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

Abstract

Radioembolization with 90Y-microspheres has been reported to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth. The aim of the present systematic review was to summarize the evidence of contralateral liver hypertrophy and oncological outcome following unilateral treatment with radioembolization. A systematic literature search using the MEDLINE, EMBASE, and Cochrane libraries for studies published between 2008 and 2020 was performed. A total of 16 studies, comprising 602 patients, were included. The median kinetic growth rate per week of the contralateral liver lobe was 0.7% and declined slightly over time. The local tumor control was 84%. Surgical resection after radioembolization was carried out in 109 out of 362 patients (30%). Although the available data suggest that radioembolization prior to major hepatectomy is safe with a promising oncological outcome, the definitive role of radioembolization requires assessment within controlled clinical trials.

Yttrium-90 Radioembolization Dosimetry: What Trainees Need to Know

“…[64][65][66][67][68] The manufacturer's training manual recommends a maximal dose of 80 or 70 Gy, respectively, for noncirrhotic or cirrhotic normal liver tissue (D N ) using the partition model. 69 Despite reports that the normal liver is able to tolerate higher doses of Y90 resin microspheres, 70 data on post-Y90-RE liver toxicity and its association with contralateral lobe hypertrophy remain somewhat limited 71,72 -suggesting that the maximum doses recommended by the manufacturer may be as adequate as other recommendation for Y90-RL with resin microspheres. If Y90-RS is technically feasible but Y90-RL is still the plan (which would imply that contralateral lobar hypertrophy is still desired), one can consider a "modified" Y90-RL, which is where a single-session ablative Y90-RS is followed by Y90-RL.…”

Two-stage hepatectomy with radioembolization for bilateral colorectal liver metastases: A case report

“…After TARE, however, compared to PVE/PVL, the hypertrophy is radiation-induced rather than caused by embolization and is reached at a slower rate. According to a recent systematic review[ 5 ], the median kinetic growth rate of the controlateral lobe for patients underwent lobar TARE for CRLM was 0.8% per week compared to 6.1% of PVE. Despite a slower increase, however, a hypertrophy of 26%-47% was obtained at time intervals ranging from 44 d to 9 mo[ 4 ], of similar magnitude to that observed after PVE.…”

“…Despite a slower increase, however, a hypertrophy of 26%-47% was obtained at time intervals ranging from 44 d to 9 mo[ 4 ], of similar magnitude to that observed after PVE. In addition, Birgin et al [ 5 ] found that up to 84% of patients affected by primary and secondary hepatic malignancies had a local tumor control following TARE and about 30% of unresectable tumors underwent hepatic resection.…”

Review of Intra-Arterial Therapies for Colorectal Cancer Liver Metastasis

“…If the FLR hypertrophy is insufficient after RL, this also does not preclude the patient from undergoing future subsequent procedures to induce further contralateral hypertrophy. In a recent systematic review [ 122 ] of 16 studies comprising 602 patients, evaluating contralateral liver hypertrophy and oncological outcomes following RL, the median kinetic growth rate per week of the contralateral liver lobe was 0.7%, with the maximum degree of contralateral hypertrophy exceeding 40% achieved after 9 months. Further, reported local tumor control was 84%, with CTR achieved in 30% of patients.…”