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[Contralateral hepatic hypertrophy following unilateral yttrium-90 radioembolization : Implications for liver surgery]. Chirurg 2016; 87:380-8. [PMID: 26879820 DOI: 10.1007/s00104-016-0154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Preservation of an adequate future liver remnant (FLR) is the principal limitation to liver surgery in patients with primary or secondary liver malignancies. Hence, methods to increase the volume of the FLR in preparation for liver resection are gaining in importance. OBJECTIVE In addition to the traditional methods for induction of FLR hypertrophy, such as portal vein embolization (PVE) or portal vein ligation (PVL) with or without parenchymal dissection (ALPPS, in situ split), radioembolization (RE) using yttrium-90 microspheres also leads to a volume increase of non-embolized liver parenchyma. This review outlines its potential role as an alternative procedure for induction of liver hypertrophy. MATERIAL AND METHODS Synopsis and critical discussion of the available literature on the mechanisms of induction of liver hypertrophy, the advantages and drawbacks of the traditional methods, and current research on volume changes associated with RE as well as their implications for possible clinical use in preparation for liver surgery. RESULTS Both PVE and PVL can achieve a substantial contralateral volume gain of up to 70 %. The development of contralateral hypertrophy can be accelerated by dissecting the liver parenchyma along the intended plane of resection in addition to PVL (in situ split). Compared to these methods, RE achieves less contralateral liver hypertrophy; however, this effect should not be disregarded as RE provides effective treatment of ipsilateral liver tumors along with induction of hypertrophy and may be associated with a reduced risk of tumor progression compared to PVE and PVL. CONCLUSION The available data suggest that RE can complement the armamentarium of methods for induction of FLR hypertrophy in specific situations. Further studies are needed to establish its definitive role for this indication and are in preparation.
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Teo JY, Allen JC, Ng DC, Choo SP, Tai DW, Chang JP, Cheah FK, Chow PK, Goh BK. A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90. HPB (Oxford) 2016; 18:7-12. [PMID: 26776845 PMCID: PMC4750235 DOI: 10.1016/j.hpb.2015.07.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Curative liver resection is the treatment of choice for both primary and secondary liver malignancies. However, an inadequate future liver remnant (FLR) frequently precludes successful surgery. Portal vein embolization is the gold-standard modality for inducing hypertrophy of the FLR. In recent times, unilobar Yttrium-90 selective internal radiation therapy (SIRT) has been reported to induce hypertrophy of the contralateral, untreated liver lobe. The aim of this study is to review the current literature reporting on contralateral liver hypertrophy induced by unilobar SIRT. METHODS A systematic review of the English-language literature between 2000 and 2014 was performed using the search terms "Yttrium 90" OR "selective internal radiation therapy" OR "radioembolization" AND "hypertrophy". RESULTS Seven studies, reporting on 312 patients, were included. Two hundred and eighty four patients (91.0%) received treatment to the right lobe. Two hundred and fifteen patients had hepatocellular carcinoma (HCC), 12 had intrahepatic cholangiocarcinoma, and 85 had liver metastases from mixed primaries. Y90 SIRT resulted in contralateral liver hypertrophy which ranged from 26 to 47% at 44 days-9 months. All studies were retrospective in nature, and heterogeneous, with substantial variations relative to pathology treated, underlying liver disease, dosage and delivery of Y90, number of treatment sessions and time to measurement of hypertrophy. CONCLUSION Unilobar Y90 SIRT results in significant hypertrophy of the contralateral liver lobe. The rate of hypertrophy seems to be slower than that achieved by other methods.
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Affiliation(s)
- Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - John C. Allen
- Duke-NUS Graduate Medical School Singapore, Singapore
| | - David C. Ng
- Department of Nuclear Medicine, Singapore General Hospital, Singapore
| | - Su-Pin Choo
- Division of Medical Oncology, National Cancer Center Singapore, Singapore
| | - David W.M. Tai
- Division of Medical Oncology, National Cancer Center Singapore, Singapore
| | - Jason P.E. Chang
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | | | - Pierce K.H. Chow
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore,Duke-NUS Graduate Medical School Singapore, Singapore
| | - Brian K.P. Goh
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore,Duke-NUS Graduate Medical School Singapore, Singapore,Correspondence Brian K.P. Goh, Department of Hepatopancreatobiliary and Transplantation Surgery, Division of Surgery, Singapore General Hospital, 20 College Road, Academia, 169856, Singapore. Tel: +65 63214051. Fax: +65 62209323.
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103
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Transarterial Chemoembolization and (90)Y Radioembolization for Hepatocellular Carcinoma: Review of Current Applications Beyond Intermediate-Stage Disease. AJR Am J Roentgenol 2015; 205:742-52. [PMID: 26397322 DOI: 10.2214/ajr.15.14802] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The practice guideline of the American Association for the Study of Liver Diseases currently recommends transarterial chemoembolization (TACE) for the treatment of intermediate-stage hepatocellular carcinoma (HCC). The use of transarterial radioembolization (TARE) using (90)Y microspheres is not formally recommended. This article discusses the current clinical applications of TACE and TARE and compares the clinical utility of these techniques for various subpopulations of patients with HCC. CONCLUSION For most clinical scenarios, the efficacy and safety of TACE and TARE are probably equivalent. However, TARE appears to have an advantage over TACE in the facilitation of surgical resection by resulting in compensatory hypertrophy of the future liver remnant and possibly in the treatment of patients with portal vein tumor thrombus. On the contrary, TACE is the transarterial treatment of choice for patients with marginal hepatic reserve (i.e., hyperbilirubinemia, ascites) who may be candidates for transplant.
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104
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Molvar C, Lewandowski R. Yttrium-90 Radioembolization of Hepatocellular Carcinoma-Performance, Technical Advances, and Future Concepts. Semin Intervent Radiol 2015; 32:388-97. [PMID: 26622103 DOI: 10.1055/s-0035-1564704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatocellular carcinoma (HCC) is a lethal tumor, claiming over half a million lives per year. Treatment of HCC is commonly performed without curative intent, and palliative options dominate, including catheter-based therapies, namely, transarterial chemoembolization and yttrium-90 ((90)Y) radioembolization. This review will showcase the performance of (90)Y radioembolization for the treatment of HCC, focusing on recent seminal data and technical advances. In particular, novel radioembolization treatment concepts are discussed and compared with conventional HCC therapy.
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Affiliation(s)
- Christopher Molvar
- Section of Vascular and Interventional Radiology, Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Robert Lewandowski
- Division of Interventional Oncology, Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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105
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Teo JY, Allen JC, Ng DC, Choo SP, Tai DWM, Chang JPE, Cheah FK, Chow PKH, Goh BKP. A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90. HPB (Oxford) 2015:n/a-n/a. [PMID: 26472490 DOI: 10.1111/hpb.12490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/01/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A curative liver resection is the treatment of choice for both primary and secondary liver malignancies. However, an inadequate future liver remnant (FLR) frequently precludes successful surgery. Portal vein embolization is the gold-standard modality for inducing hypertrophy of the FLR. In recent times, unilobar Yttrium-90 selective internal radiation therapy (SIRT) has been reported to induce hypertrophy of the contralateral, untreated liver lobe. The aim of this study was to review the current literature reporting on contralateral liver hypertrophy induced by unilobar SIRT. METHODS A systematic review of the English-language literature between 2000 and 2014 was performed using the search terms 'Yttrium 90' OR 'selective internal radiation therapy' OR 'radioembolization' AND 'hypertrophy'. RESULTS Seven studies, reporting on 312 patients, were included. Two hundred and eighty-four patients (91.0%) received treatment to the right lobe. Two hundred and fifteen patients had hepatocellular carcinoma (HCC), 12 had intrahepatic cholangiocarcinoma and 85 had liver metastases from mixed primaries. Y90 SIRT resulted in contralateral liver hypertrophy that ranged from 26% to 47% at 44 days to 9 months. All studies were retrospective in nature, and heterogeneous, with substantial variations relative to pathology treated, underlying liver disease, dosage and delivery of Y90, the number of treatment sessions and time to measurement of hypertrophy. CONCLUSION Unilobar Y90 SIRT results in significant hypertrophy of the contralateral liver lobe. The rate of hypertrophy seems to be slower than that achieved by other methods.
