Modified Radiation Lobectomy Strategy of Radioembolization for Right-Sided Unresectable Primary Liver Tumors
Journal of Vascular and Interventional Radiology(2024)
摘要
Purpose
To assess the safety and effectiveness of using modified radiation lobectomy (mRL) to treat primary hepatic tumors located in the right hepatic lobe (segments V-VIII) and determine future liver remnant (FLR) hypertrophy.
Methods
A retrospective review was performed at a single institution to include 19 consecutive patients (7 Female, 12 Male) who underwent single-session mRL for right sided primary hepatic tumors: 15 received segmentectomy plus lobectomy (segmental dose >190 Gy and lobar dose >80 Gy); 4 were treated with the double-segmental approach (dominant segments >190 Gy and non-dominant segments > 80 Gy). Treated tumors included 13 hepatocellular carcinoma (HCC), 4 cholangiocarcinoma (CCA), and 2 mixed-type HCC-CCA with a median dominant tumor size of 5.3 cm (Interquartile range [IQR]: 3.7-7.3cm). FLR of the left hepatic lobe was measured at baseline, T1 (4-8 weeks), T2 (2-4 months), T3 (4-6 months), and T4 (9-12 months).
Results
Objective tumor response and tumor control were achieved in 17/19 (89.5%) and 18/19 (94.7%) patients, respectively. FLR hypertrophy was observed at T1 (median 47.8%, p=0.0245), T2 (median 48.4%, p=0.0120), T3 (median 50.4%, p=0.0147), and T4 (median 59.1%, p=0.00023). Non-cirrhotic patients demonstrated greater hypertrophy by 6-month (median 55.8% vs 47.2%, p=0.0310). One patient developed a grade 3 adverse event (ascites requiring paracentesis) at 1-month follow-up. Grade 2 or above serum toxicities are associated with worse baseline Child-Pugh Score, serum albumin, and total bilirubin (p<0.05). Among 7 patients who underwent neoadjuvant mRL, two underwent resection and one received liver transplant.
Conclusion
mRL appears safe and effective for treatment of right-sided primary hepatic tumors with the benefit of promoting FLR hypertrophy.
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关键词
hypertrophy,liver tumor,lobectomy,radioembolization,segmentectomy
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