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Yu Q, Wang Y, Ungchusri E, Pillai A, Liao CY, Fung J, DiSabato D, Baker T, Patel M, Van Ha T, Ahmed O. Modified Radiation Lobectomy Strategy of Radioembolization for Right-Sided Unresectable Primary Liver Tumors. J Vasc Interv Radiol 2024; 35:989-997.e2. [PMID: 38490364 DOI: 10.1016/j.jvir.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/18/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE To assess the safety and effectiveness of using modified radiation lobectomy (mRL) to treat primary hepatic tumors located in the right hepatic lobe (Segments V-VIII) and to determine future liver remnant (FLR) hypertrophy. MATERIALS AND METHODS A retrospective review was performed at a single institution to include 19 consecutive patients (7 females, 12 males) who underwent single-session mRL for right-sided primary hepatic tumors: 15 received segmentectomy plus lobectomy (segmental dose of >190 Gy and lobar dose of >80 Gy); 4 were treated with the double-segmental approach (dominant segments of >190 Gy and nondominant segments of >80 Gy). Treated tumors included 13 hepatocellular carcinoma (HCC), 4 cholangiocarcinoma (CCA), and 2 mixed-type HCC-CCA with a median dominant tumor size of 5.3 cm (interquartile range [IQR], 3.7-7.3 cm). FLR of the left hepatic lobe was measured at baseline, T1 (4-8 weeks), T2 (2-4 months), T3 (4-6 months), and T4 (9-12 months). RESULTS Objective tumor response and tumor control were achieved in 17 of the 19 (89.5%) and 18 of the 19 (94.7%) patients, respectively. FLR hypertrophy was observed at T1 (median, 47.8%; P = .025), T2 (median, 48.4%; P = .012), T3 (median, 50.4%; P = .015), and T4 (median, 59.1%; P < .001). Patients without cirrhosis demonstrated greater hypertrophy by 6 months (median, 55.8% vs 47.2%; P = .031). One patient developed a Grade 3 adverse event (ascites requiring paracentesis) at 1-month follow-up. Grade ≥2 serum toxicities were associated with worse baseline Child-Pugh Score, serum albumin, and total bilirubin (P < .05). Among 7 patients who underwent neoadjuvant mRL, 2 underwent resection and 1 received liver transplant. CONCLUSIONS mRL appears safe and effective for treatment of right-sided primary hepatic tumors with the benefit of promoting FLR hypertrophy.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
| | - Yating Wang
- Hematology and Oncology, Ascension Providence Hospital, Southfield, Michigan
| | - Ethan Ungchusri
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Chih-Yi Liao
- Department of Medicine; Hematology and Oncology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - John Fung
- Department of Surgery, Section of Transplant Surgery, The University of Chicago Medicine, Chicago, Illinois
| | - Diego DiSabato
- Department of Surgery, Section of Transplant Surgery, The University of Chicago Medicine, Chicago, Illinois
| | - Talia Baker
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mikin Patel
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Thuong Van Ha
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
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Shah HJ, Ruppell E, Bokhari R, Aland P, Lele VR, Ge C, McIntosh LJ. Current and upcoming radionuclide therapies in the direction of precision oncology: A narrative review. Eur J Radiol Open 2023; 10:100477. [PMID: 36785643 PMCID: PMC9918751 DOI: 10.1016/j.ejro.2023.100477] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 02/01/2023] Open
Abstract
As new molecular tracers are identified to target specific receptors, tissue, and tumor types, opportunities arise for the development of both diagnostic tracers and their therapeutic counterparts, termed "theranostics." While diagnostic tracers utilize positron emitters or gamma-emitting radionuclides, their theranostic counterparts are typically bound to beta and alpha emitters, which can deliver specific and localized radiation to targets with minimal collateral damage to uninvolved surrounding structures. This is an exciting time in molecular imaging and therapy and a step towards personalized and precise medicine in which patients who were either without treatment options or not candidates for other therapies now have expanded options, with tangible data showing improved outcomes. This manuscript explores the current state of theranostics, providing background, treatment specifics, and toxicities, and discusses future potential trends.
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Affiliation(s)
- Hina J. Shah
- Department of Radiology, Division of Nuclear Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA,Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02115, USA,Corresponding author at: Department of Radiology, Division of Nuclear Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA.
| | - Evan Ruppell
- Department of Radiology, University of Massachusetts Chan Medical School, Memorial Health Care, Worcester, MA 01655, USA
| | - Rozan Bokhari
- Department of Radiology, Beth Israel Lahey Health, Burlington, MA 01803, USA
| | - Parag Aland
- In-charge Nuclear Medicine and PET/CT, Infinity Medical Centre, Mumbai, Maharashtra 400015, India
| | - Vikram R. Lele
- Chief, Department of Nuclear Medicine and PET/CT, Jaslok Hospital and Research Centre, Mumbai, Maharashtra 400026, India
| | - Connie Ge
- University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Lacey J. McIntosh
- Division of Oncologic and Molecular Imaging, University of Massachusetts Chan Medical School / Memorial Health Care, Worcester, MA 0165, USA
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Entezari P, Toskich BB, Kim E, Padia S, Christopher D, Sher A, Thornburg B, Hohlastos ES, Salem R, Collins JD, Lewandowski RJ. Promoting Surgical Resection through Future Liver Remnant Hypertrophy. Radiographics 2022; 42:2166-2183. [PMID: 36206182 DOI: 10.1148/rg.220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An inadequate future liver remnant (FLR) can preclude curative-intent surgical resection for patients with primary or secondary hepatic malignancies. For patients with normal baseline liver function and without risk factors, an FLR of 20% is needed to maintain postsurgical hepatic function. However, the FLR requirement is higher for patients who are exposed to systemic chemotherapy (FLR, >30%) or have cirrhosis (FLR, >40%). Interventional radiologic and surgical methods to achieve FLR hypertrophy are evolving, including portal vein ligation, portal vein embolization, radiation lobectomy, hepatic venous deprivation, and associating liver partition and portal vein ligation for staged hepatectomy. Each technique offers particular advantages and disadvantages. Knowledge of these procedures can help clinicians to choose the suitable technique for each patient. The authors review the techniques used to develop FLR hypertrophy, focusing on technical considerations, outcomes, and the advantages and disadvantages of each approach. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Pouya Entezari
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Beau B Toskich
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Edward Kim
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Siddharth Padia
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Derrick Christopher
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Alex Sher
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Bartley Thornburg
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Elias S Hohlastos
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Riad Salem
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Jeremy D Collins
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Robert J Lewandowski
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
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