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Affiliation(s)
- Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - John C Allen
- Duke-NUS Graduate Medical School Singapore, Singapore
| | - David C Ng
- Department of Nuclear Medicine, Singapore General Hospital, Singapore
| | - Su-Pin Choo
- Division of Medical Oncology, National Cancer Center Singapore, Singapore
| | - David W M Tai
- Division of Medical Oncology, National Cancer Center Singapore, Singapore
| | - Jason P E Chang
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | | | - Pierce K H Chow
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School Singapore, Singapore
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Iñarrairaegui M, Sangro B. Radioembolization as an adjunct therapy to the resection of liver tumors. Hepat Oncol 2015; 2:335-338. [PMID: 30191014 PMCID: PMC6095312 DOI: 10.2217/hep.15.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Mercedes Iñarrairaegui
- Liver Unit at Clinica Universidad de Navarra, CIBEREHD, & Navarra Institute for Health Research, Avda. Pio XII 36, 31008 Pamplona, Spain
| | - Bruno Sangro
- Liver Unit at Clinica Universidad de Navarra, CIBEREHD, & Navarra Institute for Health Research, Avda. Pio XII 36, 31008 Pamplona, Spain
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107
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Sacco R, Giorgi L, Fornaro L, Bargellini I. Trans-Arterial Radioembolization for Hepatocellular Carcinoma. Dig Dis 2015; 33:661-7. [PMID: 26398498 DOI: 10.1159/000438476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article offers an overview of a new therapeutic option in hepatocellular carcinoma using trans-arterial radioembolization. In particular, it covers practical aspects of the technique and the currently available preliminary data in terms of disease control. We explore the potentials of radioembolization both in early and advanced stages of the disease, as single treatment and as companion to targeted agents such as sorafenib.
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Affiliation(s)
- Rodolfo Sacco
- Department of Gastroenterology, Pisa University Hospital, Pisa, Italy
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108
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Sacco R, Mismas V, Marceglia S, Romano A, Giacomelli L, Bertini M, Federici G, Metrangolo S, Parisi G, Tumino E, Bresci G, Corti A, Tredici M, Piccinno M, Giorgi L, Bartolozzi C, Bargellini I. Transarterial radioembolization for hepatocellular carcinoma: An update and perspectives. World J Gastroenterol 2015; 21:6518-25. [PMID: 26074690 PMCID: PMC4458762 DOI: 10.3748/wjg.v21.i21.6518] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/13/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
In the last decade trans-arterial radioembolization has given promising results in the treatment of patients with intermediate or advanced stage hepatocellular carcinoma (HCC), both in terms of disease control and tolerability profile. This technique consists of the selective intra-arterial administration of microspheres loaded with a radioactive compound (usually Yttrium(90)), and exerts its therapeutic effect through the radiation carried by these microspheres. A careful and meticulous selection of patients is crucial before performing the radioembolization to correctly perform the procedure and reduce the incidence of complications. Radioembolization is a technically complex and expensive technique, which has only recently entered clinical practice and is supported by scant results from phase III clinical trials. Nevertheless, it may represent a valid alternative to transarterial chemoembolization (TACE) in the treatment of intermediate-stage HCC patients, as shown by a comparative retrospective assessment that reported a longer time to progression, but not of overall survival, and a more favorable safety profile for radioembolization. In addition, this treatment has reported a higher percentage of tumor shrinkage, if compared to TACE, for pre-transplant downsizing and it represents a promising therapeutic option in patients with large extent of disease and insufficient residual liver volume who are not immediately eligible for surgery. Radioembolization might also be a suitable companion to sorafenib in advanced HCC or it can be used as a potential alternative to this treatment in patients who are not responding or do not tolerate sorafenib.
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109
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Fernandez-Ros N, Iñarrairaegui M, Paramo JA, Berasain C, Avila MA, Chopitea A, Varo N, Sarobe P, Bilbao JI, Dominguez I, D'Avola D, Herrero JI, Quiroga J, Sangro B. Radioembolization of hepatocellular carcinoma activates liver regeneration, induces inflammation and endothelial stress and activates coagulation. Liver Int 2015; 35:1590-6. [PMID: 24836705 DOI: 10.1111/liv.12592] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/12/2014] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Radioembolization may rarely induce liver disease resulting in a syndrome that is similar to veno-occlusive disease complicating bone marrow transplantation where inflammation, endothelial cell activation and thrombosis are likely involved. We hypothesized that similar mechanisms could be implicated in radioembolization-induced liver disease (REILD). Moreover, lobar radioembolization may induce hypertrophy of the non-treated hemiliver most probably by inducing liver regeneration. METHODS In patients with hepatocellular carcinoma, we prospectively studied serum levels of markers of liver regeneration, oxidative stress, pro-inflammatory pathways, endothelial activation and coagulation parameters over 2 months after radioembolization. RESULTS Although REILD did not occur among 14 treated patients, a decrease in effective liver blood flow was observed. Radioembolization was followed by a persistent increase in pro-inflammatory (interleukin 6 and 8) and oxidative stress (malondyaldehide) markers, an induction of endothelial injury markers (vW factor and PAI-1) and an activation of the coagulation cascade (factor VIII, PAI-1, D-Dimer) as well as a significant increase in factors related to liver regeneration (FGF-19 and HGF). CONCLUSION Radioembolization activates liver regeneration, produces oxidative stress, activates inflammatory cytokines and induces endothelial injury with partial activation of the coagulation cascade. These findings may have implications in the pathogenesis, prevention and therapy of REILD and in the development of new therapies to enhance hypertrophy with a surgical perspective.
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110
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Habib A, Desai K, Hickey R, Thornburg B, Lewandowski R, Salem R. Locoregional therapy of hepatocellular carcinoma. Clin Liver Dis 2015; 19:401-20. [PMID: 25921670 DOI: 10.1016/j.cld.2015.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatocellular carcinoma can be treated using minimally invasive, image-guided, catheter-based or percutaneous techniques. Such procedures offer compelling clinical outcomes with a favorable side-effect profile in a population of patients who are poor candidates for surgical or systemic treatment. This article discusses key data regarding the effectiveness of locoregional therapies in treating these patients. Disease-specific treatment is discussed in the context of hepatocellular carcinoma, with additional data discussed in the context of transplantation. As rapid innovation occurs in the realm of oncology, interventional oncology represents a safe, effective alternative that continues to generate impressive data that could potentially change treatment paradigms.
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Affiliation(s)
- Ali Habib
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Kush Desai
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Ryan Hickey
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Bartley Thornburg
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Robert Lewandowski
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Vascular and Interventional Radiology, Image-Guided Therapy, Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611, USA.
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111
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Gibbs P, Tie J, Bester L. Radioembolization for hepatocellular carcinoma: current role and future directions – the medical oncologist's perspective. Hepat Oncol 2015; 2:117-132. [DOI: 10.2217/hep.14.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The incidence and impact of hepatocelluar carcinoma (HCC) continues to increase worldwide. While radical therapies such as resection, radiofrequency ablation or transplantation are potentially curative for patients with early-stage HCC, the majority of patients in routine practice present with more advanced tumors, where treatment goals are palliation and extending survival. With multiple new and promising treatment options emerging for these patients, the challenge for the medical oncologist is how best to integrate these therapies into routine clinical practice. Here we review the most recent data on the efficacy and safety of yttrium-90 radioembolization in HCC, the considerations involved in patient selection, and the optimal assessment and management of patients receiving treatment. We also examine the potential impact of several ongoing clinical trials.
