Abstract
Background: The functional changes that occur over time in the liver following 90Y-radioembolization (RE) using personalized dosimetry (PD) remain to be investigated. Methods: November 2016–October 2019: we retrospectively included hepatocellular carcinoma (HCC) patients treated by 90Y-glass RE using PD, who underwent hepatobiliary scintigraphy (HBS) at baseline and at 15 days, 1, 2, 3, and 6 months after RE. Results: There were 16 patients with unilobar disease (100%) included, and 64 HBS were performed. Whole liver function significantly decreased over time. The loss was maximal at 2 weeks: −32% (p = 0.002) and remained below baseline at 1 (−15%; p = 0.002), 2 (−25%; p < 0.001), and 3 months (−16%; p = 0.027). No radioembolization-induced liver disease was observed. Treated liver function strongly decreased to reach −64% (p < 0.001) at 2 months. Nontreated liver function decreased at 2 weeks (−21%; p = 0.027) and remained below baseline before reaching +20% (p = 0.002) and +59% (p < 0.001) at 3 and 6 months, respectively. Volumetric and functional changes exhibited parallel evolutions in the treated livers (p = 0.01) but independent evolutions in the nontreated livers (p = 0.08). Conclusion: RE using PD induces significant regional changes in liver function over time. As early as 15 days following RE, both the treated and nontreated livers showed a decreased function. Nontreated liver function recovered after 3 months and greatly increased afterwards.
Highlights
Radioembolization (RE) is a form of brachytherapy in which 90Y microspheres are injected intra-arterially for the internal radiation of liver tumors and, especially, hepatocellular carcinoma (HCC)
We evaluated three different regions of interest (ROIs): the global liver, the treated liver, and the non-treated liver
For the 3 patients evaluated at 6 months, the median whole liver function increased by 25% (IQR: 4.8–31.9%; p = 0.159)
Summary
Radioembolization (RE) is a form of brachytherapy in which 90Y microspheres are injected intra-arterially for the internal radiation of liver tumors and, especially, hepatocellular carcinoma (HCC). A recent post-hoc analysis of one of the negative trials showed increased OS and tumor response in patients with a higher tumor radiation-absorbed dose [7]. The main risk of RE is radiation-induced damage to the nontumoral parenchyma, which may cause liver decompensation known as radioembolization-induced liver disease (REILD) [10]. This serious complication is of great importance in HCC, which usually occurs in cirrhotic livers with compromised liver function. This study, aimed to monitor the changes in regional liver function through repeated HBS examinations in HCC patients treated by RE using personalized dosimetry
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