A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90

Teo, Jin‐Yao; Allen, John C.; Ng, David; Choo, Su-Pin; Tai, David; Chang, Jaerak; Cheah, Foong Koon; Chow, Pierce K. H.; Goh, Brian K. P.

doi:10.1016/j.hpb.2015.07.002

Cited by 103 publications

(67 citation statements)

References 30 publications

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“…Neoadjuvant RL offers a unique advantage by delivering ablative transarterial brachytherapy in addition to generating FLR hypertrophy. The majority of patients in this series received RL doses greater than 200 Gy, higher than prior reported doses of 120-150 Gy in prior studies (23)(24)(25). Higher hepatic doses and concurrent systemic therapy were well-tolerated in these first line patients without significant clinical toxicity (grade I C-D complications) or hepatic dysfunction.…”

Section: Discussionmentioning

confidence: 71%

“…Three out of four patients received RL as an outpatient treatment. was equivalent or superior to FLR hypertrophy after RL was PVE but may be dependent on radiation dose (23,24 In addition to FLR hypertrophy, ablative transarterial brachytherapy is tumoricidal and provides local disease control. 100% local disease control was achieved in our experience with 50% of patients demonstrating complete pathologic response after RL and systemic chemotherapy.…”

Section: A B a Bmentioning

confidence: 99%

“…In distinction to conventional radioembolization, RL delivers intentionally ablative transarterial brachytherapy to both tumor and adjacent hepatic substrate. It is well-tolerated, generates FLR hypertrophy equivalent or greater to PVE, and can be used in patients with PVT or concurrent systemic chemotherapy (23,24). Contrary to PVE or ALPPS, RL has potential to control disease which permits FLR hypertrophy over several months allowing for surveillance of tumor biology.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation

Shah

Zendejas-Ruiz

Thornton

et al. 2017

J. Gastrointest. Oncol.

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Colorectal cancer patients have a high incidence of liver metastasis (ml-CRC). Surgical resection is the gold standard for treatment of hepatic metastasis but only a small percent of patients are traditional candidates based on disease extent and adequate size of the future liver remnant (FLR). Interventions such as portal vein embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are performed to increase FLR for operative conversion. Limitations to PVE include intrahepatic disease progression, portal vascular invasion, and utilization with concurrent chemotherapy. ALPPS is associated with a high morbidly and mortality. Radiation lobectomy (RL) with yttrium-90 (Y-90) delivers transarterial ablative brachytherapy to the future hepatectomy site which generates FLR hypertrophy similar or greater than PVE. Early results indicate that RL is safe, effective, and may offer unique benefits by providing cytoreduction of hepatic metastases which extends FLR hypertrophy time and allows FLR surveillance to gauge disease biology. A retrospective analysis of four patients with ml-CRC treated with RL prior to hepatectomy was performed to evaluate initial safety, efficacy, FLR hypertrophy, and radiopathologic correlation. Adverse events after RL and hepatectomy were evaluated. Imaging findings were analyzed for efficacy defined as FLR hypertrophy and disease control. Radiopathologic correlation was performed after histologic analysis. RL was well tolerated without major adverse events or hepatic decompensation. FLR hypertrophy ranged from 24.9% to 119% at mean follow-up of three months. The majority of complications were related to surgical instrumentation of the FLR due to upstaging at time of surgery. Hepatectomy specimen histology demonstrated complete pathologic response in 50% of patients, 50% radiopathologic concordance rate, and no significant hepatic fibrosis. Initial experience with neoadjuvant RL for ml-CRC is safe and provides both durable disease control and FLR hypertrophy with concurrent chemotherapy. A 50% complete pathologic response rate raises the possibility of definitive chemoradiation in poor surgical candidates. Prospective investigation is required.