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Affiliation(s)
- Peter Gibbs
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - Lourens Bester
- Interventional Radiology, Department of Medical Imaging, St Vincent's Hospital, Sydney, Australia
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112
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Teo JY, Goh BKP. Contra-lateral liver lobe hypertrophy after unilobar Y90 radioembolization: An alternative to portal vein embolization? World J Gastroenterol 2015; 21:3170-3173. [PMID: 25805922 PMCID: PMC4363745 DOI: 10.3748/wjg.v21.i11.3170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/11/2014] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
Liver resection (LR) with negative margins confers survival advantage in many patients with hepatic malignancies. However, an adequate future liver remnant (FLR) is imperative for safe LR. Presently, in patients with an inadequate FLR; the 2 most established clinical techniques performed to induce liver hypertrophy are portal vein embolization (PVE) and portal vein ligation. More recently, it has been observed that patients who undergo treatment via Y90 radioembolization experience hypertrophy of the contra-lateral untreated liver lobe. Based on these observations, several investigators have proposed the potential use of this modality as an alternative technique for increasing the FLR prior to liver resection. Y90 radioembolization induces hypertrophy at a slower rate than PVE but has the added advantage of concomitant local disease control and tumour down-staging.
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113
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Edeline J, Gilabert M, Garin E, Boucher E, Raoul JL. Yttrium-90 microsphere radioembolization for hepatocellular carcinoma. Liver Cancer 2015; 4:16-25. [PMID: 26020026 PMCID: PMC4439788 DOI: 10.1159/000343878] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Yttrium-90 (Y90) radioembolization is an emerging strategy to treat liver malignancies, and clinical data supporting its use have accumulated in recent years. Y90-radioembolization has shown clinical effectiveness in intermediate and advanced hepatocellular carcinoma, with a favorable safety profile. Retrospective data show similar levels of effectiveness to transarterial chemoembolization in intermediate hepatocellular carcinoma, with some evidence of better tolerance. While phase 3 studies comparing Y90-radioembolization to chemoembolization in intermediate hepatocellular carcinoma would be difficult to conduct, studies comparing or combining Y90-radioembolization with sorafenib are under way. Questions also remain about the most suitable modalities for defining the dose to administer. Phase 3 studies are under way to clarify the place of Y90-radioembolization in the algorithm of HCC treatment.
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Affiliation(s)
- Julien Edeline
- Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes, France
| | - Marine Gilabert
- Medical Oncology, Paoli Calmette Institute, Marseille, France
| | - Etienne Garin
- Nuclear Medicine, Eugene Marquis Comprehensive Cancer Center, Rennes, France
| | - Eveline Boucher
- Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes, France
| | - Jean-Luc Raoul
- Medical Oncology, Paoli Calmette Institute, Marseille, France,*Jean-Luc Raoul, MD, PhD, Institut Paoli Calmette, 232, boulevard Sainte Marguerite, BP 156, 13273 Marseille cedex9 (France), Tel. +33 4 9122 3679, E-Mail
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115
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Manas DM. Hypertrophy in the contralateral lobe post-selective internal radiation therapy. Future Oncol 2014; 10:65-7. [PMID: 25478771 DOI: 10.2217/fon.14.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Bas A, Samanci C, Gulsen F, Cantasdemir M, Kabasakal L, Kantarci F, Numan F. Evaluation of Liver Stiffness After Radioembolization by Real-Time ShearWave™ Elastography: Preliminary Study. Cardiovasc Intervent Radiol 2014; 38:957-63. [PMID: 25413262 DOI: 10.1007/s00270-014-1021-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/19/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the effect of ShearWave(™) elastography (SWE) for the assessment of liver fibrosis after radioembolization (RE) in patients with liver malignancies. MATERIALS AND METHODS We prospectively examined the effects of SWE before and after RE in 17 adult patients, from June 2012 to September 2013. All patients underwent SWE within 1 month before and 3 months (96.3 ± 22.9 days) after RE. Measurements were taken in segments III, IV, V, and VI (lateral/medial left lobe and anterior/posterior right lobe, respectively). Liver stiffness was studied in the 39 treated segments. RESULTS The mean stiffness of liver tissue according to the pre-RE SWE measurements was not different from the post-RE SWE measurements in the segments that did not undergo RE. Conversely, segments treated with RE were significantly stiffer according to the post-RE SWE measurements (mean SWE 17.4 kPa) than according to the baseline measurements (7.0 kPa) (p < 0.001). Patients with hepatocellular carcinoma and preexisting infection with hepatitis B and C viruses had higher pre-embolization stiffness, and the post-embolization stiffness of the treated segments in these patients was higher than that in the remainder of the study population. CONCLUSION These data suggest that SWE measurements of liver stiffness increase as early as the third month after RE. SWE could be used as a noninvasive complementary imaging method for preliminary assessment of liver fibrosis before and after RE.
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Affiliation(s)
- Ahmet Bas
- Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, KMPasa, Fatih, Istanbul, 34098, Turkey,
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Cappelli A, Pettinato C, Golfieri R. Transarterial radioembolization using yttrium-90 microspheres in the treatment of hepatocellular carcinoma: a review on clinical utility and developments. J Hepatocell Carcinoma 2014; 1:163-82. [PMID: 27508185 PMCID: PMC4918277 DOI: 10.2147/jhc.s50472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A selective intra-arterial liver injection using yttrium-90-loaded microspheres as sources for internal radiation therapy is a form of transarterial radioembolization (TARE). Current data from the literature suggest that TARE is effective in hepatocellular carcinoma (HCC) and is associated with a low rate of adverse events; however, they are all based on retrospective series or non-controlled prospective studies, since randomized controlled trials comparing the other liver-directed therapies for intermediate and locally advanced stages HCC are still ongoing. The available data show that TARE provides similar or even better survival rates. TARE is very well tolerated and has a low rate of complications; these complications do not result from the embolic effects but mainly from the unintended irradiation to non-target tissue, including the liver parenchyma. The complications can be further reduced by accurate patient selection and a strict pre-treatment evaluation, including dosimetry and assessment of the vascular anatomy. First-line TARE is best indicated for intermediate-stage patients (according to the Barcelona Clinic Liver Cancer [BCLC] staging classification) who are poor candidates for transarterial chemoembolization or patients having locally advanced disease with segmental or lobar branch portal vein thrombosis. Moreover, data are emerging regarding the use of TARE in patients classified slightly above the criteria for liver transplantation with the purpose of downstaging them. TARE can also be applied as a second-line treatment in patients progressing to transarterial chemoembolization or sorafenib; a large number of Phase II/III trials are in progress in order to evaluate the best association with systemic therapies. Given the complexity of a correct treatment algorithm for potential TARE candidates and the need for clinical guidance, a comprehensive review was carried out analyzing both the best selection criteria of patients who really benefit from TARE and the new advances of this therapy which add significant value to the therapeutic weaponry against HCC.
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Affiliation(s)
| | - Cinzia Pettinato
- Medical Physics Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, S Orsola-Malpighi Hospital, Bologna, Italy
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Abstract
Over the last decade, transarterial therapies have gained worldwide acceptance as standard of care for inoperable primary liver cancer. Survival times after transarterial chemoembolization (TACE) continue to improve as the technique and selection criteria are refined. Transarterial treatments, frequently provided in an outpatient setting, are now safely and effectively being applied to patients with even advanced malignancy or partially decompensated cirrhosis. In the coming years, newer transarterial therapies such as radiation segmentectomy, boosted-transarterial radioembolzation, combined TACE-ablation, TACE-portal vein embolization, and transarterial infusion of cancer-specific metabolic inhibitors promise to continue improving survival and quality of life.
