Markus Zimmermann1, Maximilian Schulze-Hagen2, Martin Liebl2, Federico Pedersoli2, Fabian Goerg2, Tom Florian Ulmer3, Alexander Heinzel4, Peter Isfort2, Christiane Kuhl2, Philipp Bruners2. 1. Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany. mzimmermann@ukaachen.de. 2. Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany. 3. Department of General Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany. 4. Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
Abstract
PURPOSE: To evaluate the safety and efficacy of yttrium-90 radioembolization (RE) following left or right hepatic lobectomy. MATERIALS AND METHODS: Between 2011 and 2016, 15 patients underwent RE with Y90-resin microspheres following right (8/15) or left (7/15) hepatic lobectomy. In eight patients, the whole liver remnant was treated during a single session, whereas the remaining seven patients received up to 3 selective RE at 1- to 2-month intervals. The administered patient activity was calculated based on the body surface area (BSA) method in all cases. In addition, CT-based volumetry of the liver remnant was performed and used to calculate the absorbed liver dose. Patient follow-up data were retrospectively analyzed regarding signs of radioembolization-induced liver disease (REILD), defined as occurrence of bilirubin >3.0 mg/dl and ascites within 1-2 months after treatment without tumor progression or bile duct occlusion. RESULTS: The mean volume of the liver remnant was 1.471 ± 341 ml, the mean administered amount of activity amounted to 1.31 ± 0.74 GBq, and the calculated mean absorbed dose was 42.8 ± 20.6 Gy. The early response to treatment was generally positive, with only one patient showing signs of progressive disease of the treated area on follow-up examinations within the first 2 months post-RE. None of the 15 patients developed a REILD. CONCLUSION: Y-90 radioembolization following extended hepatic lobectomy appears to be safe and effective. Although the standard BSA-based dosing seems to suffice to avoid REILD, it results in quite variable liver doses due to variable hypertrophy of the liver remnant post-hepatectomy. LEVEL OF EVIDENCE: Level IV, Case series.
PURPOSE: To evaluate the safety and efficacy of yttrium-90 radioembolization (RE) following left or right hepatic lobectomy. MATERIALS AND METHODS: Between 2011 and 2016, 15 patients underwent RE with Y90-resin microspheres following right (8/15) or left (7/15) hepatic lobectomy. In eight patients, the whole liver remnant was treated during a single session, whereas the remaining seven patients received up to 3 selective RE at 1- to 2-month intervals. The administered patient activity was calculated based on the body surface area (BSA) method in all cases. In addition, CT-based volumetry of the liver remnant was performed and used to calculate the absorbed liver dose. Patient follow-up data were retrospectively analyzed regarding signs of radioembolization-induced liver disease (REILD), defined as occurrence of bilirubin >3.0 mg/dl and ascites within 1-2 months after treatment without tumor progression or bile duct occlusion. RESULTS: The mean volume of the liver remnant was 1.471 ± 341 ml, the mean administered amount of activity amounted to 1.31 ± 0.74 GBq, and the calculated mean absorbed dose was 42.8 ± 20.6 Gy. The early response to treatment was generally positive, with only one patient showing signs of progressive disease of the treated area on follow-up examinations within the first 2 months post-RE. None of the 15 patients developed a REILD. CONCLUSION: Y-90 radioembolization following extended hepatic lobectomy appears to be safe and effective. Although the standard BSA-based dosing seems to suffice to avoid REILD, it results in quite variable liver doses due to variable hypertrophy of the liver remnant post-hepatectomy. LEVEL OF EVIDENCE: Level IV, Case series.
Authors: Rehan Ali; Ahsun Riaz; Ahmed Gabr; Nadine Abouchaleh; Ronald Mora; Ali Al Asadi; Juan Carlos Caicedo; Michael Abecassis; Nitin Katariya; Haripriya Maddur; Laura Kulik; Robert J Lewandowski; Riad Salem Journal: Eur J Nucl Med Mol Imaging Date: 2017-08-15 Impact factor: 9.236