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

• Published in: Surgery Vol. 163; no. 5; pp. 1008 - 1013
• Main Authors: Teo, Jin Yao, Allen, John Carson, Ng, David Chee Eng, Abdul Latiff, Julianah Bee, Choo, Su Pin, Tai, David Wai-Meng, Low, Albert Su Chong, Cheah, Foong Koon, Chang, Jason Pik Eu, Kam, Juinn Huar, Lee, Victor T.W., Chung, Alexander Yaw Fui, Chan, Chung Yip, Chow, Pierce Kah Hoe, Goh, Brian K.P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2018
• Subjects: Adult; Aged; Carcinoma, Hepatocellular - radiotherapy; Hepatomegaly; Humans; Liver Neoplasms - radiotherapy; Male; Middle Aged; Prospective Studies; Yttrium Radioisotopes - therapeutic use
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2017.10.014

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. 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. 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. 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.)