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Murata S, Mine T, Sugihara F, Yasui D, Yamaguchi H, Ueda T, Onozawa S, Kumita SI. Interventional treatment for unresectable hepatocellular carcinoma. World J Gastroenterol 2014; 20:13453-13465. [PMID: 25309076 PMCID: PMC4188897 DOI: 10.3748/wjg.v20.i37.13453] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/22/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death in the world. The Barcelona clinic liver cancer classification is the current standard classification system for the clinical management of patients with HCC and suggests that patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE). Interventional treatments such as TACE, balloon-occluded TACE, drug-eluting bead embolization, radioembolization, and combined therapies including TACE and radiofrequency ablation, continue to evolve, resulting in improved patient prognosis. However, patients with advanced-stage HCC typically receive only chemotherapy with sorafenib, a multi-kinase inhibitor, or palliative and conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. However, these patients require therapy that is more effective than sorafenib or conservative treatment. Several researchers try to perform more effective therapies, such as combined therapies (TACE with radiotherapy and sorafenib with TACE), modified TACE for HCC with arterioportal or arteriohepatic vein shunts, TACE based on hepatic hemodynamics, and isolated hepatic perfusion. This review summarizes the published data and data on important ongoing studies concerning interventional treatments for unresectable HCC and discusses the technical improvements in these interventions, particularly for advanced-stage HCC.
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120
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Schlaak JF. Radioembolization with yttrium-90 glass microspheres for patients with hepatocellular carcinoma: a review. Hepat Oncol 2014; 1:387-393. [DOI: 10.2217/hep.14.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Clinical studies have evaluated the safety and efficacy of radioembolization with yttrium-90 in patients with unresectable hepatocellular carcinoma (HCC). Citing literature published within the last 5 years, we review the clinical evidence of survival outcomes and safety of yttrium-90 treatment in patients with unresectable HCC. This paper is primarily focused on survival rates following the typical application of yttrium-90 in HCC treatment, and also includes time to progression and safety data. Also discussed are special indications and new developments related to yttrium-90 therapy in HCC, as well as patient selection and its correlation with successful treatment outcomes.
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121
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Sangro B. Chemoembolization and radioembolization. Best Pract Res Clin Gastroenterol 2014; 28:909-19. [PMID: 25260317 DOI: 10.1016/j.bpg.2014.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/15/2014] [Indexed: 01/31/2023]
Abstract
Chemoembolization and radioembolization are at the core of the treatment of patients with hepatocellular carcinoma who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. They differ in the mechanism of action (ischaemia and increase cytotoxic drug exposure for chemoembolization, internal irradiation for radioembolization) and may target different patient populations. Chemoembolization with cytotoxic drug-eluting beads is a more standardized although not necessarily more effective way of performing chemoembolization. Cytoreduction is achieved in most patients but complete tumor ablation may be achieved and lead to extended survival. Grade 1 level of evidence support the use of chemoembolization for the treatment of patients in the early and intermediate stages while grade 2 evidence supports the use of radioembolization for the treatment of patients in intermediate to advanced stages. Selecting the best candidates for both techniques is still a work in progress that ongoing clinical trials are trying to address.
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Affiliation(s)
- Bruno Sangro
- Clinica Universidad de Navarra, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Avda, Pio XII 36, 31008 Pamplona, Spain.
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Lee HS, Choi GH, Choi JS, Kim KS, Han KH, Seong J, Ahn SH, Kim DY, Park JY, Kim SU, Kim BK. Surgical resection after down-staging of locally advanced hepatocellular carcinoma by localized concurrent chemoradiotherapy. Ann Surg Oncol 2014; 21:3646-3653. [PMID: 24916746 DOI: 10.1245/s10434-014-3652-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Indexed: 09/25/2023]
Abstract
BACKGROUND This study evaluated the down-staging efficacy and impact on resectability of concurrent chemoradiotherapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in locally advanced hepatocellular carcinoma, and identified prognostic factors of disease-free survival (DFS) and overall survival (OS) after curative resection. METHODS DFS and OS were investigated using clinicopathologic variables. Functional residual liver volume (FRLV) was assessed before CCRT and again before surgery in patients with major hepatectomy. Tumor marker response was defined as elevated tumor marker levels at diagnosis but levels below cutoff values before surgery (α-fetoprotein < 20 ng/mL, protein induced by vitamin K absence or antagonist-II < 40 mAU/mL). RESULTS Of 243 patients who received CCRT followed by HAIC between 2005 and 2011, 41 (16.9 %) underwent curative resection. Tumor down-staging was demonstrated in 32 (78 %) of the resected patients. FRLV significantly increased from 47.5 to 69.9 % before surgery in patients who underwent major hepatectomy. In addition, the OS of the curative resection group was significantly higher than the OS of the CCRT followed by HAIC alone group (49.6 vs. 9.8 % at 5-year survival; p < 0.001). By multivariate analysis, the poor prognostic factors for DFS after curative resection were tumor marker non-response and the presence of a satellite nodule; however, tumor marker non-response was the only independent poor prognostic factor of OS. CONCLUSIONS CCRT followed by HAIC increased resectability by down-staging tumors and increasing FRLV. Curative resection may provide good long-term survival in tumor marker responders who undergo CCRT followed by HAIC.
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Affiliation(s)
- Hyung Soon Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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123
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Abstract
The most common non-surgical approaches for the treatment of localized hepatocellular carcinoma remain hepatic artery-delivered particles laden with chemotherapy (TACE), or radioactive microparticles (TARE). External beam radiotherapy has been an effective option in many parts of the world for selected HCC patients, but now has an expanded role with stereotactic and proton beam technologies. This review focuses on existing evidence and current guidance for utilizing these modalities for localized, but unresectable, non-transplantable HCC patients.x.
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Affiliation(s)
- Andrew S Kennedy
- Radiation Oncology Research, Sarah Cannon Research Institute, 3322 West End Avenue, Suite 800, Nashville, TN, 37203, USA,
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124
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Golfieri R. SIR-Spheres yttrium-90 radioembolization for the treatment of unresectable liver cancers. Hepat Oncol 2014; 1:265-283. [PMID: 30190962 DOI: 10.2217/hep.14.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Transarterial radioembolization with yttrium-90 resin microspheres (SIR-Spheres; Sirtex Medical Limited, Sydney, Australia) is a liver-directed therapy that is gaining recognition as a treatment option for liver-dominant primary and metastatic cancers. The incidence of complications is low and can be further reduced by patient selection and rigorous pretreatment assessment. Ideal candidates for radioembolization have preserved liver function without ascites or encephalopathy, Child-Pugh score <7 and limited lung shunting. Phase III randomized controlled trials (RCTs) against other liver-directed therapies are lacking for intermediate-stage hepatocellular carcinoma. However, preliminary data from a recent RCT has suggested that radioembolization has a similar time-to-progression and comparable toxicity to selective chemoembolization. Phase II/III RCTs are now ongoing to evaluate the combination of radioembolization with systemic therapies in advanced-stage hepatocellular carcinoma and metastatic liver-dominant colorectal cancer in order to expand the treatment opportunities for patients with cancers in the liver.
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Affiliation(s)
- Rita Golfieri
- Radiology Unit, Department of Digestive Diseases & Internal Medicine, Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna, Italy
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125
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Teo JY, Goh BKP, Cheah FK, Allen JC, Lo RHG, Ng DCE, Goh ASW, Khor AYK, Sim HS, Ng JJ, Chow PKH. Underlying liver disease influences volumetric changes in the spared hemiliver after selective internal radiation therapy with 90Y in patients with hepatocellular carcinoma. J Dig Dis 2014; 15:444-50. [PMID: 24828952 DOI: 10.1111/1751-2980.12162] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Hypertrophy of the contralateral liver lobe after treatment with yttrium-90 ((90)Y) microspheres has recently been reported. This study aimed to quantify left hepatic lobe hypertrophy after right-sided radioembolization for hepatocellular carcinoma (HCC) and to identify pretreatment predictive factors of hypertrophy in an Asian population. METHODS A retrospective review of patients with inoperable HCC undergoing selective internal radiation treatment (SIRT) with (90)Y microspheres at a single institution from January 2008 to January 2012 was performed. Only patients who had treatment delivered via the right hepatic artery alone were included. RESULTS In all, 17 patients fulfilling the study criteria were identified. The mean percentage of left-lobe hypertrophy was 34.2% ± 34.9% (range 19.0-106.5%) during a median of 5-month follow-up. Patients with hepatitis B were found to experience a significantly greater degree of hypertrophy than those with hepatitis C or alcoholic liver cirrhosis. There were no cases of acute liver failure after the administration of SIRT in this study and none of the patients developed disease in the contralateral lobe over the study period. CONCLUSIONS Administration of unilobar SIRT to the right liver lobe in patients with HCC resulted in a significant degree of contralateral left lobe hypertrophy. Patients with hepatitis B experienced a greater degree of hypertrophy than those with hepatitis C or alcoholic liver cirrhosis.
