Modified Radiation Lobectomy Strategy of Radioembolization for Right-Sided Unresectable Primary Liver Tumors

Abstract

PurposeTo 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. Materials and MethodsA retrospective review was performed at a single institution to include 19 consecutive patients (7 females, 12 males) who underwent single-session mRL for right-sided primary hepatic tumors: 15 received segmentectomy plus lobectomy (segmental dose of >190 Gy and lobar dose of >80 Gy); 4 were treated with the double-segmental approach (dominant segments of >190 Gy and nondominant segments of >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], 3.7–7.3 cm). 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). ResultsObjective tumor response and tumor control were achieved in 17 of the 19 (89.5%) and 18 of the 19 (94.7%) patients, respectively. FLR hypertrophy was observed at T1 (median, 47.8%; P = .0245), T2 (median, 48.4%; P = .0120), T3 (median, 50.4%; P = .0147), and T4 (median, 59.1%; P = .00023). Patients without cirrhosis demonstrated greater hypertrophy by 6 months (median, 55.8% vs 47.2%; P = .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 < .05). Among 7 patients who underwent neoadjuvant mRL, 2 underwent resection and 1 received liver transplant. ConclusionsmRL appears safe and effective for treatment of right-sided primary hepatic tumors with the benefit of promoting FLR hypertrophy.