Liver Resection for Metastatic Disease After Y90 Radioembolization: A Case Series with Long-Term Follow-Up

Henry, Leonard R.; Hostetter, R.; Ressler, Brittany; Adm-Bc, Ingrid Bowser, Ms, Aprn-Bc, Aocnp®,; Yan, Min; Vaghefi, Houman; Abad, John D.; Güleç, Seza A.; Schwarz, Roderich E.

doi:10.1245/s10434-014-4012-z

Cited by 27 publications

(26 citation statements)

References 27 publications

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“…Several case reports and small case series have suggested it can be a technically feasible option in carefully selected patients [25][26][27][28][29][30]. Only four larger series have also been published with a total experience of n = 64 [11,12,31,32]. In two of these series, resection was an afterthought following SIRT [10,11] while Justinger et al specifically selected marginally resectable cases and performed their surgical resections at a shorter interval (approximately 2 months) following SIRT [31].…”

Section: Discussionmentioning

confidence: 99%

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Liver Resection After Selective Internal Radiation Therapy with Yttrium-90: Safety and Outcomes

Mafeld

Littler

Hayhurst

et al. 2019

J Gastrointest Canc

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Introduction Selective internal radiotherapy (SIRT) with yttrium-90 (Y-90) is an intra-arterial therapy for hepatic malignancy in patients who are unsuitable for surgical resection. This treatment is considered palliative, although some patients can demonstrate a response that is adequate to facilitate surgical resection with curative intent. Methods All patients who underwent liver resection post SIRT were reviewed. Data gathered included patient demographics, tumor type, surgical details, and post-operative outcomes. Results Twelve patients underwent SIRT followed by liver resection (7 males and 5 females). Pathologies were hepatocellular carcinoma (n = 5), metastatic colorectal cancer (n = 5), and neuroendocrine tumor (n = 2). Lesional response (size, volume, and RECIST (response evaluation criteria in solid tumors)) was calculated and where appropriate functional liver remnant (FLR) is presented. Mean FLR increase was 264cm 3 (range − 123 to 909), and all cases demonstrated a partial response according to RECIST with a mean largest lesion volume reduction of 475cm 3 (range 14-1632). No post-SIRT complications were noted. Hepatectomy occurred at a mean of 322 days from SIRT treatment. Ninety-day morbidity was 67% (n = 6), complications postsurgery were analyzed according to the Clavien-Dindo classification scale; a total of 15 events occurred in 6 patients. Ninety-day mortality of 11% (n = 1). Conclusion In selected cases, liver resection is possible post SIRT. As this can represent a potentially curative option, it is important to reconsider resection in the follow-up of patients undergoing SIRT. Post-operative complications are noted following major and extended liver resection. Therefore, further studies are needed to improve patient selection.

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Section: Discussionmentioning

confidence: 99%

“…Despite promising results, SIRT is considered a salvage therapy. A small cohort of patients can however have a response to SIRT which renders them potential candidates for curative surgical resection [11,12]. The experience with hepatic resection post SIRT is limited with less than 100 published cases.…”

Section: Introductionmentioning

confidence: 99%

Liver Resection After Selective Internal Radiation Therapy with Yttrium-90: Safety and Outcomes

Mafeld

Littler

Hayhurst

et al. 2019

J Gastrointest Canc

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“…Unlike PVE, patients in this study had a minimal time to resection of 3 months (25). This increased observational period may circumvent an unnecessary resection should there be FLR disease progression that cannot be addressed (7,26). Patient 1 would have avoided surgical complications if the team had 6 months data which would have demonstrated FLR disease and potentially obviated surgery.…”

Section: A B a Bmentioning

confidence: 99%

Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation

Shah

Zendejas-Ruiz

Thornton

et al. 2017

J. Gastrointest. Oncol.

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Colorectal cancer patients have a high incidence of liver metastasis (ml-CRC). Surgical resection is the gold standard for treatment of hepatic metastasis but only a small percent of patients are traditional candidates based on disease extent and adequate size of the future liver remnant (FLR). Interventions such as portal vein embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are performed to increase FLR for operative conversion. Limitations to PVE include intrahepatic disease progression, portal vascular invasion, and utilization with concurrent chemotherapy. ALPPS is associated with a high morbidly and mortality. Radiation lobectomy (RL) with yttrium-90 (Y-90) delivers transarterial ablative brachytherapy to the future hepatectomy site which generates FLR hypertrophy similar or greater than PVE. Early results indicate that RL is safe, effective, and may offer unique benefits by providing cytoreduction of hepatic metastases which extends FLR hypertrophy time and allows FLR surveillance to gauge disease biology. A retrospective analysis of four patients with ml-CRC treated with RL prior to hepatectomy was performed to evaluate initial safety, efficacy, FLR hypertrophy, and radiopathologic correlation. Adverse events after RL and hepatectomy were evaluated. Imaging findings were analyzed for efficacy defined as FLR hypertrophy and disease control. Radiopathologic correlation was performed after histologic analysis. RL was well tolerated without major adverse events or hepatic decompensation. FLR hypertrophy ranged from 24.9% to 119% at mean follow-up of three months. The majority of complications were related to surgical instrumentation of the FLR due to upstaging at time of surgery. Hepatectomy specimen histology demonstrated complete pathologic response in 50% of patients, 50% radiopathologic concordance rate, and no significant hepatic fibrosis. Initial experience with neoadjuvant RL for ml-CRC is safe and provides both durable disease control and FLR hypertrophy with concurrent chemotherapy. A 50% complete pathologic response rate raises the possibility of definitive chemoradiation in poor surgical candidates. Prospective investigation is required.

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“…The gland had a thick, fibrotic capsule and the parenchyma was dense, inflexible, and difficult to dissect, consistent with the previously reported morbidity of these operations. 2 Extended right hepatectomy was performed. Final pathology demonstrated 15 foci of metastatic well-differentiated neuroendocrine carcinoma that were negative for necrosis, as was expected given her continued symptoms despite radioembolization.…”

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confidence: 99%

“…3 Surgical cytoreduction and complete metastasectomy continue to offer improvement in symptoms, quality of life, and survival in patients with neuroendocrine liver metastases, however, hepatectomy after radioembolization is unique and carries increased morbidity/mortality, 2 likely due to Y90-induced liver fibrosis. We demonstrate images of fibrotic yttrium-90 radiation affected liver (A), and histological sections of radioembolic microbeads in blood vessels and distributed around resected tumors (B).…”

mentioning

confidence: 99%

Hepatectomy After Yttrium-90 (Y90) Radioembolization-Induced Liver Fibrosis

Maker

August

Maker³

et al. 2016

Journal of Gastrointestinal Surgery

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Liver Resection for Metastatic Disease After Y90 Radioembolization: A Case Series with Long-Term Follow-Up

Cited by 27 publications

References 27 publications

Liver Resection After Selective Internal Radiation Therapy with Yttrium-90: Safety and Outcomes

Liver Resection After Selective Internal Radiation Therapy with Yttrium-90: Safety and Outcomes

Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation

Hepatectomy After Yttrium-90 (Y90) Radioembolization-Induced Liver Fibrosis

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