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Affiliation(s)
- Jin Yao Teo
- Department of General Surgery, Singapore General Hospital, Singapore
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Braat AJAT, Huijbregts JE, Molenaar IQ, Borel Rinkes IHM, van den Bosch MAAJ, Lam MGEH. Hepatic radioembolization as a bridge to liver surgery. Front Oncol 2014; 4:199. [PMID: 25126539 PMCID: PMC4115667 DOI: 10.3389/fonc.2014.00199] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/15/2014] [Indexed: 12/11/2022] Open
Abstract
Treatment of oncologic disease has improved significantly in the last decades and in the future a vast majority of cancer types will continue to increase worldwide. As a result, many patients are confronted with primary liver cancers or metastatic liver disease. Surgery in liver malignancies has steeply improved and curative resections are applicable in wider settings, leading to a prolonged survival. Simultaneously, radiofrequency ablation (RFA) and liver transplantation (LTx) have been applied more commonly in oncologic settings with improving results. To minimize adverse events in treatments of liver malignancies, locoregional minimal invasive treatments have made their appearance in this field, in which radioembolization (RE) has shown promising results in recent years with few adverse events and high response rates. We discuss several other applications of RE for oncologic patients, other than its use in the palliative setting, whether or not combined with other treatments. This review is focused on the role of RE in acquiring patient eligibility for radical treatments, like surgery, RFA, and LTx. Inducing significant tumor reduction can downstage patients for resection or, through attaining stable disease, patients can stay on the LTx waiting list. Hereby, RE could make a difference between curative of palliative intent in oncologic patient management. Prior to surgery, the future remnant liver volume might be inadequate in some patients. In these patients, forming an adequate liver reserve through RE leads to prolonged survival without risking post-operative liver failure and minimizing tumor progression while inducing hypertrophy. In order to optimize results, developments in procedures surrounding RE are equally important. Predicting the remaining liver function after radical treatment and finding the right balance between maximum tumor irradiation and minimizing the chance of inducing radiation-related complications are still challenges.
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Affiliation(s)
- Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht , Utrecht , Netherlands
| | - Julia E Huijbregts
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht , Utrecht , Netherlands
| | - I Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht , Utrecht , Netherlands
| | | | | | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht , Utrecht , Netherlands
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Abstract
Unresectable primary and metastatic liver tumors are a leading cause of cancer mortality and morbidity. This remains a challenging and key task for every oncologist despite significant advances that have been made with selective targeted systemic agents and in technology advances with radiotherapy delivery. Radioembolization (RE) is a technique of permanently implanting microspheres containing Yttrium-90 ((90)Y), a beta-emitting isotope with a treatment range of 2 mm, into hepatic tumors. This form of brachytherapy utilizes the unique dual vascular anatomy of the liver to preferentially deliver radioactive particles via the hepatic artery to tumor, sparing normal liver parenchyma. The main treatment inclusion criteria are patients with solid tumors, compensated liver functions, life expectancy of at least three months, and ECOG performance status 0-2. Benefit of RE has been proven in patients that have low-to-moderate extrahepatic disease burden, prior liver radiotherapy, heavy prior chemotherapy and biologic agent exposure, and history of hepatic surgery or ablation. Most of the clinical evidence is reported in metastatic colorectal, and neuroendocrine tumors (NET), and primary hepatocellular cancer. A growing body of data supports the use of RE in hepatic metastatic breast cancer, intrahepatic cholangiocarinoma, and many other metastatic tumor types. Side effects are typically mild constitutional and GI issues limited to the first 7-14 days post treatment, with only 6% grade 3 toxicity reported in large series. Potentially serious or fatal radiation induced liver disease is extremely rare, reported in only 1% or fewer in major series of both metastatic and primary tumors treated with RE. Currently, high priority prospective clinical trials are testing RE combined with chemotherapy in first line therapy for colorectal hepatic metastases, and combined with sorafenib for hepatocellular carcinomas (HCCs). Fortunately, this beneficial and now widely available therapy is being increasingly incorporated into the standard therapy algorithms of multidisciplinary GI cancer teams worldwide. This form of radiotherapy differs significantly from daily external beam radiotherapy in many ways, particularly in dose rate, dosimetric coverage and duration of radiation delivery, side effects, and patient selection factors. A wealth of experience using RE in solid tumors exists and ongoing major prospective clinical trials will soon clarify the role of RE in the management of metastatic colorectal liver metastases.
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Affiliation(s)
- Andrew Kennedy
- Radiation Oncology Research, Sarah Cannon Research Institute, 3322 West End Ave., Suite 800 Nashville, TN 37203, USA
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128
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Reataza M, Imagawa DK. Advances in managing hepatocellular carcinoma. Front Med 2014; 8:175-89. [PMID: 24810646 DOI: 10.1007/s11684-014-0332-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 02/28/2014] [Indexed: 12/13/2022]
Abstract
Multiple modalities for treatment of hepatocellular carcinoma are available, depending on tumor size and number. Surgical resection remains the gold standard, so long as the residual liver function reserve is sufficient. In patients with advanced cirrhosis, liver transplantation is the preferred option, as these patients may not have adequate hepatic reserve after resection. Salvage liver transplantation has also become an option for a select few patients who recur after surgical resection. Ablative techniques have been used for palliation as well as to either completely destroy the tumor, act as an adjunct to resection, or downstage the tumor to meet Milan criteria such that a patient may be a candidate for liver transplantation. Radiofrequency ablation, microwave ablation, chemoembolization, radioembolization, and irreversible electroporation have all been used in this capacity. Currently, sorafenib is the only US Food and Drug Administration-approved chemotherapeutic for hepatocellular carcinoma. The efficacy of sorafenib, in combination with other agents, transarterial chemoembolization, and surgical resection is currently being investigated. Sunitinib and brivanib, tyrosine kinase inhibitors, have failed as potential first- or second-line options for chemotherapy. Bevacizumab in combination with erlotinib is also currently being studied. Final analysis for ramucirumab and axitinib are pending. Tivantinib, a selective mesenchymal-epithelial transition factor (MET) inhibitor, is also undergoing clinical trials for efficacy in MET-high tumors. This review serves to emphasize the current and new technologies emerging in the treatment of hepatocellular carcinoma.
