Hepatocellular carcinoma and liver cirrhosis: assessment of the liver function after Yttrium-90 radioembolization with resin microspheres or after CT-guided high-dose-rate brachytherapy.
OBJECTIVE
To identify changes of liver function after single-fraction irradiation or yttrium-90 radioembolization ((90)Y-RE) of hepatocellular carcinoma associated with liver cirrhosis on the basis of laboratory data.


METHODS
24 patients with primary liver carcinoma and liver cirrhosis classified Child-Pugh A or B were treated either by image-guided high-dose-rate brachytherapy (HDR-BT) (12 patients) or by (90)Y-RE (12 patients). The following laboratory parameters were assessed 1 day before and 3 days, 6 weeks and 3 months after the intervention: total bilirubin and gamma-glutamyl transpeptidase (GGTP) as parameters of detoxification function, albumin and cholinesterase (ChE) as direct synthesis parameters, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (AP) as indicators of liver tissue damage. Preinterventional values were taken as baseline, following values were calculated as percentage changes from the baseline value. Statistical analysis was performed using the Wilcoxon-matched pairs test, comparing postinterventional with preinterventional values. Differences were considered statistically significant with a p value <0.05.


RESULTS
In all patients the median bilirubin, ALT, AP and albumin values remained within normal limits at any time of follow-up. AST levels in the RE group and GGTP in both groups have been already elevated over a normal range before the intervention, and in both groups both parameters showed a slight increase after interventions. ChE activity was lowered already in the baseline values and showed a further decrease 3 days after BT as well as 3 days and 6 weeks after RE, with final reconstitution to baseline values. All liver function test parameters showed mild changes shortly after radiation therapy but floating laboratory values recovering within 12 weeks to baseline values. Radiation or RE-induced liver disease was recorded in no patient.


CONCLUSIONS
Liver function parameters show only mild changes shortly after intervention with recovery within 6-12 weeks to baseline values.
Rühl
Ricarda
R
Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg AöR, Magdeburg, Germany. Ricarda.ruehl@med.ovgu.de
Seidensticker
Max
M
Peters
Nils
N
Mohnike
Konrad
K
Bornschein
Jan
J
Schütte
Kerstin
K
Amthauer
Holger
H
Malfertheiner
Peter
P
Pech
Maciej
M
Ricke
Jens
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000418:Albumins / Q000378:metabolism; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001918:Brachytherapy; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000532:radiotherapy*; D002802:Cholinesterases / Q000097:blood; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000528:radiation effects*; D008103:Liver Cirrhosis / Q000150:complications; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D015021:Yttrium Radioisotopes / Q000627:therapeutic use; D005723:gamma-Glutamyltransferase / Q000097:blood
D000418:Albumins; D015021:Yttrium Radioisotopes; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D002802:Cholinesterases; D000469:Alkaline Phosphatase; D001663:Bilirubin