Radiation Lobectomy: An Overview of Concept and Applications, Technical Considerations, Outcomes

Pouya Entezari; Ahmed Gabr; Kristie Kennedy; Riad Salem; Robert J. Lewandowski

doi:10.1055/s-0041-1735530

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2021; 38(04): 419-424
DOI: 10.1055/s-0041-1735530

Review Article

Radiation Lobectomy: An Overview of Concept and Applications, Technical Considerations, Outcomes

Pouya Entezari

¹Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois

,

Ahmed Gabr

¹Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois

,

Kristie Kennedy

¹Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois

,

Riad Salem

¹Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois

²Division of Transplantation, Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois

,

Robert J. Lewandowski

¹Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois

²Division of Transplantation, Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois

› Author Affiliations

Abstract

Surgical resection has long been considered curative for patients with early-stage hepatocellular carcinoma (HCC). However, inadequate future liver remnant (FLR) renders many patients not amenable to surgery. Recently, lobar administration of yttrium-90 (Y90) radioembolization has been utilized to induce FLR hypertrophy while providing disease control, eventually facilitating resection in patients with hepatic malignancy. This has been termed “radiation lobectomy (RL).” The concept is evolving, with modified approaches combining RL and high-dose curative-intent radioembolization (radiation segmentectomy) to achieve tumor ablation. This article provides an overview of the concept and applications of RL, including technical considerations and outcomes in patients with hepatic malignancies.

Keywords

radiation lobectomy - radioembolization - future liver remnant - hepatocellular carcinoma - interventional radiology