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Affiliation(s)
- Marielle Reataza
- Irvine Medical Center, University of California, Orange, CA, 92868, USA
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129
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Garlipp B, de Baere T, Damm R, Irmscher R, van Buskirk M, Stübs P, Deschamps F, Meyer F, Seidensticker R, Mohnike K, Pech M, Amthauer H, Lippert H, Ricke J, Seidensticker M. Left-liver hypertrophy after therapeutic right-liver radioembolization is substantial but less than after portal vein embolization. Hepatology 2014; 59:1864-73. [PMID: 24259442 DOI: 10.1002/hep.26947] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/17/2013] [Indexed: 12/22/2022]
Abstract
UNLABELLED In patients with liver malignancies potentially amenable to curative extended right hepatectomy but insufficient size of the future liver remnant (FLR), portal vein embolization (PVE) of the tumor-bearing liver is used to induce contralateral liver hypertrophy but leaves the tumor untreated. Radioembolization (RE) treats the tumor in the embolized lobe along with contralateral hypertrophy induction. We performed a matched-pair analysis to compare the capacity for hypertrophy induction of these two modalities. Patients with right-hepatic secondary liver malignancies with no or negligible left-hepatic tumor involvement who were treated by right-lobar PVE (n = 141) or RE (n = 35) at two centers were matched for criteria known to influence liver regeneration following PVE: 1) baseline FLR/Total liver volume ratio (<25 versus ≥ 25%); 2) prior platinum-containing systemic chemotherapy; 3) embolization of segments 5-8 versus 4-8; and 4) baseline platelet count (<200 versus ≥ 200 Gpt/L).The primary endpoint was relative change in FLR volume from baseline to follow-up. Twenty-six matched pairs were identified. FLR volume increase from baseline to follow-up (median 33 [24-56] days after PVE or 46 [27-79] days after RE) was significant in both groups but PVE produced significantly more FLR hypertrophy than RE (61.5 versus 29%, P < 0.001). Time between treatment and follow-up was not correlated with the degree of contralateral hypertrophy achieved in both groups. Although group differences in patient history and treatment setting were present and some bias cannot be excluded, this was minimized by the matched-pair design, as remaining group differences after matching were found to have no significant influence on contralateral hypertrophy development. CONCLUSION PVE induces significantly more contralateral hypertrophy than RE with therapeutic (nonlobectomy) doses. However, contralateral hypertrophy induced by RE is substantial and RE minimizes the risk of tumor progression in the treated lobe, possibly making it a suitable modality for selected patients.
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Affiliation(s)
- Benjamin Garlipp
- Universitätsklinikum Magdeburg, Klinik für Allgemein-, Viszeral- und Gefäβchirurgie, Magdeburg, Germany
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Fernández-Ros N, Silva N, Bilbao JI, Iñarrairaegui M, Benito A, D'Avola D, Rodriguez M, Rotellar F, Pardo F, Sangro B. Partial liver volume radioembolization induces hypertrophy in the spared hemiliver and no major signs of portal hypertension. HPB (Oxford) 2014; 16:243-9. [PMID: 23530966 PMCID: PMC3945850 DOI: 10.1111/hpb.12095] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 02/07/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post-treatment contralateral hemiliver hypertrophy has created an interest in lobar liver radioembolization (RE) as a pre-surgery tool. METHODS Liver and spleen volumes and function were studied in 83 patients submitted to partial liver volume RE at 4-8 weeks (T1), 10-26 weeks (T2), and >26 weeks (T3) after RE. RESULTS More than half of the patients had cirrhosis with hepatocellular carcinoma. The main finding was a progressive increase in the volume of the spared hemiliver (mean absolute increase at T3: 230 ml). The percentage of patients in whom the baseline ratio of spared volume to total liver volume was <40% dropped from 56.6% at baseline to 29.4% at T2 (P < 0.001). A significant and progressive increase in spleen volume but not in portal vein diameter was also observed. A small percentage of patients developed hypersplenism, mostly those without cirrhosis (16.0% at T2). Six patients (five with portal vein thrombosis, cirrhosis or both) developed signs of portal hypertension by T2. CONCLUSIONS The present results warrant further studies to better elucidate the mechanism underlying this phenomenon of spared hemiliver hypertrophy and to investigate its role as an alternative to portal vein embolization in the management of patients with potentially resectable liver tumours.
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Affiliation(s)
- Nerea Fernández-Ros
- Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Nuno Silva
- Department of Radiology, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Jose Ignacio Bilbao
- Department of Radiology, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Mercedes Iñarrairaegui
- Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; Network Centre for Biomedical Research into Hepatic and Digestive Diseases)Pamplona, Spain
| | - Alberto Benito
- Department of Radiology, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Delia D'Avola
- Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; Network Centre for Biomedical Research into Hepatic and Digestive Diseases)Pamplona, Spain
| | - Macarena Rodriguez
- Department of Nuclear Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Fernando Rotellar
- Department of Hepatopancreatobiliary (HPB) Surgery, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Fernando Pardo
- Department of Hepatopancreatobiliary (HPB) Surgery, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain
| | - Bruno Sangro
- Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,HPB Oncology Area, Clinica Universidad de Navarra (University Clinic of Navarra)Pamplona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd; Network Centre for Biomedical Research into Hepatic and Digestive Diseases)Pamplona, Spain,Correspondence Bruno Sangro, Liver Unit, Department of Internal Medicine, Clinica Universidad de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. Tel: + 34 948 296 637. Fax: + 34 948 296 500. E-mail:
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132
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Abstract
Transarterial radioembolization (TARE) with yttrium 90 microspheres is an increasingly popular therapy for both primary and secondary liver malignancies. TARE entails delivery of β-particle brachytherapy and embolization of the tumor vasculature. The consequent biological sequelae are distinct from those of other transarterial therapies for liver tumors, as reflected in the often baffling post-treatment imaging features. As the clinical use of TARE is increasing, more diverse post-treatment radiological findings are encountered with variable overlap among treatment response, residual disease, reactionary changes and complications. Thus, post-TARE image interpretation is challenging. This review provides a comprehensive description of the different findings seen in post-treatment scans, with the aim of facilitating appropriate radiological interpretation of post-TARE pathologic changes, notwithstanding their existing limitations.
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Affiliation(s)
- Pavel Singh
- Department of Diagnostic Imaging, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gopinathan Anil
- Department of Diagnostic Imaging, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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133
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Yoon HI, Seong J. Multimodality Treatment Involving Radiotherapy for Advanced Liver-Confined Hepatocellular Carcinoma. Oncology 2014; 87 Suppl 1:90-8. [DOI: 10.1159/000368151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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134
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van Lienden KP, Hoekstra LT, van Trigt JD, Roelofs JJ, van Delden OM, van Gulik TM. Effect of hepatic artery embolization on liver hypertrophy response in a rabbit liver VX2 tumor model. Hepatobiliary Pancreat Dis Int 2013; 12:622-9. [PMID: 24322748 DOI: 10.1016/s1499-3872(13)60098-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Portal vein embolization not only induces hypertrophy of the non-embolized liver, but also enhances tumor growth. The latter could be prevented by embolizing the hepatic arteries supplying the tumor-bearing liver segments. This study aimed to determine the effects of transcatheter arterial embolization (TAE) on tumor volume and liver regeneration in a rabbit VX2 tumor model. METHODS Twenty-three rabbits underwent subcapsular tumor implantation with a VX2 tumor. Two weeks after implantation, 18 rabbits were used for TAE experiments, 5 were for sham controls. Tumor response and liver regeneration response of the embolized cranial and non-embolized caudal liver lobes were assessed by CT volumetry, liver to body weight index, and the amount of proliferating hepatocytes. RESULTS All super-selective arterial tumor embolization procedures were performed successfully. Despite embolization, the tumor volume increased after an initial steady state. The tumor volume after embolization was smaller than that of the sham group, but this difference was not significant. Massive necrosis of the tumor, however, was seen after embolization, without damage of the surrounding liver parenchyma. There was a significant atrophy response of the tumor bearing cranial lobe after super-selective arterial embolization of the tumor with a concomitant hypertrophy response of the non-embolized, caudal lobe. This regeneration response was confirmed histologically by a significantly higher number of proliferating hepatocytes on the Ki-67 stained slides. CONCLUSIONS Super-selective, bland arterial coil embolization causes massive necrosis of the tumor, despite increase of volume on CT scan. Atrophy of the tumor bearing liver lobe is seen after arterial embolization of the tumor with a concomitant hypertrophy response of the non-embolized lobe, despite absence of histological damage of the tumor-surrounding liver parenchyma.
