Dosimetric parameters predicting contralateral liver hypertrophy after unilobar radioembolization of hepatocellular carcinoma

• Published in: European journal of nuclear medicine and molecular imaging Vol. 45; no. 3; pp. 392 - 401
• Main Authors: Palard, Xavier, Edeline, Julien, Rolland, Yan, Le Sourd, Samuel, Pracht, Marc, Laffont, Sophie, Lenoir, Laurence, Boudjema, Karim, Ugen, Thomas, Brun, Vanessa, Mesbah, Habiba, Haumont, Laure-Anne, Loyer, Pascal, Garin, Etienne
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2018; Springer Nature B.V; Springer Verlag (Germany) [1976-....]
• Subjects: Aged; Carcinoma, Hepatocellular - radiotherapy; Cardiology; Continuity (mathematics); Dosimeters; Dosimetry; Embolization, Therapeutic - adverse effects; Female; Hepatocellular carcinoma; Humans; Hypertrophy; Hypertrophy - etiology; Imaging; Lesions; Life Sciences; Liver; Liver - pathology; Liver - radiation effects; Liver cancer; Liver diseases; Liver Neoplasms - radiotherapy; Male; Mathematical analysis; Medical treatment; Medicine; Medicine & Public Health; Microspheres; Multivariate analysis; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Parameter identification; Patients; Radiology; Radiometry; Retrospective Studies; Technetium Tc 99m Aggregated Albumin - adverse effects; Technetium Tc 99m Aggregated Albumin - therapeutic use; Tumors; Yttrium Radioisotopes - adverse effects; Yttrium Radioisotopes - therapeutic use; Hepatocellular carcinoma; Predictive dosimetry; Radioembolization; Tc-labeled albumin; Y–loaded glass microspheres; Liver hypertrophy; 90Y–loaded glass microspheres; 99mTc-labeled albumin; Tc-99m-labeled albumin; Y-90-loaded glass microspheres
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-017-3845-7

Purpose This study aimed at identifying prior therapy dosimetric parameters using 99m Tc-labeled macro-aggregates of albumin (MAA) that are associated with contralateral hepatic hypertrophy occurring after unilobar radioembolization of hepatocellular carcinoma (HCC) performed with 90 Y–loaded glass microspheres. Methods The dosimetry data of 73 HCC patients were collected prior to the treatment with 90 Y–loaded microspheres for unilateral disease. The injected liver dose (ILD), the tumor dose (TD) and healthy injected liver dose (HILD) were calculated based on MAA quantification. Following treatment, the maximal hypertrophy (MHT) of an untreated lobe was calculated. Results Mean MHT was 35.4 ± 40.4%. When using continuous variables, the MHT was not correlated with any tested variable, i.e., injected activity, ILD, HILD or TD except with a percentage of future remnant liver (FRL) following the 90 Y–microspheres injection  ( r  = −0.56). MHT ≥ 10% was significantly more frequent for patients with HILD ≥ 88 Gy, (52% of the cases), i.e., in 92.2% versus 65.7% for HILD < 88 Gy ( p  = 0.032). MHT ≥ 10% was also significantly more frequent for patients with a TD ≥ 205 Gy and a tumor volume (VT) ≥ 100 cm 3 in patients with initial FRL < 50%. MHT ≥10% was seen in 83.9% for patients with either an HILD ≥ 88 Gy or a TD ≥ 205 Gy for tumors larger than 100cm 3 (85% of the cases), versus only 54.5% ( p  = 0.0265) for patients with none of those parameters. MHT ≥10% was also associated with FRL and the Child-Pugh score. Using multivariate analysis, the Child-Pugh score ( p  < 0.0001), FRL ( p  = 0.0023) and HILD ( p  = 0.0029) were still significantly associated with MHT ≥10%. Conclusion This study demonstrates for the first time that HILD is significantly associated with liver hypertrophy. There is also an impact of high tumor doses in large lesions in one subgroup of patients. Larger prospective studies evaluating the MAA dosimetric parameters have to be conducted to confirm these promising results.