Annals of Surgical Oncology

, Volume 20, Issue 8, pp 2518–2525 | Cite as

Volumetric Changes after 90Y Radioembolization for Hepatocellular Carcinoma in Cirrhosis: An Option to Portal Vein Embolization in a Preoperative Setting?

  • Julien Edeline
  • Laurence Lenoir
  • Karim Boudjema
  • Yan Rolland
  • Anne Boulic
  • Fanny Le Du
  • Marc Pracht
  • Jean-Luc Raoul
  • Bruno Clément
  • Etienne Garin
  • Eveline Boucher
Hepatobiliary Tumors

Abstract

Background

Contralateral hypertrophy after 90Y radioembolization has been described in case reports, but the incidence and quantitative extent of liver volume modifications after this therapy are unknown.

Methods

This retrospective study examined patients with hepatocellular carcinoma and underlying cirrhosis treated by 90Y radioembolization. The main inclusion criteria were unilateral treatment, no prior liver surgery, and computed tomographic scans allowing for volumetric assessments. Treated, tumor, and contralateral liver volumes were measured. Whole liver volume and the ratio of contralateral to total functional liver volume after a virtual hepatectomy were calculated.

Results

Data of 34 patients were analyzed. Response rates were 26 % according to Response Evaluation Criteria in Solid Tumors (RECIST) and 63 % according to modified RECIST. Median overall survival was 13.5 months. Median treated volume decreased from 938 mL (interquartile range [IQR] = 719) to 702 mL (IQR = 656) (p < 0.001), while median contralateral volume increased from 724 mL (IQR = 541) to 920 mL (IQR = 530) (p < 0.001). The whole liver volume remained stable, with a median volume of 1,702 mL (IQR = 568) versus 1,577 mL (IQR 670), respectively (p = 0.55). The mean maximal increase in contralateral volume was 42 % (95 % confidence interval 16–67). Overall, 13 patients (38.2 %) exhibited increases greater than 30 %, while 13 patients (38.2 %) showed no increase or showed increases less than 10 %. The median ratio of contralateral to total functional liver volume increased from 48.5 to 64.9 % (p < 0.001), with the proportion of patients with a ratio of ≥50 % increasing from 47.1 to 67.6 % (p = 0.013).

Conclusions

90Y radioembolization induced frequent and similar increases in functional liver remnant volume compared with portal vein embolization. This technique should be tested in a prospective study phase 2 study before liver resection.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Julien Edeline
    • 1
    • 2
    • 3
  • Laurence Lenoir
    • 2
    • 3
    • 4
  • Karim Boudjema
    • 3
    • 5
  • Yan Rolland
    • 2
    • 6
  • Anne Boulic
    • 7
  • Fanny Le Du
    • 1
  • Marc Pracht
    • 1
    • 2
  • Jean-Luc Raoul
    • 8
  • Bruno Clément
    • 2
  • Etienne Garin
    • 2
    • 3
    • 4
  • Eveline Boucher
    • 1
  1. 1.Medical Oncology DepartmentComprehensive Cancer Institute Eugène MarquisRennesFrance
  2. 2.Liver, Metabolism and CancerINSERMRennesFrance
  3. 3.University of RennesRennesFrance
  4. 4.Nuclear Medicine DepartmentComprehensive Cancer Institute Eugène MarquisRennesFrance
  5. 5.Hepatobiliary SurgeryCHU PontchaillouRennesFrance
  6. 6.Imaging DepartmentComprehensive Cancer Institute Eugène MarquisRennesFrance
  7. 7.Imaging DepartmentCHU PontchaillouRennesFrance
  8. 8.Medical Oncology DepartmentComprehensive Cancer Institute Paoli CalmetteMarseillesFrance

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