Hepatic toxicity after radioembolization of the liver using (90)Y-microspheres: sequential lobar versus whole liver approach.
OBJECTIVE
(90)Y-radioembolization (RE) is a promising technique for delivering high doses of radiation to liver tumors but may result in compromise of liver function. To gain further perspective, we evaluated the toxicity rates of sequential lobar versus "whole liver" (90)Y-radioembolization.


METHODS
Thirty-four patients with liver malignancy in noncirrhotic livers were included; (90)Y-radioembolization was performed as either whole liver or sequential lobar treatment in 17 patients each. Standard clinical and liver specific laboratory parameters as well as MR imaging before treatment and at follow-up (6 and 12 weeks) after radioembolization were evaluated for toxicity using the Common Terminology Criteria for Adverse Events (CTCAE). Volumetry of the liver, tumor, and spleen and measurement of portal vein diameter also were performed.


RESULTS
Three months after whole liver RE, 14 liver-related grade 3/4 events were recorded versus 2 events after sequential lobar treatment (P < 0.05). Three patients treated with whole liver RE suffered from radioembolization-induced liver disease (REILD). Pathological increases in bilirubin at 3 months were observed for the whole liver group only (52.3 vs. 18.7 μmol/l, P = 0.012). Total liver volume did not change significantly in either group, but shrinkage of the initially treated hepatic lobe with compensatory hypertrophy of the subsequently treated lobe was observed in the sequential lobar group (P < 0.05). Portal vein diameter increased significantly in whole liver-treated patients only (+17% vs. +6.6%, P = 0.043).


CONCLUSIONS
Noncirrhotic patients undergoing sequential lobar radioembolization had less hepatic toxicity compared to whole liver embolization. The sequential approach should be the preferred strategy.
Universitätsklinikum Magdeburg, Klinik für Radiologie & Nuklearmedizin, Magdeburg, Germany.
Ricarda
R
Seidensticker
Max
M
Seidensticker
Robert
R
Damm
Konrad
K
Mohnike
Kerstin
K
Schütte
Peter
P
Malfertheiner
Mark
M
Van Buskirk
Maciej
M
Pech
Holger
H
Amthauer
Jens
J
Ricke
D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects*
D015021:Yttrium Radioisotopes