Outcomes of Surgical Resection after Radioembolization for Hepatocellular Carcinoma

Gabr, Ahmed; Abouchaleh, Nadine; Ali, Rehan; Baker, Talia; Caicedo, Juan C.; Katariya, Nitin; Abecassis, Michael; Riaz, Ahsun; Lewandowski, Robert J.; Salem, Riad

doi:10.1016/j.jvir.2018.06.027

Cited by 70 publications

(51 citation statements)

References 27 publications

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“…The 16 included studies comprised a total of 602 patients who underwent RE for primary and/or secondary liver malignancies [14,15,[21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Patient characteristics and outcomes are summarized in Table 1.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…According to RECIST, complete and/or partial response was observed in 36 patients (31%), stable disease was noted in 65 patients (55%), and a total of 17 patients showed evidence of progressive disease (14%). Two studies (n = 44 patients) reported tumor response corresponding to the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO) criteria [26,34]. According to WHO criteria, partial response was demonstrated in 11 patients, stable disease in 30 patients, and progressive disease in 3 patients.…”

Section: Oncological Outcomementioning

confidence: 99%

“…Ten studies provided data on liver surgery following RE in primarily unresectable liver tumors, resulting in 109 out of 362 patients (30%) who underwent secondary surgery. The time interval of surgery after the last treatment of RE was reported in three studies with time points ranging between 2 and 30 weeks after RE [25,26,34].…”

Section: Oncological Outcomementioning

confidence: 99%

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

Birgin

Rasbach

Seyfried

et al. 2020

Cancers

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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.

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Section: Baseline Characteristicsmentioning

confidence: 99%

Section: Oncological Outcomementioning

confidence: 99%

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

Birgin

Rasbach

Seyfried

et al. 2020

Cancers

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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%

“…SIRT can also induce adhesion formation between the liver and adjacent structures which has in one case required partial diaphragmatic resection [7,25]. One series with HCC patients alone reported a much lower complication rate (16% Clavien-Dindo grade III or above) [32].…”

Section: Discussionmentioning

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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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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Survival Outcomes Among Patients With Hepatocellular Carcinoma in a Large Integrated US Health System

Yilma,

Houhong Xu,

Saxena

et al. 2024

JAMA Netw Open

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ImportanceHepatocellular carcinoma (HCC) is the leading oncologic cause of death among patients with cirrhosis, but large studies examining mortality trends are lacking.ObjectiveTo evaluate survival among patients with HCC in one of the largest integrated health care systems in the US.Design, Setting, and ParticipantsThis retrospective cohort study included 3441 adult patients who received a diagnosis of HCC between January 1, 2006, and December 31, 2019, with end of follow-up on December 31, 2020. The study period was further categorized as era 1, defined as 2006 to 2012, and era 2, defined as 2013 to 2019. Statistical analysis was conducted from January 2021 to June 2024.ExposuresPatient demographic characteristics and disease factors.Main Outcomes and MeasuresAll-cause and HCC-specific mortality were used as primary end points, and survival probabilities were estimated using the Kaplan-Meier method. Cox proportional hazards regression analyses were adjusted for age at diagnosis, sex, race and ethnicity, cause of disease, Barcelona Clinic Liver Cancer (BCLC) stage, alpha-fetoprotein level, and treatment type.ResultsOf 3441 patients with HCC, 2581 (75.0%) were men, and the median age was 65 years (IQR, 58-73 years). A total of 1195 patients (34.7%) received curative treatment, 1374 (39.9%) received noncurative treatment, and 872 (25.3%) received no treatment. During the study period, 2500 patients (72.7%) experienced all-cause mortality, and 1809 (52.6%) had HCC-specific mortality. In multivariable analysis, being 70 years of age or older (adjusted hazard ratio [AHR], 1.39; 95% CI, 1.22-1.59), male sex (AHR, 1.20; 95% CI, 1.07-1.35), BCLC stage C or D (AHR, 2.40; 95% CI, 2.15-2.67), increasing alpha-fetoprotein level (vs &lt;20 ng/mL; 20-99 ng/mL: AHR, 1.20; 95% CI, 1.04-1.38; ≥1000 ng/mL: AHR, 2.84; 95% CI, 2.45-3.25), noncurative treatment (AHR, 2.51; 95% CI, 2.16-2.90), and no treatment (AHR, 3.15; 95% CI, 2.64-3.76) were associated with higher all-cause mortality, while Asian or Other Pacific Islander race and ethnicity (vs non-Hispanic White; AHR, 0.76; 95% CI, 0.65-0.88) was associated with lower all-cause mortality. Survival improved in diagnosis era 2 (2013-2019; n = 2007) compared with diagnosis era 1 (2006-2012; n = 1434).Conclusions and RelevanceThis large, racially and ethnically diverse cohort study of patients with HCC found improving survival over time, especially among individuals with early-stage HCC receiving potentially curative treatments. This study highlights the importance of surveillance for detection of HCC at early stages, particularly among groups at risk for poorer outcomes.

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Outcomes of Surgical Resection after Radioembolization for Hepatocellular Carcinoma

Cited by 70 publications

References 27 publications

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

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

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

Survival Outcomes Among Patients With Hepatocellular Carcinoma in a Large Integrated US Health System

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