Safety and Efficacy of Y-90 Radioembolization After Prior Major Hepatic Resection.

Abstract

To evaluate the safety and efficacy of yttrium-90 radioembolization (RE) following left or right hepatic lobectomy. Between 2011 and 2016, 15 patients underwent RE with Y90-resin microspheres following right (8/15) or left (7/15) hepatic lobectomy. In eight patients, the whole liver remnant was treated during a single session, whereas the remaining seven patients received up to 3 selective RE at 1- to 2-month intervals. The administered patient activity was calculated based on the body surface area (BSA) method in all cases. In addition, CT-based volumetry of the liver remnant was performed and used to calculate the absorbed liver dose. Patient follow-up data were retrospectively analyzed regarding signs of radioembolization-induced liver disease (REILD), defined as occurrence of bilirubin >3.0mg/dl and ascites within 1-2months after treatment without tumor progression or bile duct occlusion. The mean volume of the liver remnant was 1.471±341ml, the mean administered amount of activity amounted to 1.31±0.74GBq, and the calculated mean absorbed dose was 42.8±20.6Gy. The early response to treatment was generally positive, with only one patient showing signs of progressive disease of the treated area on follow-up examinations within the first 2months post-RE. None of the 15 patients developed a REILD. Y-90 radioembolization following extended hepatic lobectomy appears to be safe and effective. Although the standard BSA-based dosing seems to suffice to avoid REILD, it results in quite variable liver doses due to variable hypertrophy of the liver remnant post-hepatectomy. Level IV, Case series.