title: Radioembolization following Liver Resection: Safety and Dosing Considerations.
abstract: OBJECTIVE
  To evaluate the impact of previous liver resection on the safety of resin microsphere radioembolization (RE).
  
  
  METHODS
  A single-center retrospective review was performed of 22 patients who underwent resin microsphere RE after liver resection during the period 2009-2014. Prescribed patient dose using the body surface area (BSA) model and a theoretical dose calculated from the actual liver volume on imaging were recorded. Patient and treatment characteristics were analyzed for factors that contributed to toxicity.
  
  
  RESULTS
  In 13 patients, 20 grade 1-3 toxicities were identified. No differences in toxicity were seen based on extent of prior hepatic resection or whether whole-liver treatments were performed (P = .2). The measured liver volume based on cross-sectional imaging correlated poorly with the expected liver volume based on BSA (r = 0.43). After adjusting for the patients' measured liver volume on cross-sectional imaging, five patients were determined to be relatively overdosed and seven patients were determined to be relatively underdosed by the BSA method. Despite these differences, no association was found with patient toxicities and either an overestimation or an underestimation of liver volume (P = .4).
  
  
  CONCLUSIONS
  Previous hepatic resection does not adversely alter the safety profile of yttrium-90 RE. BSA poorly predicts expected liver volume in this population. However, standard BSA-based dosing and whole-liver remnant treatments do not increase hepatotoxicity.
authors.affiliation: Departments of Radiology (J.K., J.J.P.), City of Hope National Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010. Electronic address: jkessler@coh.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kessler
authors.affiliation: Division of Interventional Radiology, and Surgery (A.L., S.G., P.H.G.I.), City of Hope National Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010.
authors.forename: Aaron
authors.initials: A
authors.lastname: Lewis
authors.affiliation: Division of Interventional Radiology, and Surgery (A.L., S.G., P.H.G.I.), City of Hope National Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010.
authors.forename: Singh
authors.initials: S
authors.lastname: Gagandeep
authors.affiliation: Division of Interventional Radiology, and Surgery (A.L., S.G., P.H.G.I.), City of Hope National Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010.
authors.forename: Philip H G
authors.initials: PH
authors.lastname: Ituarte
authors.affiliation: Departments of Radiology (J.K., J.J.P.), City of Hope National Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010.
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001830:Body Surface Area; D001918:Brachytherapy; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes