LiverProspective study to determine early hypertrophy of the contra-lateral liver lobe after unilobar, Yttrium-90, selective internal radiation therapy in patients with hepatocellular carcinoma
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.
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Nuclear Medicine Therapy in primary liver cancers
2022, Nuclear Medicine and Molecular Imaging: Volume 1-4Hepatobiliary Imaging in Liver-directed Treatments
2019, Seminars in Nuclear MedicineCitation Excerpt :This tumor progression is an aspect that has received too little attention, but in fact is fairly common. In the study of Teo et al., 5/24 patients developed new lesions in the untreated liver lobe.32 Likewise, in the study of Vouche et al. 17/83 patients developed new lesions in the left lobe after right radiation lobectomy.37
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.