Radioembolisation and portal vein embolization before resection of large hepatocellular carcinoma

Abstract

Resectability of hepatocellular carcinoma in patients with chronic liver disease is dramatically limited by the need to preserve sufficient remnant liver in order to avoid postoperative liver insufficiency. Preoperative treatments aimed at downsizing the tumor and promoting hypertrophy of the future remnant liver may improve resectability and reduce operative morbidity. Here we report the case of a patient with a large hepatocellular carcinoma arising from chronic liver disease. Preoperative treatment, including tumor downsizing with transarterial radioembolization and induction of future remnant liver hypertrophy with right portal vein embolization, resulted in a 53% reduction in tumor volume and compensatory hypertrophy in the contralateral liver. The patient subsequently underwent extended right hepatectomy with no postoperative signs of liver decompensation. Pathological examination demonstrated a margin-free resection and major tumor response. This new therapeutic sequence, combining efficient tumor targeting and subsequent portal vein embolization, could improve the feasibility and safety of major liver resection for hepatocellular carcinoma in patients with liver injury.

Contralateral Liver Hypertrophy and Oncological Outcome Following Radioembolization with 90Y-Microspheres: A Systematic Review

“…Although the present review depicted a substantial lower KGR for RE with values ranging between 0.3% and 2.5%, certain patient selection without heavily pretreated patients might overcome these low values, and this needs to be addressed in prospective trials. In case of insufficient hypertrophy levels after RE, the option of PVE/portal vein ligation or even a combination of transarterial and transportal RE is feasible [25,39,40]. To date, the only comparative study between RE and PVE, a matched-pair analysis, demonstrated a significantly higher mean relative hypertrophy level of 62% following PVE compared to a mean relative hypertrophy level of 29% following RE [23].…”

Effect of portal vein embolization on treatment plan prior to major hepatectomy for hepatocellular carcinoma

“…However, the increase in hepatic arterial perfusion following PVE may have a growth effect on both primary and secondary liver tumors. This has led some investigators to explore the use of trans-arterial chemo-embolization (TACE), 21,22 or radioembolization using Yttrium-90 microspheres, 23 prior to PVE. These combined approaches are reported to induce greater hypertrophy of the FLR and atrophy of the HCC than PVE alone.…”

The role of 90Y-radioembolization in downstaging primary and secondary hepatic malignancies: a systematic review

“…On the other hand, the coinciding anti-tumoral effect of RE allows for more time for the FLR to hypertrophy. And if FLR hypertrophy is insufficient after RE, subsequent PVE/PVL can be considered [ 46 , 62 ]. Another option might be combining transarterial and transportal RE.…”