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Section: Discussionmentioning

confidence: 71%

Section: A B a Bmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation

Shah

Zendejas-Ruiz

Thornton

et al. 2017

J. Gastrointest. Oncol.

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“…Promising results have recently been published after selective internal radiation therapy (SIRT), using a less invasive arterial access in patients with primary liver malignancies, showing low morbidity rates and comparable hypertrophy rates of the future liver remnant in comparison to PVE [35,36,37,38]. This new therapy leads to an internal radiation of the liver tumor via microspheres with a decrease in the tumor size.…”

Section: Discussionmentioning

confidence: 99%

Limits of and Complications after Embolization of the Hepatic Artery and Portal Vein to Induce Segmental Hypertrophy of the Liver: A Large Mini-Pig Study

et al. 2016

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Background: The aim of this study was to compare arterial embolization (AE) with portal vein embolization (PVE) for the induction of segmental hypertrophy regarding procedural efficacy, safety and outcome. Methods: A total of 29 mini pigs were subjected to PVE, AE or assigned to the sham (SO) group. Correspondingly, 75% of the hepatic artery or portal vein branches were embolized. Growth and atrophy of the liver lobes, calculating the liver-to-body weight index (LBWI), laboratory data, arteriography, portography, Doppler ultrasound (US) and histopathology were analyzed. Results: After PVE, 2 animals had to be excluded due to technical problems. After AE, 4 animals had to be excluded because of technical problems and early sacrifice. Postprocedural US demonstrated effective AE and PVE of the respective lobes. Four weeks after PVE, portography showed a slow refilling of the embolized lobe by collateral portal venous vessels. Four weeks after AE, arteriography revealed a slight revascularization of the embolized lobes by arterial neovascularization. Segmental AE led to extensive necrotic and inflammatory alterations in the liver and bile duct parenchyma. Significant hypertrophy of the non-embolized lobe was only noted in the PVE group (LBWI: 0.91 ± 0.28%; p = 0.001). There was no increase in the non-embolized lobe in the AE (LBWI: 0.45 ± 0.087%) and SO group (LBWI: 0.45 ± 0.13%). Conclusion: PVE is safe and effective to induce segmental hypertrophy. Portal reperfusion by collateral vessels may limit hypertrophy. AE did not increase the segmental hepatic volume but carries the risk of extensive necrotic inflammatory damage.

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“…In addition, SIRT can produce concomitant hypertrophy in the contralateral lobe (88), a phenomenon that occurs in approximately 26% to 47% of patients after between 44 days and 9 months (88).…”

Section: Sirt and Surgerymentioning

confidence: 99%

Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: expert consensus

Kennedy

Brown

Feilchenfeldt

et al. 2017

J. Gastrointest. Oncol.

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Selective internal radiation therapy (SIRT) with microspheres labelled with the β-emitter yttrium-90 (Y-90) enables targeted delivery of radiation to hepatic tumors. SIRT is primarily used to treat inoperable primary or metastatic liver tumors. Eligible patients have usually been exposed to a variety of systemic anticancer therapies, including cytotoxic agents, targeted biologics, immunotherapy and peptide receptor radionuclide therapy (PRRT). All these treatments have potential interactions with SIRT; however, robust evidence on the safety of these potential combinations is lacking. This paper provides current clinical experiences and expert consensus guidelines for the use of SIRT in combination with the anticancer treatment agents likely to be encountered in clinical practice. It was agreed by the expert panel that precautions need to be taken with certain drugs, but that, in general, systemic therapies do not necessarily have to be stopped to perform SIRT. The authors recommend stopping vascular endothelial growth factor inhibitors 4-6 weeks before SIRT, and restart after the patient has recovered from the procedure. It may also be prudent to stop potent radiosensitizers such as gemcitabine therapy 4 weeks before SIRT, and restart treatment at least 2-4 weeks later. Data from phase III studies combining SIRT with fluorouracil (5FU) or folinic acid/5FU/oxaliplatin (FOLFOX) suggest that hematological toxicity is more common from the combination than it is from chemotherapy without SIRT. There is no evidence to suggest that chemotherapy increases SIRT-specific gastro-intestinal or liver toxicities.

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A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90

Abstract: 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.

Cited by 103 publications

References 30 publications

Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation

Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation

Limits of and Complications after Embolization of the Hepatic Artery and Portal Vein to Induce Segmental Hypertrophy of the Liver: A Large Mini-Pig Study

Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: expert consensus

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