Chemoembolic lobectomy: imaging findings of hepatic lobar volume reduction after transcatheter arterial chemoembolization

Abstract

Recently, there has been much interest in the concept of radiation-induced hepatic lobar ablation with marked volumetric loss and contralateral compensatory lobar hypertrophy (1-3). This phenomenon, termed radiation lobectomy, has been described to occur after yttrium-90 ( 90 Y) microsphere radioembolization and has been associated with high rates of tumor response and improved long-term patient survival in preliminary investigations (1). At present, the causative relationship between the administered radiation dose and the volumetric change is unknown, and the degree to which vascular embolization contributes to the observed changes remains uncertain. We recently encountered a striking case of hepatic lobar atrophy-hypertrophy complex formation after transcatheter arterial chemoembolization that suggests a possible contribution of arterial embolization to the volumetric response, which we present herein. Case reportA 50-year-old man with a history of type 2 diabetes mellitus, hypertension, and hepatitis B virus liver disease was referred to interventional radiology for liver-directed therapy for the treatment of biopsy-proven hepatocellular carcinoma (HCC). The patient initially presented for assessment after screening computed tomography (CT) scan demonstrated a 4-cm right hepatic lobe mass, which was confirmed as HCC by image-guided core needle biopsy. Metastatic disease was ruled out with a chest CT and bone scan. The patient evaluation demonstrated an Eastern Cooperative Oncology Group performance status of zero (4), and the lab examination showed normal synthetic liver function (total bilirubin 0.9 mg/dL, albumin 4.2 g/dL, and prothrombin time 10.0 s). The initial -fetoprotein level was only slightly elevated, measuring 15.5 ng/mL. Treatment options were discussed, and transcatheter arterial chemoembolization was elected for local tumor control.Subsequently, the patient underwent drug eluting bead chemoembolization using 300-500-micron LC beads (Angiodynamics; Queensbury, New York, USA) loaded with 50 mg doxorubicin and mixed with 50 mg cisplatin and 20 mg mitomycin C in suspension. For chemoembolization, a standard right common femoral artery approach was used to position a 5 French reverse curve catheter in the celiac artery. The chemoembolic material was administered through a 2.8 French microcatheter placed coaxially in a segmental distribution via a right hepatic artery ascending branch (Fig. a) to a static angiographic endpoint. The patient had an uneventful post-procedure hospital course and was discharged 24 hours after treatment.The patient follow-up included serial CT scans and lab assessment, which were performed initially at one month post-procedure and then at approximately three-month intervals. Although the one-month post- ABSTRACT Hepatic lobar atrophy-hypertrophy complex formation is an uncommonly reported sequella of hepatic arterial embolotherapy procedures. Whereas radiation-induced hepatic lobar ablation has been described after intra-arterial therapy with yttrium-90 microspheres, thi...

Implementing Radiation Dose-Volume Liver Response in Biomechanical Deformable Image Registration

“…cirrhosis and hepatitis) and spatial location of the tumor [19, 29–32]. To maintain statistical confidence within the stratifications, stratifications were only performed in groups that maintained at least 30 samples.…”