title: Hepatopulmonary shunting after surgical, interventional and systemic therapy in patients with liver malignancies scheduled for radioembolization.
abstract: BACKGROUND
  Hepatopulmonary shunts (HPS) lead to radiation exposure of the lungs in patients undergoing radioembolization (RE) of malignant liver tumors.
  
  
  OBJECTIVE
  To retrospectively analyze how HPS is affected by prior systemic or local therapy of the liver.
  
  
  METHODS
  The percentage HPS was calculated from SPECT/CT scans obtained after technetium-99 m macroaggregated albumin administration into hepatic arteries in 316 patients evaluated for RE.
  
  
  RESULTS
  Patients with partial liver resection (n = 80) did not differ in HPS from the remaining patient population (n = 236) (HPS (median [range]) = 10.2 [2.1-48.3]resection% vs. 8.9 [2.3-32.9]no resection%; P = 0.527). In patients undergoing sequential RE, HPS was significantly higher in the liver lobe treated second (n = 10; HPS = 6.4 [2.1-10.2]firstlobe/session% vs. 12.0 [2.0-24.6]second lobe/session%; P = 0.019). (Chemo-)embolization (n = 19; HPS = 11.0 [2.8-48.3]%) or transcutaneous ablation (n = 63; HPS = 8.8 [3.0-32.9]%) had no effect on HPS compared to patients without prior interventions (no (chemo-)embolization: n = 297; HPS = 9.3 [2.1-47.3]%; P = 0.489; no ablation: n = 253; HPS = 9.5 [2.1-48.3]%; P = 0.382). Pretreatment with sorafenib (HPS = 9.5 [2.3-35.9]yes% vs. 10.2 [2.8-42.0]no%; P = 0.777) orbevacizumab (HPS = 10.7 [2.1-30.6]yes% vs. 9.0 [3.9-23.3]no%; P = 0.870) had no effect on HPS.
  
  
  CONCLUSIONS
  Sequential RE results in an increase in the HPS in the contralateral liver lobe at the time of the second RE session. Other investigated therapy do not affect HPS.
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Erxleben
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Scheurig-Münkler
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Geisel
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gebauer
authors.affiliation: Department of Radiology, Otto-von-Guericke-Universität, Magdeburg, Germany maciej.powerski@med.ovgu.de.
authors.forename: Maciej Janusz
authors.initials: MJ
authors.lastname: Powerski
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D008168:Lung / Q000473:pathology* / Q000528:radiation effects*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes
keywords: Radioembolization; biologics; hepatopulmonary shunt; liver tumor; partial liver resection; radiological liver interventions