Volumetric Changes after 90Y Radioembolization for Hepatocellular Carcinoma in Cirrhosis: An Option to Portal Vein Embolization in a Preoperative Setting?

Abstract

Contralateral hypertrophy after (90)Y radioembolization has been described in case reports, but the incidence and quantitative extent of liver volume modifications after this therapy are unknown. This retrospective study examined patients with hepatocellular carcinoma and underlying cirrhosis treated by (90)Y radioembolization. The main inclusion criteria were unilateral treatment, no prior liver surgery, and computed tomographic scans allowing for volumetric assessments. Treated, tumor, and contralateral liver volumes were measured. Whole liver volume and the ratio of contralateral to total functional liver volume after a virtual hepatectomy were calculated. Data of 34 patients were analyzed. Response rates were 26% according to Response Evaluation Criteria in Solid Tumors (RECIST) and 63% according to modified RECIST. Median overall survival was 13.5months. Median treated volume decreased from 938mL (interquartile range [IQR]=719) to 702mL (IQR=656) (p<0.001), while median contralateral volume increased from 724mL (IQR=541) to 920mL (IQR=530) (p<0.001). The whole liver volume remained stable, with a median volume of 1,702mL (IQR=568) versus 1,577mL (IQR670), respectively (p=0.55). The mean maximal increase in contralateral volume was 42% (95% confidence interval 16-67). Overall, 13 patients (38.2%) exhibited increases greater than 30%, while 13 patients (38.2%) showed no increase or showed increases less than 10%. The median ratio of contralateral to total functional liver volume increased from 48.5 to 64.9% (p<0.001), with the proportion of patients with a ratio of ≥50% increasing from 47.1 to 67.6% (p=0.013). (90)Y radioembolization induced frequent and similar increases in functional liver remnant volume compared with portal vein embolization. This technique should be tested in a prospective study phase 2 study before liver resection.