Hepatic volume changes post-selective internal radiation therapy with 90 Y microspheres

Abstract

Introduction: To examine the hepatic volume changes post-selective internal radiation therapy with ⁹⁰ Y microspheres. This technique has been demonstrated to be a suitable alternative to portal vein embolisation to induce hypertrophy of the future liver remnant (FLR) in patients with malignant disease of the liver preoperatively. The role of both techniques is to decrease postoperative morbidity and increase the numbers of patients eligible for surgical resection. Unlike portal vein embolisation, radioembolisation has the additional benefit of treating liver malignancy and reducing the risk of tumour progression during the hypertrophy period.

Methods: A retrospective analysis was conducted of 29 patients from August 2012 to November 2016 that had right liver lobe malignant disease (primary or secondary) and underwent selective internal radiation therapy. Changes in liver volume were measured from CT or MRI before treatment and at 3, 6 and 12 months post-SIRT.

Results: Eighteen patients (62%) had primary liver malignancies (HCC n = 15, cholangiocarcinoma n = 3), and 11 patients (38%) had metastases (colorectal carcinoma n = 10, ampullary carcinoma n = 1). There was a mean increase in the FLR volume relative to baseline of 37.2% at 3 months (n = 25), 42.6% at 6 months (n = 19) and 63.5% at 12 months (n = 12). There was a mean decrease in whole liver volume at 12 months by -13.3%.

Conclusion: Right liver lobe SIRT induces left liver lobe (FLR) compensatory hypertrophy. This study's data support the use of SIRT in selected patients with right liver lobe malignancy to undergo SIRT to facilitate liver resection.

Keywords: Yttrium-90 microspheres; hypertrophy; liver; malignancy; radioembolisation.