title: Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: a novel approach to improving the safety of major hepatic resections.
abstract: BACKGROUND
  Extended liver resections are being performed more liberally than ever. The extent of resection of liver metastases, however, is restricted by the volume of the future liver remnant (FLR). An intervention that would both accomplish tumor control and induce compensatory hypertrophy, with good patient tolerability, could improve clinical outcomes.
  
  
  METHODS
  A 53-year-old woman with a history of cervical cancer presented with a large liver mass. Subsequent biopsy indicated poorly differentiated carcinoma with necrosis suggestive of squamous cell origin. A decision was made to proceed with pre-operative chemotherapy and Y-90 microsphere SIRT with the intent to obtain systemic control over the disease, downsize the hepatic lesion, and improve the FLR. A surgical exploration was performed six months after the first SIRT (three months after the second). There was no extrahepatic disease. The tumor was found to be significantly decreased in size with central and peripheral scarring. The left lobe was satisfactorily hypertrophied. A formal right hepatic lobectomy was performed with macroscopic negative margins.
  
  
  CONCLUSIONS
  Selective internal radiation treatment (SIRT) with yttrium-90 (Y-90) microspheres has emerged as an effective liver-directed therapy with a favorable therapeutic ratio. We present this case report to suggest that the portal vein radiation dose can be substantially increased with the intent of inducing portal/periportal fibrosis. Such a therapeutic manipulation in lobar Y-90 microsphere treatment could accomplish the end points of PVE with avoidance of the concern regarding tumor progression.
authors.affiliation: Center for Cancer Care at Goshen Health System, Goshen, IN, USA. sgulec@fiu.edu
authors.forename: Seza A
authors.initials: SA
authors.lastname: Gulec
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pennington
authors.forename: Michael
authors.initials: M
authors.lastname: Hall
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary; D004621:Embolization, Therapeutic; D005260:Female; D019788:Fluorodeoxyglucose F18; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000473:pathology; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes; D019788:Fluorodeoxyglucose F18