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Surgery. 2018 May;163(5):1008-1013. doi: 10.1016/j.surg.2017.10.014. Epub 2018 Jan 3.

Prospective study to determine early hypertrophy of the contra-lateral liver lobe after unilobar, Yttrium-90, selective internal radiation therapy in patients with hepatocellular carcinoma.

Author information

1
Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore.
2
Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore.
3
Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore.
4
Division of Nursing, Singapore General Hospital, Singapore.
5
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
6
Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
7
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
8
Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore. Electronic address: bsgkp@hotmail.com.

Abstract

BACKGROUND:

Liver resection is a major curative option in patients presenting with hepatocellular carcinoma. An inadequate functional liver remnant is a major limiting factor precluding liver resection. In recent years, hypertrophy of the functional liver remnant after selective internal radiation therapy hypertrophy has been observed, but the degree of hypertrophy in the early postselective internal radiation therapy period has not been well studied.

METHODS:

We conducted a prospective study on patients undergoing unilobar, Yttrium-90 selective internal radiation therapy for hepatocellular carcinoma to evaluate early hypertrophy at 4-6 weeks and 8-12 weeks after selective internal radiation therapy.

RESULTS:

In the study, 24 eligible patients were recruited and had serial volumetric measurements performed. The median age was 66 years (38-75 years). All patients were either Child-Pugh Class A or B, and 6/24 patients had documented, clinically relevant portal hypertension; 15 of the 24 patients were hepatitis B positive. At 4-6 weeks, modest hypertrophy was seen (median 3%; range -12 to 42%) and this increased at 8-12 weeks (median 9%; range -12 to 179%). No preprocedural factors predictive of hypertrophy were identified.

CONCLUSION:

Hypertrophy of the functional liver remnant after selective internal radiation therapy with Yttrium-90 occurred in a subset of patients but was modest and unpredictable in the early stages. Selective internal radiation therapy cannot be recommended as a standard treatment modality to induce early hypertrophy for patients with hepatocellular carcinoma. (Surgery 2017;160:XXX-XXX.).

PMID:
29306542
DOI:
10.1016/j.surg.2017.10.014
[Indexed for MEDLINE]

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