Abstract
PurposeThis study aimed at identifying prior therapy dosimetric parameters using 99mTc-labeled macro-aggregates of albumin (MAA) that are associated with contralateral hepatic hypertrophy occurring after unilobar radioembolization of hepatocellular carcinoma (HCC) performed with 90Y–loaded glass microspheres.MethodsThe dosimetry data of 73 HCC patients were collected prior to the treatment with 90Y–loaded microspheres for unilateral disease. The injected liver dose (ILD), the tumor dose (TD) and healthy injected liver dose (HILD) were calculated based on MAA quantification. Following treatment, the maximal hypertrophy (MHT) of an untreated lobe was calculated.ResultsMean MHT was 35.4 ± 40.4%. When using continuous variables, the MHT was not correlated with any tested variable, i.e., injected activity, ILD, HILD or TD except with a percentage of future remnant liver (FRL) following the 90Y–microspheres injection (r = −0.56). MHT ≥ 10% was significantly more frequent for patients with HILD ≥ 88 Gy, (52% of the cases), i.e., in 92.2% versus 65.7% for HILD < 88 Gy (p = 0.032). MHT ≥ 10% was also significantly more frequent for patients with a TD ≥ 205 Gy and a tumor volume (VT) ≥ 100 cm3 in patients with initial FRL < 50%. MHT ≥10% was seen in 83.9% for patients with either an HILD ≥ 88 Gy or a TD ≥ 205 Gy for tumors larger than 100cm3 (85% of the cases), versus only 54.5% (p = 0.0265) for patients with none of those parameters. MHT ≥10% was also associated with FRL and the Child-Pugh score. Using multivariate analysis, the Child-Pugh score (p < 0.0001), FRL (p = 0.0023) and HILD (p = 0.0029) were still significantly associated with MHT ≥10%.ConclusionThis study demonstrates for the first time that HILD is significantly associated with liver hypertrophy. There is also an impact of high tumor doses in large lesions in one subgroup of patients. Larger prospective studies evaluating the MAA dosimetric parameters have to be conducted to confirm these promising results.
Highlights
Radioembolization (RE) using 90Y–loaded microspheres is increasingly used in a palliative setting for primary [1, 2] and secondary liver diseases [3]
We have measured the dosimetric parameters following unilobar injection of 99mTc-labeled macro-aggregates of albumin (MAA) in patients suffering from hepatocellular carcinoma (HCC) and prior 90Y–loaded microspheres radiotherapy in order to define specific dosimetry endpoints associated with elevated contralateral hypertrophy in noninjected liver after RE
maximal hypertrophy (MHT) ≥ 10% was observed in 92.2% of the patients having a healthy injected liver dose (HILD) ≥ 88Gy, while the MHT ≥ 10% was found in only 65.7% of the patients when HILD was
Summary
Radioembolization (RE) using 90Y–loaded microspheres is increasingly used in a palliative setting for primary [1, 2] and secondary liver diseases [3]. The interest of RE for downstaging has been described [2, 4, 5] especially in a recent randomized phase 2 study highlighting the superiority of RE in comparison with chemoembolization [5] opening new perspectives of surgical ablation for patients with large tumors. Several retrospective studies have recently shown the capacity of RE to induce, after unilateral treatment, a significant hypertrophy of the opposite lobe [6,7,8,9,10,11,12,13], which is of particular interest in a neoadjuvant setting. Understanding the factors inducing liver hypertrophy after RE and developing RE for hypertrophy purposes is of major interest
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