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Effect of selective internal radiation therapy (SIRT) in patients with unresectable primary or metastatic liver tumors on microsomal liver function by means of 13C-methacetin breath test (MBT)
13 August 2018 (online)
Selective internal radiation therapy (SIRT) is a therapeutic option for patients with unresectable liver tumors. MBT is a feasible function test for the assessment of hepatic functional reserve, overall prognosis and treatment complications in patients with liver diseases.
To assess prospectively in a pilot study the effect of SIRT with 90Y-loaded resin microspheres on hepatic function in patients with primary and secondary liver malignancies.
18 patients (13 m, 5f, age 64 ± 2 y., BMI 25.9 ± 1.0 kg/m2, MELD 8.8 ± 0.7, mean ± SEM) with malignancies of different etiologies (HCC 7: 5 w/o, 2 w/cirrhosis; NET 5; colon CA 2; ovarial CA 1; mamma CA 1; choroidal/ciliary melanoma 2) were studied. Each patient received 75 mg of 13C-methacetin dissolved in 100 ml of water before (d0), 1 (d1) and 7days (d7) after coil embolization for aberrant visceral arteries as well as before (d0), 1 (d1), 7 (d7), 28 (d28) and 56 days (d56) after SIRT (1.2 ± 0.17GBq). 13C/12C ratio in breath was determined over 1h in 10 minute intervals by nondispersive infrared spectroscopy (IRIS, Mayoly, France) as delta values. Maximal percentage dose rate (PDRmax [%/h]) was calculated. Linear mixed effects model fits were applied (R 3.2.3).
Coil embolization induced a strong short-term decrease in microsomal liver function 24h following therapy [PDRmax (%/h): d0: 27.3 ± 2.4; d1: 19.9 ± 2.0; d7: 25.9 ± 2.0; p = 0.0009 d0 vs. d1; p = 0.46 d0 vs. d7]. SIRT had only a marginal effect on microsomal liver function at d1 with even an increase in oxidative function at d7 [PDRmax (%/h): d0: 25.2 ± 2.1; d1: 20.7 ± 2.6; d7: 39.5 ± 3.1; d28: 27.3 ± 3.1; d56: 25.3 ± 3.7; p = 0.09 d0 vs. d1; p < 0.0001d0 vs. d7].
In this pilot study in a patient group with well-preserved liver function a significant short term reduction in functional hepatic reserve reflected by a decrease in 13C-methacetin metabolism was unexpectedly observed after coil embolization but not SIRT. However, the observed sensitivity for assessment of changes in liver function might therefore be helpful in the quantification of postprocedural liver function and prediction of decompensation. Our results indicate that the SIRT procedure per se does not induce a significant decrease in liver function in non-cirrhotic subjects.