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Radiation Segmentectomy for the Treatment of Primary Hepatic Malignancies of the Caudate Lobe: A Case Series

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Tumors involving the caudate lobe present a unique therapeutic challenge due to their complex anatomy and the safety and efficacy of locoregional therapy can be variable. The purpose of this study is to analyze the outcomes of radiation segmentectomy for primary caudate lobe tumors.

Materials and Methods

Eight patients [5 women and 3 men; median age = 69 y (range 50–79)] that underwent transarterial radioembolization (TARE) using yttrium-90 (Y90) glass microspheres for primary caudate lobe tumors (hepatocellular carcinoma = 6, intrahepatic cholangiocarcinoma = 2) from August 2017 to March 2021 were retrospectively analyzed. Descriptive statistics, treatment parameters, tumor response (using modified response evaluation criteria in solid tumors), adverse events [using common terminology criteria for adverse events (CTCAE)], and survival outcomes were evaluated.

Results

Eight primary caudate lobe tumors with a median size of 2.2 cm [interquartile range (IQR), 1.7–3.3] and Child–Pugh class A liver function underwent TARE of the caudate lobe. The median radiation dose was 596 Gy (IQR 356–1585), median total activity was 0.84 GBq (IQR 0.56–1.31), median specific activity was 473 Bq/sphere (IQR 226–671), and the median number of Y90 microspheres used was 1.4 million (IQR 1.2–3.4). All complications were CTCAE grade 1, and no clinically significant hilar plate complications were observed. In targeted tumors, complete response was seen in all patients.  At a median follow-up period of 16.6 months (IQR 6.6–21.6) 75% (6/8) of patients were alive with no in-field progression.

Conclusion

Radiation segmentectomy of primary caudate lobe tumors appears effective and is well tolerated in this limited case series within the described treatment parameters.

Level of Evidence

Level 4, Case Series.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Division of Interventional Radiology, Department of Radiology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA

    Manasi Arora, Beau B. Toskich, Andrew R. Lewis, Carlos A. Padula, Seyed Ali Montazeri, Charles Ritchie, Gregory Frey, Ricardo Paz-Fumagalli, J. Mark McKinney & Zlatko Devcic

Authors
  1. Manasi Arora
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  2. Beau B. Toskich
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  3. Andrew R. Lewis
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  4. Carlos A. Padula
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  5. Seyed Ali Montazeri
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  7. Gregory Frey
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  8. Ricardo Paz-Fumagalli
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Contributions

The study conception and design were performed by ZD and BT. Material preparation, data collection, and analysis were performed by MA, ZD, BT, CP, SAM, AL, CR, GF, RP-F, and JMM. The first draft of the manuscript was written by MA and ZD, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zlatko Devcic.

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Conflict of interest

Author BT is an advisor to Boston Scientific Corporation, Sirtex, Johnson and Johnson, AstraZeneca, Genentech, Eisai, Histosonics, and Vivos. Authors MA, AL, CP, AM, CR, GF, RPF, MM, and ZD declare that they have no conflict of interest.

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For this type of study, formal consent is not required.

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This study has obtained IRB approval from Mayo Clinic College of Medicine and Science and the need for informed consent was waived.

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Arora, M., Toskich, B.B., Lewis, A.R. et al. Radiation Segmentectomy for the Treatment of Primary Hepatic Malignancies of the Caudate Lobe: A Case Series. Cardiovasc Intervent Radiol 45, 1485–1493 (2022). https://doi.org/10.1007/s00270-022-03250-8

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