Elsevier

Surgery

Volume 163, Issue 5, May 2018, Pages 1008-1013
Surgery

Liver
Prospective study to determine early hypertrophy of the contra-lateral liver lobe after unilobar, Yttrium-90, selective internal radiation therapy in patients with hepatocellular carcinoma

https://doi.org/10.1016/j.surg.2017.10.014Get rights and content

Abstract

Background

Liver resection is a major curative option in patients presenting with hepatocellular carcinoma. An inadequate functional liver remnant is a major limiting factor precluding liver resection. In recent years, hypertrophy of the functional liver remnant after selective internal radiation therapy hypertrophy has been observed, but the degree of hypertrophy in the early postselective internal radiation therapy period has not been well studied.

Methods

We conducted a prospective study on patients undergoing unilobar, Yttrium-90 selective internal radiation therapy for hepatocellular carcinoma to evaluate early hypertrophy at 4–6 weeks and 8–12 weeks after selective internal radiation therapy.

Results

In the study, 24 eligible patients were recruited and had serial volumetric measurements performed. The median age was 66 years (38–75 years). All patients were either Child-Pugh Class A or B, and 6/24 patients had documented, clinically relevant portal hypertension; 15 of the 24 patients were hepatitis B positive. At 4–6 weeks, modest hypertrophy was seen (median 3%; range −12 to 42%) and this increased at 8–12 weeks (median 9%; range −12 to 179%). No preprocedural factors predictive of hypertrophy were identified.

Conclusion

Hypertrophy of the functional liver remnant after selective internal radiation therapy with Yttrium-90 occurred in a subset of patients but was modest and unpredictable in the early stages. Selective internal radiation therapy cannot be recommended as a standard treatment modality to induce early hypertrophy for patients with hepatocellular carcinoma. (Surgery 2017;160:XXX-XXX.)

Section snippets

Methods

All Singapore residents scheduled to undergo unilobar (right or left) SIRT with Y90 for HCC at the Singapore General Hospital were eligible for this study. Institutional review board (IRB) approval was obtained after ethics review, and the trial was registered at clinicaltrials.org (NCT02783261).

The indications for Y90 included primarily patients with unresectable disease who underwent Y90 with palliative intent and also several patients with potentially resectable HCC who underwent Y90 for

Results

From December 2014 to December 2016, 25 patients were recruited (Fig 1). Of these, one patient had a previous hemihepatectomy and thus was omitted from further data collection and analysis. All patients were male, with a median age (range) of 66 years (38–75 years; Table 1). Fourteen patients were Child Pugh Class A and 10 were Child Pugh Class B, and 6/24 patients had documented clinically relevant and important portal hypertension; 15 (63%) patients were hepatitis B positive.

In terms of tumor

Discussion

Achieving an adequate FLR is a prerequisite to perform major liver resection safely. PVE is a well-established, safe, and efficacious method to induce hypertrophy of the FLR.8 Presently, it is regarded as the gold standard against which other techniques should be compared. The major drawback of PVE, however, is that tumor growth is unchecked while awaiting hypertrophy to occur.20 In contrast, SIRT provides excellent local tumor control, with radiologic response rates of up to 42–70%,13, 14, 15

Acknowledgments

We would like to thank Kuan Ling Shi Sharon, Tan Hwee Siah, and Tan Hwee Min for technical support and performing the volumetric calculations. We would like to thank Drs Koo Wen Hsin, London Ooi, Prema Raj Jeyaraj, and Anthony Goh for the clinical management of some of the patients.

References (20)

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Funded by a grant from the SingHealth Foundation SHF/FG526P/2013. Dr Choo is a member of the Sirtex Medical advisory board. Drs Goh and Chow have received honoraria and travel grants from Sirtex Medical.

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