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Affiliation(s)
- Krijn P van Lienden
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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135
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Salem R, Mazzaferro V, Sangro B. Yttrium 90 radioembolization for the treatment of hepatocellular carcinoma: biological lessons, current challenges, and clinical perspectives. Hepatology 2013; 58:2188-97. [PMID: 23512791 PMCID: PMC3732811 DOI: 10.1002/hep.26382] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/06/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Riad Salem
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago IL
| | - Vincenzo Mazzaferro
- Gastro-Intestinal Surgery and Liver Transplantation Unit, National Cancer Institute, Istituto Nazionale Tumori IRCCS, Milan, Italy
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
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Malik J, Tilocca A. Hydration Effects on the Structural and Vibrational Properties of Yttrium Aluminosilicate Glasses for in Situ Radiotherapy. J Phys Chem B 2013; 117:14518-28. [DOI: 10.1021/jp4073203] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jahangir Malik
- Department of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, United Kingdom
| | - Antonio Tilocca
- Department of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, United Kingdom
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137
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Vouche M, Lewandowski RJ, Atassi R, Memon K, Gates VL, Ryu RK, Gaba RC, Mulcahy MF, Baker T, Sato K, Hickey R, Ganger D, Riaz A, Fryer J, Caicedo JC, Abecassis M, Kulik L, Salem R. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol 2013; 59:1029-36. [PMID: 23811303 PMCID: PMC5085290 DOI: 10.1016/j.jhep.2013.06.015] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/21/2013] [Accepted: 06/17/2013] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with (90)Y-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed at testing this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization. METHODS 83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N=67), cholangiocarcinoma (CC; N=8) or colorectal cancer (CRC; N=8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion. RESULTS Right lobe atrophy (p=0.003), left lobe hypertrophy (p<0.001), and FLR hypertrophy (p<0.001) were observed 1 month after Y90 and this was consistent at all follow-up time points. Median %FLR hypertrophy reached 45% (5-186) after 9 months (p<0.001). The median maximal %FLR hypertrophy was 26% (-14 → 86). Portal vein thrombosis was correlated to %FLR hypertrophy (p=0.02). Median Child-Pugh score worsening (6 → 7) was seen at 1 to 3 months (p=0.03) and 3 to 6 months (p=0.05) after treatment. Five patients underwent successful right lobectomy (HCC N=3, CRC N=1, CC N=1) and 6 HCCs were transplanted. CONCLUSIONS Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.
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Affiliation(s)
- Michael Vouche
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Robert J. Lewandowski
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Rohi Atassi
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Khairuddin Memon
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Vanessa L. Gates
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Robert K. Ryu
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Ron C. Gaba
- Department of Radiology, University of Illinois, Chicago, IL, USA
| | - Mary F. Mulcahy
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Talia Baker
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Kent Sato
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Daniel Ganger
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL, USA
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Jonathan Fryer
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Michael Abecassis
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Laura Kulik
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA,Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA,Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA,Corresponding author. Address: Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611, USA. (R. Salem)
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Theysohn JM, Ertle J, Müller S, Schlaak JF, Nensa F, Sipilae S, Bockisch A, Lauenstein TC. Hepatic volume changes after lobar selective internal radiation therapy (SIRT) of hepatocellular carcinoma. Clin Radiol 2013; 69:172-8. [PMID: 24209871 DOI: 10.1016/j.crad.2013.09.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/16/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
AIM To assess volume changes of treated and non-treated liver segments after selective internal radiation therapy (SIRT) in patients with hepatocellular carcinoma (HCC) and compromised hepatic function due to cirrhosis over a time course of 12 months after SIRT. MATERIALS AND METHODS All patients underwent SIRT of the right liver lobe with yttrium 90 (Y-90). Absolute volumes of the right liver lobe (RLV) and left liver lobe (LLV) were assessed using computed tomography (CT) before and 1, 3, 6, 9, and 12 months after SIRT. Changes at follow-up relative to baseline volumes were analysed ("normalized" volumes). Furthermore, the relative volume of the LLV [LLV/(RLV + LLV)] was calculated ("relative" volumes). For statistical analysis p < 0.05 was considered statistically significant. RESULTS Forty-five HCC patients (36 men, nine women, mean age 71.9 years, range 55-90 years) were studied. The mean baseline RLV and LLV reached 1116 ml [95% confidence intervals (CI): 1006-1226 ml] and 601 ml (95% CI: 514-688 ml), respectively. At 6 months following radioembolization, the LLV increased by 30.8% (RLV -33.9%), with the relative LLV increasing from 35% (pre-radioembolization) to 50.5%. RLV further decreased and LLV increased 12 months after SIRT (nRLV -44.9%, nLLV +40.1%, relative LLV 56.5%). All changes were significant. CONCLUSION Constraints of liver function after radioembolization of one liver lobe can be partially compensated through hypertrophy of the contralateral lobe. The rate of volumetric changes is the highest in the first 6 months following radioembolization. The present data can also be the basis to propagate radiation lobectomy for selected patients, simultaneously providing tumour control and future remnant liver hypertrophy before curative hemihepatectomy.
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Affiliation(s)
- J M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - J Ertle
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - S Müller
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - J F Schlaak
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - F Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - S Sipilae
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - A Bockisch
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - T C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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139
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Safety of 90Y Radioembolization in Patients Who Have Undergone Previous External Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2013; 87:323-9. [DOI: 10.1016/j.ijrobp.2013.05.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/19/2013] [Accepted: 05/21/2013] [Indexed: 01/27/2023]
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140
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Tabone M, Calvo A, Viganò L, Ferrero A. Downstaging to liver resection by radioembolization: A difficult to reach strategy? Eur J Surg Oncol 2013; 39:918-9. [DOI: 10.1016/j.ejso.2013.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/08/2013] [Indexed: 12/12/2022] Open
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Hickey R, Vouche M, Sze D, Hohlastos E, Collins J, Schirmang T, Memon K, Ryu RK, Sato K, Chen R, Gupta R, Resnick S, Carr J, Chrisman H, Nemcek A, Vogelzang R, Lewandowski RJ, Salem R. Cancer concepts and principles: primer for the interventional oncologist-part II. J Vasc Interv Radiol 2013; 24:1167-88. [PMID: 23810312 PMCID: PMC3800031 DOI: 10.1016/j.jvir.2013.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/20/2013] [Accepted: 04/20/2013] [Indexed: 02/07/2023] Open
Abstract
This is the second of a two-part overview of the fundamentals of oncology for interventional radiologists. The first part focused on clinical trials, basic statistics, assessment of response, and overall concepts in oncology. This second part aims to review the methods of tumor characterization; principles of the oncology specialties, including medical, surgical, radiation, and interventional oncology; and current treatment paradigms for the most common cancers encountered in interventional oncology, along with the levels of evidence that guide these treatments.
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Affiliation(s)
- Ryan Hickey
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Michael Vouche
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Daniel Sze
- Department of Radiology, Stanford University, Palo Alto, CA
| | - Elias Hohlastos
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Jeremy Collins
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Todd Schirmang
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Khairuddin Memon
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert K Ryu
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Kent Sato
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Richard Chen
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Ramona Gupta
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Scott Resnick
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - James Carr
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Howard Chrisman
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Al Nemcek
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert Vogelzang
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert J Lewandowski
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Riad Salem
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
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Downstaging to liver resection by radioembolization: a difficult to reach strategy? Author reply. Eur J Surg Oncol 2013; 39:920-1. [PMID: 23707136 DOI: 10.1016/j.ejso.2013.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/08/2013] [Indexed: 11/22/2022] Open
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143
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Edeline J, Lenoir L, Boudjema K, Rolland Y, Boulic A, Le Du F, Pracht M, Raoul JL, Clément B, Garin E, Boucher E. Volumetric changes after (90)y radioembolization for hepatocellular carcinoma in cirrhosis: an option to portal vein embolization in a preoperative setting? Ann Surg Oncol 2013; 20:2518-25. [PMID: 23494107 DOI: 10.1245/s10434-013-2906-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Contralateral hypertrophy after (90)Y 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 (90)Y 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 (90)Y 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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Affiliation(s)
- Julien Edeline
- Medical Oncology Department, Comprehensive Cancer Institute Eugène Marquis, Rennes, France.
