AU - Salem, Riad

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: To longitudinally study clinical and radiologic outcomes of patients with hepatocellular carcinoma (HCC) who underwent yttrium-90 transarterial radioembolization (TARE) as a bridge to surgical resection. Materials and Methods: TARE was performed in 31 patients with HCC before resection. Of patients, 25 underwent major hepatic resection (16 received right hepatectomy and 9 received trisegmentectomy), and 6 underwent partial hepatectomy. Clinical outcomes after TARE and after resection were recorded. Future liver remnant (FLR) was calculated before and after TARE, and actual liver remnant volume was calculated after resection. Radiologic response after TARE and pathologic necrosis were assessed. Overall and recurrence-free survivals after resection were estimated. Results: Median time between TARE and resection was 2.9 months (interquartile range [IQR]: 2–5 months). Median FLR hypertrophy after TARE (and before resection) was 23.3% (IQR:10%–48%) for patients who had radiation lobectomy and 9% (IQR: 6%–25%) for patients who had radiation segmentectomy (P =.037). Median augmented hypertrophy of the liver remnant 3 months after resection was 72% (IQR:45%–88%) in patients who had radiation lobectomy and 94% (IQR: 72%–146%) in patients who had radiation segmentectomy. Complete, 50%–99%, and < 50% pathologic tumor necrosis was identified in 14 (45%), 10 (32%), and 7 (23%) tumors. Disease control was achieved in all 31 patients. Survival rates at 1 and 3 years were 96% and 86%, respectively. Median recurrence-free survival was 34.2 months (95% confidence interval,18.7–34.2). Conclusions: TARE can serve as a safe bridge to resection providing FLR hypertrophy and disease control.

AB - Purpose: To longitudinally study clinical and radiologic outcomes of patients with hepatocellular carcinoma (HCC) who underwent yttrium-90 transarterial radioembolization (TARE) as a bridge to surgical resection. Materials and Methods: TARE was performed in 31 patients with HCC before resection. Of patients, 25 underwent major hepatic resection (16 received right hepatectomy and 9 received trisegmentectomy), and 6 underwent partial hepatectomy. Clinical outcomes after TARE and after resection were recorded. Future liver remnant (FLR) was calculated before and after TARE, and actual liver remnant volume was calculated after resection. Radiologic response after TARE and pathologic necrosis were assessed. Overall and recurrence-free survivals after resection were estimated. Results: Median time between TARE and resection was 2.9 months (interquartile range [IQR]: 2–5 months). Median FLR hypertrophy after TARE (and before resection) was 23.3% (IQR:10%–48%) for patients who had radiation lobectomy and 9% (IQR: 6%–25%) for patients who had radiation segmentectomy (P =.037). Median augmented hypertrophy of the liver remnant 3 months after resection was 72% (IQR:45%–88%) in patients who had radiation lobectomy and 94% (IQR: 72%–146%) in patients who had radiation segmentectomy. Complete, 50%–99%, and < 50% pathologic tumor necrosis was identified in 14 (45%), 10 (32%), and 7 (23%) tumors. Disease control was achieved in all 31 patients. Survival rates at 1 and 3 years were 96% and 86%, respectively. Median recurrence-free survival was 34.2 months (95% confidence interval,18.7–34.2). Conclusions: TARE can serve as a safe bridge to resection providing FLR hypertrophy and disease control.

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U2 - 10.1016/j.jvir.2018.06.027

DO - 10.1016/j.jvir.2018.06.027

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JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

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