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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2009

01-06-2009 | Hepatobiliary and Pancreatic Tumors

Radiation Lobectomy: Preliminary Findings of Hepatic Volumetric Response to Lobar Yttrium-90 Radioembolization

Authors: Ron C. Gaba, MD, Robert J. Lewandowski, MD, Laura M. Kulik, MD, Ahsun Riaz, MD, Saad M. Ibrahim, MD, Mary F. Mulcahy, MD, Robert K. Ryu, MD, Kent T. Sato, MD, Vanessa Gates, MS, Michael M. Abecassis, MD, MBA, Reed A. Omary, MD, MS, Talia B. Baker, MD, Riad Salem, MD, MBA

Published in: Annals of Surgical Oncology | Issue 6/2009

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Abstract

Purpose

To describe volumetric changes of “radiation lobectomy,” a manifestation of hepatic parenchymal response to lobar 90Y microsphere radioembolization.

Methods

Twenty patients exhibiting this phenomenon were identified. Pre- and posttreatment absolute right and left hepatic lobar volume (HLV), relative HLV (rHLV = HLV/total liver volume), and degree of lobar atrophy (DA) or hypertrophy (DH) (DA or DH = |posttreatment rHLV – pretreatment rHLV|) were determined. Laboratory toxicities, tumor response, and patient survival were also assessed.

Results

Twenty patients with primary (HCC, n = 17; peripheral cholangiocarcinoma, n = 3) liver malignancies demonstrated findings of radiation lobectomy. Initial absolute right and left HLV was 955 cm3 (range 644–1,842 cm3, rHLV = 57%) and 719 cm3 (range 328–1,387 cm3, rHLV = 43%), respectively. Following 90Y, absolute right HLV decreased to 460 cm3 (range 185–948 cm3, 52% reduction, rHLV = 31%, DA = 26%, P < 0.0001), while absolute left HLV increased to 1,004 cm3 (range 560–1,558 cm3, 40% increase, rHLV = 69%, DH = 26%, P < 0.0001). No grade 3 or 4 bilirubin toxicities were encountered. Tumor response ranged from 55% to 70% by size criteria. Forty-six percent 5-year survival was achieved in HCC patients.

Conclusions

Radiation lobectomy following 90Y radioembolization of right lobe tumors manifests extensive contralateral lobar hypertrophy, high response rates, and prolonged survival. This phenomenon was noted in 6.4% (20/315) of the entire cohort and 19.8% (20/101) of patients with unilobar right lobe tumors. Further investigation is necessary to determine contributing factors that may predict this effect.
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Metadata
Title
Radiation Lobectomy: Preliminary Findings of Hepatic Volumetric Response to Lobar Yttrium-90 Radioembolization
Authors
Ron C. Gaba, MD
Robert J. Lewandowski, MD
Laura M. Kulik, MD
Ahsun Riaz, MD
Saad M. Ibrahim, MD
Mary F. Mulcahy, MD
Robert K. Ryu, MD
Kent T. Sato, MD
Vanessa Gates, MS
Michael M. Abecassis, MD, MBA
Reed A. Omary, MD, MS
Talia B. Baker, MD
Riad Salem, MD, MBA
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0454-0

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