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Goedicke A, Berker Y, Verburg FA, Behrendt FF, Winz O, Mottaghy FM. Study-parameter impact in quantitative 90-Yttrium PET imaging for radioembolization treatment monitoring and dosimetry. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:485-492. [PMID: 23047863 DOI: 10.1109/tmi.2012.2221135] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A small positron-generating branch in 90-Yttrium ((90)Y) decay enables post-therapy dose assessment in liver cancer radioembolization treatment. The aim of this study was to validate clinical (90)Y positron emission tomography (PET) quantification, focusing on scanner linearity as well as acquisition and reconstruction parameter impact on scanner calibration. Data from three dedicated phantom studies (activity range: 55.2 MBq-2.1 GBq) carried out on a Philips Gemini TF 16 PET/CT scanner were analyzed after reconstruction with up to 361 parameter configurations. For activities above 200 MBq, scanner linearity could be confirmed with relative error margins 4%. An acquisition-time-normalized calibration factor of 1.04 MBq·s/CNTS was determined for the employed scanner. Stable activity convergence was found in hot phantom regions with relative differences in summed image intensities between -3.6% and +2.4%. Absolute differences in background noise artifacts between - 79.9% and + 350% were observed. Quantitative accuracy was dominated by subset size selection in the reconstruction. Using adequate segmentation and optimized acquisition parameters, the average activity recovery error induced by the axial scanner sensitivity profile was reduced to +2.4%±3.4% (mean ± standard deviation). We conclude that post-therapy dose assessment in (90)Y PET can be improved using adapted parameter setups.
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Affiliation(s)
- Andreas Goedicke
- Department of Nuclear Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany.
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145
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Yttrium 90 microspheres for the treatment of hepatocellular carcinoma. Recent Results Cancer Res 2013; 190:207-24. [PMID: 22941023 DOI: 10.1007/978-3-642-16037-0_14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Yttrium-90 microspheres are radioactive particles which are increasingly being employed for treating patients with unresectable hepatocellular carcinoma (HCC). The procedure is called radioembolization. It involves the injection of micron-sized embolic particles loaded with a radioisotope by use of transarterial techniques. Because of the sensitivity of liver parenchyma and relative insensitivity of tumor, external radiation has played a limited role in treating HCC. (90)Y administered via arterial route directs the highly concentrated radiation to the tumor while healthy liver parenchyma is relatively spared due to its preferential blood supply from portal venous blood. This technique has proven useful for the majority of patients with HCC as most of them present in advanced stage, beyond potentially curative options (resection/liver transplantation). (90)Y microspheres can be used in downstaging large tumors to bring within transplantable criteria, in patients with portal venous thrombosis due to tumor invasion and as palliative therapy. There are two available devices for (90)Y administration; TheraSphere® (glass based) and SIR-Spheres® (resin based). The procedure is performed on an outpatient basis. The incidence of complications is comparatively less and may include nausea, fatigue, abdominal pain, hepatic dysfunction, biliary injury, fibrosis, radiation pneumonitis, GI ulcers, and vascular injury; however, these can be avoided by meticulous pretreatment assessment, careful patient selection, and adequate dosimetry. This article explores the technical and clinical aspects of (90)Y radioembolization with keeping emphasis on patient selection, uses, and complications.
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146
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Kim YI, Park HC, Lim DH, Park HJ, Kang SW, Park SY, Kim JS, Han Y, Paik SW. Changes of the liver volume and the Child-Pugh score after high dose hypofractionated radiotherapy in patients with small hepatocellular carcinoma. Radiat Oncol J 2012; 30:189-96. [PMID: 23346538 PMCID: PMC3546287 DOI: 10.3857/roj.2012.30.4.189] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/07/2012] [Accepted: 10/22/2012] [Indexed: 12/26/2022] Open
Abstract
Purpose To investigate the safety of high dose hypofractionated radiotherapy (RT) in patients with small hepatocellular carcinoma (HCC) in terms of liver volumetric changes and clinical liver function. Materials and Methods We retrospectively reviewed 16 patients with small HCC who were treated with high dose hypofractionated RT between 2006 and 2009. The serial changes of the liver volumetric parameter were analyzed from pre-RT and follow-up (FU) computed tomography (CT) scans. We estimated linear time trends of whole liver volume using a linear mixed model. The serial changes of the Child-Pugh (CP) scores were also analyzed in relation to the volumetric changes. Results Mean pre-RT volume of entire liver was 1,192.2 mL (range, 502.6 to 1,310.2 mL) and mean clinical target volume was 14.7 mL (range, 1.56 to 70.07 mL). Fourteen (87.5%) patients had 4 FU CT sets and 2 (12.5%) patients had 3 FU CT sets. Mean interval between FU CT acquisition was 2.5 months. After considering age, gender and the irradiated liver volume as a fixed effects, the mixed model analysis confirmed that the change in liver volume is not significant throughout the time course of FU periods. Majority of patients had a CP score change less than 2 except in 1 patient who had CP score change more than 3. Conclusion The high dose hypofractionated RT for small HCC is relatively safe and feasible in terms of liver volumetric changes and clinical liver function.
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Affiliation(s)
- Young Il Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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147
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Abstract
Resection and liver transplantation are considered effective treatments for early-stage hepatocellular carcinoma (HCC). As data from randomized trials are lacking, the choice of technique is controversial. Retrospective analyses suggest that for patients with suboptimal liver function, transplantation is the preferred treatment. For patients with preserved liver function and HCC within the Milan criteria, the overall survival rate is similar for both techniques; therefore resection is the preferred treatment. For tumours beyond the Milan criteria but within acceptable expanded criteria, transplantation has a more favourable outcome than resection. As liver grafts are in short supply, resection followed by transplantation once intrahepatic recurrence is detected would spare patients with favourable or very aggressive tumours from transplantation and enable patients with moderately aggressive tumours to undergo timely transplantation. Currently, resection and transplantation are considered complementary in the management of HCC. Expanding the transplantation and resection criteria of HCC needs to be investigated.
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148
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Fowler KJ, Linehan DC, Menias CO. Colorectal liver metastases: state of the art imaging. Ann Surg Oncol 2012; 20:1185-93. [PMID: 23115006 DOI: 10.1245/s10434-012-2730-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Indexed: 12/14/2022]
Abstract
Colorectal cancer is a leading cause of death with mortality determined predominately by metastatic involvement of the liver. Treatment of liver metastases continues to evolve and imaging plays an essential role in initial staging, preoperative planning, and treatment monitoring. This review article discusses the current role of imaging in the management of patients with colorectal liver metastases. Particular challenges such as hepatic steatosis, disappearing metastases, and following treated lesions are addressed.
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149
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Hepatic volume changes induced by radioembolization with 90Y resin microspheres. A single-centre study. Eur J Nucl Med Mol Imaging 2012; 40:80-90. [DOI: 10.1007/s00259-012-2253-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 09/12/2012] [Indexed: 12/11/2022]
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150
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Christie JK, Tilocca A. Molecular Dynamics Simulations and Structural Descriptors of Radioisotope Glass Vectors for In Situ Radiotherapy. J Phys Chem B 2012; 116:12614-20. [DOI: 10.1021/jp304200f] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jamieson K. Christie
- Department of Chemistry and Thomas
Young Centre, University College London, 20 Gordon Street, London
WC1H 0AJ, U.K
| | - Antonio Tilocca
- Department of Chemistry and Thomas
Young Centre, University College London, 20 Gordon Street, London
WC1H 0AJ, U.K
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