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Radiation Lobectomy: Preliminary Findings of Hepatic Volumetric Response to Lobar Yttrium-90 Radioembolization

  • Hepatobiliary and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Disclosure

Dr. Riad Salem is an advisor to MDS Nordion.

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Authors and Affiliations

  1. Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA

    Ron C. Gaba MD

  2. Department of Radiology, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Robert J. Lewandowski MD, Ahsun Riaz MD, Saad M. Ibrahim MD, Robert K. Ryu MD, Kent T. Sato MD, Vanessa Gates MS & Reed A. Omary MD, MS

  3. Department of Surgery, Division of Liver Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Laura M. Kulik MD, Michael M. Abecassis MD, MBA & Talia B. Baker MD

  4. Department of Medicine, Division of Medical Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Mary F. Mulcahy MD

  5. Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA

    Riad Salem MD, MBA

Authors
  1. Ron C. Gaba MD
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  2. Robert J. Lewandowski MD
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  3. Laura M. Kulik MD
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  4. Ahsun Riaz MD
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  5. Saad M. Ibrahim MD
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  6. Mary F. Mulcahy MD
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  7. Robert K. Ryu MD
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  8. Kent T. Sato MD
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  9. Vanessa Gates MS
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  10. Michael M. Abecassis MD, MBA
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  11. Reed A. Omary MD, MS
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  12. Talia B. Baker MD
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  13. Riad Salem MD, MBA
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Correspondence to Riad Salem MD, MBA.

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Gaba, R.C., Lewandowski, R.J., Kulik, L.M. et al. Radiation Lobectomy: Preliminary Findings of Hepatic Volumetric Response to Lobar Yttrium-90 Radioembolization. Ann Surg Oncol 16, 1587–1596 (2009). https://doi.org/10.1245/s10434-009-0454-0

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  • DOI: https://doi.org/10.1245/s10434-009-0454-0

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