The Impact of Unilateral 90Y-radioembolization on Functional Changes in the Contralateral Hepatic Lobe

Abstract

Objectives: To investigate how metabolic function of the contralateral liver lobe is affected by unilateral radioembolization (RE), and to compare the changes in volume and metabolic function. Background: Unilateral RE induces contralateral liver hypertrophy, but it is unknown if metabolic liver function improves in line with volume increases. Methods: This prospective open-label, nonrandomized, therapy-optimizing study included all consecutive patients undergoing right-sided or sequential 90Y-RE for liver malignancies without underlying liver disease or biliary obstruction at a single center in Germany. Magnetic resonance imaging volumetry and hepatobiliary scintigraphy were performed immediately before RE and approximately 6 weeks after RE. Results: Twenty-three patients were evaluated (11 metastatic colorectal cancer, 4 cholangiocellular carcinoma, 3 metastatic breast cancer, 1 each of metastatic neuroendocrine tumor, hepatocellular carcinoma, renal cell carcinoma, oesophageal cancer, pancreatic ductal adenocarcinoma). In the untreated contralateral left liver lobe, mean (SD) metabolic function significantly increased from 1.34 (0.76) %/min/m2 at baseline to 1.56 (0.75) %/min/m2 6 weeks after RE (P = 0.024). The mean (SD) functional volume (liver volume minus tumor volume) of the left liver lobe significantly increased from baseline (407.3 [170.3] mL) to follow-up (499.1 [209.8] mL; P < 0.01), with an equivalent magnitude to the metabolic function increase. There were no reports of grade ≥3 adverse events. Conclusion: This study indicates that unilobar RE produces a significant increase in the metabolic function, and equivalent volume increase, of the contralateral lobe. RE may be a useful option to induce hypertrophy of the future liver remnant before surgical resection of primary or secondary liver malignancies.

Assessing regional hepatic function changes after hypertrophy induction by radioembolisation: comparison of gadoxetic acid-enhanced MRI and 99mTc-mebrofenin hepatobiliary scintigraphy

“…This post hoc analysis included all twenty-three patients of the prospective open-label, non-randomised, single-centre, therapy-optimising REVoluTion study [ 7 ]. The study was approved by the institutional ethics committee at Otto von Guericke University, Magdeburg (Ref.…”

“…They were aged 18–85 with an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2. The exclusion criteria encompassed baseline non-embolised lobe functional volume > 30% of total functional liver volume, liver cirrhosis, pre-existing portal vein thrombosis, primary liver malignancies with cirrhosis or biliary dilatation, prior left liver lobe therapy/surgery or planned within 6 weeks of right-lobar RE, > 10% tumour involvement in left lobe, and contraindications for MRI, 99m Tc-mebrofenin HBS, or ICG test [ 7 ]. MRI and HBS were performed immediately before (baseline) and 6 weeks after RE (follow-up).…”

“…The percentage of the counts in the FLR in relation to the entire liver was then multiplied by the 99m Tc-mebrofenin uptake rate to obtain the actual metabolic function of the FLR. Calculations were performed to normalise the uptake rate to BSA and respective liver volumes (total, left, right) as described before [ 7 ]. Additionally, ICG (0.25 mg/kg) was administered intravenously to confirm the HBS findings, and ICG plasma disappearance rate and ICG retention at 15 min were measured non-invasively using a spectrophotometry clip attached to the patient’s index finger, with adjustments made for variations in cardiac output between baseline and follow-up measurements.…”

“…However, the relationship between liver metabolic function and volume increase after hypertrophy-inducing procedures remained uncertain for some time [ 15 , 25 – 30 ]. In the recent prospective REVoluTion study of 23 patients, it was shown that after unilobar RE, there is not only an increase in the volume of the contralateral lobe but also a significant increase in metabolic function as measured by HBS [ 7 ].…”