title: Selective Internal Radiation Therapy (SIRT) as Conversion Therapy for Unresectable Primary Liver Malignancies.
abstract: BACKGROUND
  Many patients with primary liver cancers are not candidates for surgery, and systemic therapies are seldom effective. Selective internal radiation therapy (SIRT) has been shown to obtain partial and even complete response in unresectable primary tumors. As a "side effect", SIRT can induce contra-lateral liver hypertrophy. Tumor response to SIRT can be sufficient to allow disengagement from normal vital structures whose involvement is the cause of the initial unresectability. The contra-lateral hypertrophy can thereby increase the future liver remnant (FLR) volume to over the safe threshold so that extended hepatectomy can be performed.
  
  
  CONCLUSIONS
  A review of the available literature was performed to assess the tumor response and liver hypertrophy that can be expected after SIRT, in order to delineate whether SIRTcan play a role in conversion therapy for resectability of primary liver malignancies.
  
  
  CONCLUSIONS
  Available data suggest that SIRT in unresectable hepatocellular and cholangiocellular carcinomas can provide a considerable down-sizing of the tumors to possibly allow resection. Hypertrophy of the contra-lateral lobe represents a favorable collateral effect that can help in achieving safer subsequent major hepatectomy. In patients whose FLR volume represents the only surgical concern, portal vein embolization remains the treatment of choice.
authors: Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors: Alessandro
authors: A
authors: Cucchetti
authors: Radiology Unit, Department of Diagnostic and Preventive Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors: Alberta
authors: A
authors: Cappelli
authors: Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors: Giorgio
authors: G
authors: Ercolani
authors: Radiology Unit, Department of Diagnostic and Preventive Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors: Cristina
authors: C
authors: Mosconi
authors: Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors: Matteo
authors: M
authors: Cescon
authors: Radiology Unit, Department of Diagnostic and Preventive Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy.
authors: Rita
authors: R
authors: Golfieri
authors: Department of Medical and Surgical Sciences-DIMEC, S.Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors: Antonio Daniele
authors: AD
authors: Pinna
keywords: Cholangiocellular carcinoma; Hepatocellular carcinoma; Radioembolization; Surgery; Yttrium-90