Radiation lobectomy: Preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization

Ron C. Gaba, Robert J. Lewandowski, Laura M. Kulik, Ahsun Riaz, Saad M. Ibrahim, Mary F. Mulcahy, Robert K. Ryu, Kent T. Sato, Vanessa Gates, Michael M. Abecassis, Reed A. Omary, Talia B. Baker, Riad Salem

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1587-1596
Number of pages10
JournalAnnals of Surgical Oncology
Volume16
Issue number6
DOIs
StatePublished - Jun 1 2009

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Yttrium
Radiation
Liver
Hypertrophy
Atrophy
Neoplasms
Survival
Cholangiocarcinoma
Microspheres
Bilirubin
Survival Rate

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{5c5fa55b1e2647f28d5f5f993116714e,
title = "Radiation lobectomy: Preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization",
abstract = "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.",
author = "Gaba, {Ron C.} and Lewandowski, {Robert J.} and Kulik, {Laura M.} and Ahsun Riaz and Ibrahim, {Saad M.} and Mulcahy, {Mary F.} and Ryu, {Robert K.} and Sato, {Kent T.} and Vanessa Gates and Abecassis, {Michael M.} and Omary, {Reed A.} and Baker, {Talia B.} and Riad Salem",
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language = "English (US)",
volume = "16",
pages = "1587--1596",
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Radiation lobectomy : Preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization. / Gaba, Ron C.; Lewandowski, Robert J.; Kulik, Laura M.; Riaz, Ahsun; Ibrahim, Saad M.; Mulcahy, Mary F.; Ryu, Robert K.; Sato, Kent T.; Gates, Vanessa; Abecassis, Michael M.; Omary, Reed A.; Baker, Talia B.; Salem, Riad.

In: Annals of Surgical Oncology, Vol. 16, No. 6, 01.06.2009, p. 1587-1596.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiation lobectomy

T2 - Preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization

AU - Gaba, Ron C.

AU - Lewandowski, Robert J.

AU - Kulik, Laura M.

AU - Riaz, Ahsun

AU - Ibrahim, Saad M.

AU - Mulcahy, Mary F.

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Gates, Vanessa

AU - Abecassis, Michael M.

AU - Omary, Reed A.

AU - Baker, Talia B.

AU - Salem, Riad

PY - 2009/6/1

Y1 - 2009/6/1

N2 - 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.

AB - 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.

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U2 - 10.1245/s10434-009-0454-0

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