Radiation lobectomy

Time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection

Michael Vouche, Robert J. Lewandowski, Rohi Atassi, Khairuddin Memon, Vanessa L. Gates, Robert K. Ryu, Ron C. Gaba, Mary F. Mulcahy, Talia Baker, Kent Sato, Ryan Hickey, Daniel Ganger, Ahsun Riaz, Jonathan Fryer, Juan Carlos Caicedo, Michael Abecassis, Laura Kulik, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Background & Aims Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with 90Y-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed at testing this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization. Methods 83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N = 67), cholangiocarcinoma (CC; N = 8) or colorectal cancer (CRC; N = 8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion. Results Right lobe atrophy (p = 0.003), left lobe hypertrophy (p <0.001), and FLR hypertrophy (p <0.001) were observed 1 month after Y90 and this was consistent at all follow-up time points. Median %FLR hypertrophy reached 45% (5-186) after 9 months (p <0.001). The median maximal %FLR hypertrophy was 26% (-14→86). Portal vein thrombosis was correlated to %FLR hypertrophy (p = 0.02). Median Child-Pugh score worsening (6→7) was seen at 1 to 3 months (p = 0.03) and 3 to 6 months (p = 0.05) after treatment. Five patients underwent successful right lobectomy (HCC N = 3, CRC N = 1, CC N = 1) and 6 HCCs were transplanted. Conclusions Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.

Original languageEnglish (US)
Pages (from-to)1029-1036
Number of pages8
JournalJournal of Hepatology
Volume59
Issue number5
DOIs
StatePublished - Nov 1 2013

Fingerprint

Liver Neoplasms
Radiation
Liver
Hypertrophy
Portal Vein
Neoplasms
Cholangiocarcinoma
Patient Rights
Tumor Burden
Microspheres
Atrophy
Hepatocellular Carcinoma
Colorectal Neoplasms
Thrombosis
Magnetic Resonance Imaging

Keywords

  • Future liver remnant
  • Hypertrophy
  • Liver resection
  • Radiation lobectomy
  • Radioembolization

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{8c1e0d2409ce431a84cdaabdb7acb6c9,
title = "Radiation lobectomy: Time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection",
abstract = "Background & Aims Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with 90Y-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed at testing this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization. Methods 83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N = 67), cholangiocarcinoma (CC; N = 8) or colorectal cancer (CRC; N = 8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline ({\%}FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion. Results Right lobe atrophy (p = 0.003), left lobe hypertrophy (p <0.001), and FLR hypertrophy (p <0.001) were observed 1 month after Y90 and this was consistent at all follow-up time points. Median {\%}FLR hypertrophy reached 45{\%} (5-186) after 9 months (p <0.001). The median maximal {\%}FLR hypertrophy was 26{\%} (-14→86). Portal vein thrombosis was correlated to {\%}FLR hypertrophy (p = 0.02). Median Child-Pugh score worsening (6→7) was seen at 1 to 3 months (p = 0.03) and 3 to 6 months (p = 0.05) after treatment. Five patients underwent successful right lobectomy (HCC N = 3, CRC N = 1, CC N = 1) and 6 HCCs were transplanted. Conclusions Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.",
keywords = "Future liver remnant, Hypertrophy, Liver resection, Radiation lobectomy, Radioembolization",
author = "Michael Vouche and Lewandowski, {Robert J.} and Rohi Atassi and Khairuddin Memon and Gates, {Vanessa L.} and Ryu, {Robert K.} and Gaba, {Ron C.} and Mulcahy, {Mary F.} and Talia Baker and Kent Sato and Ryan Hickey and Daniel Ganger and Ahsun Riaz and Jonathan Fryer and Caicedo, {Juan Carlos} and Michael Abecassis and Laura Kulik and Riad Salem",
year = "2013",
month = "11",
day = "1",
doi = "10.1016/j.jhep.2013.06.015",
language = "English (US)",
volume = "59",
pages = "1029--1036",
journal = "Journal of Hepatology",
issn = "0168-8278",
publisher = "Elsevier",
number = "5",

}

Radiation lobectomy : Time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. / Vouche, Michael; Lewandowski, Robert J.; Atassi, Rohi; Memon, Khairuddin; Gates, Vanessa L.; Ryu, Robert K.; Gaba, Ron C.; Mulcahy, Mary F.; Baker, Talia; Sato, Kent; Hickey, Ryan; Ganger, Daniel; Riaz, Ahsun; Fryer, Jonathan; Caicedo, Juan Carlos; Abecassis, Michael; Kulik, Laura; Salem, Riad.

In: Journal of Hepatology, Vol. 59, No. 5, 01.11.2013, p. 1029-1036.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiation lobectomy

T2 - Time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection

AU - Vouche, Michael

AU - Lewandowski, Robert J.

AU - Atassi, Rohi

AU - Memon, Khairuddin

AU - Gates, Vanessa L.

AU - Ryu, Robert K.

AU - Gaba, Ron C.

AU - Mulcahy, Mary F.

AU - Baker, Talia

AU - Sato, Kent

AU - Hickey, Ryan

AU - Ganger, Daniel

AU - Riaz, Ahsun

AU - Fryer, Jonathan

AU - Caicedo, Juan Carlos

AU - Abecassis, Michael

AU - Kulik, Laura

AU - Salem, Riad

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background & Aims Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with 90Y-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed at testing this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization. Methods 83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N = 67), cholangiocarcinoma (CC; N = 8) or colorectal cancer (CRC; N = 8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion. Results Right lobe atrophy (p = 0.003), left lobe hypertrophy (p <0.001), and FLR hypertrophy (p <0.001) were observed 1 month after Y90 and this was consistent at all follow-up time points. Median %FLR hypertrophy reached 45% (5-186) after 9 months (p <0.001). The median maximal %FLR hypertrophy was 26% (-14→86). Portal vein thrombosis was correlated to %FLR hypertrophy (p = 0.02). Median Child-Pugh score worsening (6→7) was seen at 1 to 3 months (p = 0.03) and 3 to 6 months (p = 0.05) after treatment. Five patients underwent successful right lobectomy (HCC N = 3, CRC N = 1, CC N = 1) and 6 HCCs were transplanted. Conclusions Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.

AB - Background & Aims Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with 90Y-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed at testing this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization. Methods 83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N = 67), cholangiocarcinoma (CC; N = 8) or colorectal cancer (CRC; N = 8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion. Results Right lobe atrophy (p = 0.003), left lobe hypertrophy (p <0.001), and FLR hypertrophy (p <0.001) were observed 1 month after Y90 and this was consistent at all follow-up time points. Median %FLR hypertrophy reached 45% (5-186) after 9 months (p <0.001). The median maximal %FLR hypertrophy was 26% (-14→86). Portal vein thrombosis was correlated to %FLR hypertrophy (p = 0.02). Median Child-Pugh score worsening (6→7) was seen at 1 to 3 months (p = 0.03) and 3 to 6 months (p = 0.05) after treatment. Five patients underwent successful right lobectomy (HCC N = 3, CRC N = 1, CC N = 1) and 6 HCCs were transplanted. Conclusions Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.

KW - Future liver remnant

KW - Hypertrophy

KW - Liver resection

KW - Radiation lobectomy

KW - Radioembolization

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DO - 10.1016/j.jhep.2013.06.015

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JO - Journal of Hepatology

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