Full Text

References

References
1 Bruix J, Sherman M. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (03) 1020-1022
2 Bruix J, Sherman M, Llovet JM. et al; EASL Panel of Experts on HCC, European Association for the Study of the Liver. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. J Hepatol 2001; 35 (03) 421-430
3 Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology 2016; 150 (04) 835-853
4 Roayaie S, Obeidat K, Sposito C. et al. Resection of hepatocellular cancer ≤2 cm: results from two Western centers. Hepatology 2013; 57 (04) 1426-1435
5 Tsilimigras DI, Bagante F, Moris D. et al. Recurrence patterns and outcomes after resection of hepatocellular carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria. Ann Surg Oncol 2020; 27 (07) 2321-2331
6 Pawlik TM, Delman KA, Vauthey JN. et al. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl 2005; 11 (09) 1086-1092
7 Schwarz RE, Smith DD. Trends in local therapy for hepatocellular carcinoma and survival outcomes in the US population. Am J Surg 2008; 195 (06) 829-836
8 Shindoh J, Tzeng CW, Aloia TA. et al. Optimal future liver remnant in patients treated with extensive preoperative chemotherapy for colorectal liver metastases. Ann Surg Oncol 2013; 20 (08) 2493-2500
9 Zorzi D, Laurent A, Pawlik TM, Lauwers GY, Vauthey JN, Abdalla EK. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg 2007; 94 (03) 274-286
10 Abdalla EK, Adam R, Bilchik AJ, Jaeck D, Vauthey JN, Mahvi D. Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 2006; 13 (10) 1271-1280
11 Hayashi S, Baba Y, Ueno K. et al. Acceleration of primary liver tumor growth rate in embolized hepatic lobe after portal vein embolization. Acta Radiol 2007; 48 (07) 721-727
12 Hoekstra LT, van Lienden KP, Doets A, Busch OR, Gouma DJ, van Gulik TM. Tumor progression after preoperative portal vein embolization. Ann Surg 2012; 256 (05) 812-817 discussion 817–818
13 Kokudo N, Tada K, Seki M. et al. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 2001; 34 (02) 267-272
14 Pamecha V, Levene A, Grillo F, Woodward N, Dhillon A, Davidson BR. Effect of portal vein embolisation on the growth rate of colorectal liver metastases. Br J Cancer 2009; 100 (04) 617-622
15 Pamecha V, Glantzounis G, Davies N, Fusai G, Sharma D, Davidson B. Long-term survival and disease recurrence following portal vein embolisation prior to major hepatectomy for colorectal metastases. Ann Surg Oncol 2009; 16 (05) 1202-1207
16 Madoff DC, Abdalla EK, Vauthey JN. Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. J Vasc Interv Radiol 2005; 16 (06) 779-790
17 van Lienden KP, van den Esschert JW, de Graaf W. et al. Portal vein embolization before liver resection: a systematic review. Cardiovasc Intervent Radiol 2013; 36 (01) 25-34
18 Gaba RC, Lewandowski RJ, Kulik LM. et al. Radiation lobectomy: preliminary findings of hepatic volumetric response to lobar yttrium-90 radioembolization. Ann Surg Oncol 2009; 16 (06) 1587-1596
19 Jakobs TF, Saleem S, Atassi B. et al. Fibrosis, portal hypertension, and hepatic volume changes induced by intra-arterial radiotherapy with 90yttrium microspheres. Dig Dis Sci 2008; 53 (09) 2556-2563
20 Edeline J, Lenoir L, Boudjema K. et al. Volumetric changes after (90)y radioembolization for hepatocellular carcinoma in cirrhosis: an option to portal vein embolization in a preoperative setting?. Ann Surg Oncol 2013; 20 (08) 2518-2525
21 Lewandowski RJ, Donahue L, Chokechanachaisakul A. et al. (90) Y radiation lobectomy: outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes. J Surg Oncol 2016; 114 (01) 99-105
22 Vouche M, Lewandowski RJ, Atassi R. et al. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol 2013; 59 (05) 1029-1036
23 Garlipp B, de Baere T, Damm R. et al. Left-liver hypertrophy after therapeutic right-liver radioembolization is substantial but less than after portal vein embolization. Hepatology 2014; 59 (05) 1864-1873
24 Gabr A, Polineni P, Mouli SK, Riaz A, Lewandowski RJ, Salem R. Neoadjuvant radiation lobectomy as an alternative to portal vein embolization in hepatocellular carcinoma. Semin Nucl Med 2019; 49 (03) 197-203
25 Gabr A, Riaz A, Mouli S. et al. Modified radiation lobectomy: an evolving paradigm to convert patients to liver resection candidacy. Semin Intervent Radiol 2019; 36 (04) 343-348
26 Palard X, Edeline J, Rolland Y. et al. Dosimetric parameters predicting contralateral liver hypertrophy after unilobar radioembolization of hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2018; 45 (03) 392-401
27 Salem R, Thurston KG. Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: Technical and methodologic considerations. J Vasc Interv Radiol 2006; 17 (08) 1251-1278
28 Gulec SA, Mesoloras G, Stabin M. Dosimetric techniques in 90Y-microsphere therapy of liver cancer: the MIRD equations for dose calculations. J Nucl Med 2006; 47 (07) 1209-1211
29 Lau WY, Kennedy AS, Kim YH. et al. Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres. Int J Radiat Oncol Biol Phys 2012; 82 (01) 401-407
30 Ho S, Lau WY, Leung TW. et al. Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic tumours. Eur J Nucl Med 1996; 23 (08) 947-952
31 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30 (01) 52-60
32 Therasse P, Arbuck SG, Eisenhauer EA. et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000; 92 (03) 205-216
33 Gabr A, Abouchaleh N, Ali R. et al. Outcomes of surgical resection after radioembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2018; 29 (11) 1502-1510.e1
34 Ahmadzadehfar H, Meyer C, Ezziddin S. et al. Hepatic volume changes induced by radioembolization with 90Y resin microspheres. A single-centre study. Eur J Nucl Med Mol Imaging 2013; 40 (01) 80-90
35 Fernández-Ros N, Silva N, Bilbao JI. et al. Partial liver volume radioembolization induces hypertrophy in the spared hemiliver and no major signs of portal hypertension. HPB (Oxford) 2014; 16 (03) 243-249
36 Teo JY, Goh BK, Cheah FK. et al. Underlying liver disease influences volumetric changes in the spared hemiliver after selective internal radiation therapy with 90Y in patients with hepatocellular carcinoma. J Dig Dis 2014; 15 (08) 444-450
37 Theysohn JM, Ertle J, Müller S. et al. Hepatic volume changes after lobar selective internal radiation therapy (SIRT) of hepatocellular carcinoma. Clin Radiol 2014; 69 (02) 172-178
38 Teo JY, Allen Jr JC, Ng DC. et al. A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90. HPB (Oxford) 2016; 18 (01) 7-12
39 Birgin E, Rasbach E, Seyfried S. et al. Contralateral liver hypertrophy and oncological outcome following radioembolization with ⁹⁰Y-microspheres: a systematic review. Cancers (Basel) 2020; 12 (02) 12
40 Goebel J, Sulke M, Lazik-Palm A. et al. Factors associated with contralateral liver hypertrophy after unilateral radioembolization for hepatocellular carcinoma. PLoS One 2017; 12 (07) e0181488
41 Shah JL, Zendejas-Ruiz IR, Thornton LM. et al. Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation. J Gastrointest Oncol 2017; 8 (03) E43-E51
42 Liou H, Mody K, Boyle AW. et al. Neoadjuvant radiation lobectomy and immunotherapy for angioinvasive HCC resulting in complete pathologic response. Hepatology 2020; (epub ahead of print)